Study of the mental health status of medical personnel dealing with new coronavirus pneumonia.

This paper studied the relationship between personality traits and mental health conditions of medical personnel to provide a basis and reference for the implementation of targeted education on mental health. A self-report inventory, the Symptom Checklist-90 (SCL-90), was used to investigate the mental health status of 548 medical personnel dealing with the new coronavirus pneumonia in eight provinces and cities of China. The overall mean SCL-90 score and mean values of factors (somatization, obsessive-compulsive, anxiety, phobic anxiety, and psychoticism) of the medical personnel were significantly higher than in the norm group (p < 0.05), while their average interpersonal sensitivity score was significantly lower (p < 0.01). In addition, personal factors affecting the mental health status of medical personnel were identified (all p < 0.05). The overall mental health status of medical personnel responding to new coronavirus pneumonia is generally higher than that of the norm group in China. The results of this study should contribute to measures to alleviate the psychological pressures on medical personnel dealing with the new coronavirus epidemic in China.

1. Introduction

Novel coronavirus pneumonia (NCP) is a pathogenic coronavirus often referred to as the novel coronavirus. On January 12, 2020, WHO officially named the disease Coronavirus Disease 2019 (COVID-19). The first case of COVID-19 was reported in Wuhan in China on December 12, 2019 [1-2] as causing severe acute respiratory infection (SARI). Coronaviruses are a large family of viruses known to cause illnesses such as cold and more serious diseases such as Middle East respiratory syndrome (MERS) and severe acute respiratory syndrome (SARS). COVID-19 is a new strain of coronavirus that has never been found in the human body before [3-4].

COVID-19 patients typically show symptoms such as fever, coughing, shortness of breath, and difficulty in breathing. In more severe cases, the disease can lead to pneumonia, severe acute respiratory failure, kidney failure, and even death [5]. There is as yet no specific treatment for COVID-19. Patients mainly receive symptomatic treatment and care for the prevention of complications, while supplementary medical services also appear to be very effective for infected people. The rate of COVID-19 infections has increased rapidly in a short period of time. As of February 17, 2020, the number of confirmed cases exceeded 70,000, with 1,770 deaths [6]. In addition, the disease can cause secondary infections, which has created a huge burden and pressure for the prevention and treatment of the disease in various places. At present, more than 30,000 medical personnel from various medical teams across the country have provided support in Wuhan [7]. Though the help from these medical personnel has relieved the local pressure for medical care to save critically ill COVID-19 patients, there have been serious infections among the medical staff in Wuhan and other places in Hubei Province. At present, over 3000 medical personnel have been infected, which has greatly increased the psychological pressure they experience. In the face of the catastrophic health emergency of COVID-19, medical personnel have been affected by different kinds of subjective and objective factors and confront several mental health problems. Mental illness is a form of human stress response, an explanatory, emotional, and defensive response within the human body, and a physiological response of the human body to the impact of needs or injuries. Therefore, this study aims to analyze the psychological state of medical personnel dealing with COVID-19 and its influencing factors in order to provide an objective basis for the prevention of further transmission, interventions, and countermeasures for COVID-19.

2. Research subjects and methods

2.1 Subjects

This study adopted convenience sampling to recruit research subjects. From January 25 to February 16, 2020, 560 medical personnel from 12 hospitals in eight provinces and cities across the country were enrolled as research subjects. The 12 hospitals including the 1st Affiliated Hospital of Harbin Medical University, the 2nd Affiliated Hospital of Harbin Medical University, Changchun Central Hospital, Liaoning Provincial People’s Hospital, Qilu Hospital of Shandong University, the Second Hospital of Tianjin Medical University, People’s Hospital of Inner Mongolia Autonomous Region, the First Hospital of Ningbo, the Second Hospital of Ningbo, Guizhou Provincial People’s Hospital, Sichuan Provincial People’s Hospital, and Wuhan University People’s Hospital.

Inclusion criteria: ① work experience ≥ 1 year; ② has given informed consent and agreed to participate in this study.

2.2 Methods

2.2.1 Survey tools

① Survey of demographic characteristics of medical personnel, including 18 questions related to the following aspects: province, hospital, department, occupation, gender, age, highest education level, work experience, level of expertise, marital status, children, living status, whether you have participated in training for handling of public health emergencies, whether family members support your working on the front line against coronavirus, whether you have supported in affected areas in Hubei, designated hospitals, department of infectious diseases, fever clinics or emergency department, level of concern whether you and your family have been infected, degree of suspicion that you were infected when coronavirus-related symptoms occurred, and whether you have received medical observation recently. ② The SCL-90 self-report inventory: The SCL-90 inventory, compiled by Derogatis in 1975, includes 10 factors and a total of 90 items. It had been translated into Chinese version and used in the study [8]. Each factor reflects the symptoms and pain of a patient in a certain aspect, and the distribution of symptoms can be understood through the factor scores. The 10 factors include somatization, obsessive-compulsive, depression, anxiety, hostility, phobic anxiety, paranoid ideation, psychoticism, sleep, and diet. Each item was scored using a 5-point Likert scale, ranging none, mild, moderate, moderate to severe, to severe. The total score is the sum of the scores of the 90 items. In previous studies, the homogeneity reliability of the total SCL-90 scale was 0.97, and the homogeneity reliability of each sub-scale was also greater than 0.68. The test-retest reliability was greater than 0.7, and the content validity was above 0.85, which suggest sound reliability and validity [8].

2.2.2 Survey methods and medical ethics

The study used online questionnaires for data collection. Researchers conducted surveys upon the completion of general training. All procedures were approved by the Ethics Committee of Harbin Medical University (HRBYKD-A26). The research purpose and methods were explained to subjects to seek their cooperation. Online informed consent forms were signed by participants. They were informed that their participation was completely voluntary, and they could withdraw from the study at any time. The link of the online questionnaire was then sent to a total of 560 medical personnel via the Internet.

In this study, data analysis was performed after logical checks using the statistical software SPSS 22.0. A p-value less than 0.05 (p < 0.05) was considered statistically significant.

Statistical description: The mean value, standard deviation, and frequency were used to describe the demographic data of medical personnel, while the mean value and standard deviation were used to describe the scores for the mental health status of medical personnel responding to COVID-19.

Statistical inference: Multivariate linear regression was adopted to analyze the impact of the demographic data of medical personnel on their mental health status.

3. Analysis

3.1 General information of medical personnel

A total of 560 questionnaires were distributed, and 548 valid questionnaires were recovered, for an effective recovery rate of 97.90%. These 548 questionnaires were completed by medical personnel from eight provinces and cities in China, namely Heilongjiang, Liaoning, Jilin, Inner Mongolia, Tianjin, Sichuan, Shanxi, and Shandong. Details of the respondents’ personal information are given in Table 1.

Table 1

Demographic data of medical personnel (n = 548).

Item	Number of cases	Composition ratio (%)
Class of hospital
Class IIIA	469	85.58
Class IIIB	20	3.65
Class IIA	41	7.48
Class IIB	18	3.28
Hospital department
Department of Internal Medicine	95	17.34
Department of Surgery	138	25.18
Department of Obstetrics and Gynecology	12	2.19
Department of Pediatrics	7	1.28
Emergency Department	47	8.58
Department of Critical Care	121	22.08
Outpatient Department	17	3.1
Operating Rooms	10	1.82
Others	101	18.43
Occupation
Doctor	137	25.00
Nurse	411	75.00
Gender
Male	153	27.92
Female	395	72.08
Age group (years)
Under 25 years old	46	8.39
26–35 years old	290	52.92
36–45 years old	124	22.63
45 years and older	88	16.06
Highest education level
Technical secondary school	10	1.82
College	62	11.31
Undergraduate	381	69.53
Master’s degree and above	95	17.34
Work experience
5 years and below	96	17.52
6–10 years	189	34.49
11–15 years	99	18.07
16–20 years	55	10.04
Over 20 years	109	19.89
Level of expertise
Entry-level	231	42.15
Mid-level	209	38.14
Senior-level	108	19.71
Marital status
Single	141	25.73
Married	390	71.17
Divorced	17	3.1
Any children
Yes	357	65.15
No	191	34.85
Current living situation
Live alone	107	19.53
Live with family	417	76.09
Live in shared accommodation	24	4.38
Have you participated in training for public health emergencies?
Yes	317	57.85
No	231	42.15
Does your family support your working on the front line?
Yes	444	81.02
No	104	18.98
Have you supported in affected areas in Hubei, designated hospitals, or other places?
Infected areas in Wuhan and Hubei	41	7.48
COVID-19 designated hospitals	34	6.20
Department of Infectious Diseases	7	1.28
Fever Clinics	34	6.20
Emergency Department	34	6.20
None	398	72.63
Level of concern whether you and your family have been infected
Severe	110	20.07
Moderate	172	31.39
Mild	196	35.77
No	70	12.77
Degree of suspicion that you were infected when the novel coronavirus-related symptoms occurred		18.1
Severe	28	5.11
Moderate	68	12.41
Mild	131	23.91
No	321	58.58
Have you received medical observation recently?
Yes	51	9.31
No	497	90.69

3.2 SCL-90 factor scores of medical personnel compared with national norms [9]

The overall average of SCL-90 and mean values of factors (somatization, obsessive-compulsive, anxiety, phobic anxiety, and psychoticism) of medical personnel were significantly higher than that of the norm group (p < 0.05 or p < 0.01), while the average score of the interpersonal sensitivity factor of medical personnel was significantly lower than that of the norm group (p < 0.01). Details are provided in Table 2.

Table 2

Comparison of SCL-90 factor scores between medical personnel and the national norm group (X±S).

Factor	Medical personnel (n = 548)	National norm (n = 1388)	Percentage# (%)	T-value	P-value
Somatization	1.46±0.72	1.37±0.48	33.02	2.984	0.003*
Obsessive-Compulsive	1.75±0.88	1.62±0.58	37.23	3.590	<0.0001**
Interpersonal sensitivity	1.51±0.78	1.65±0.61		4.251	<0.0001**
Depression	1.53±0.79	1.50±0.59	29.74	0.761	0.447
Anxiety	1.50±0.79	1.39±0.43	34.12	3.305	0.001**
Hostility	1.48±0.80	1.46±0.55	33.58	0.582	0.561
Phobic anxiety	1.44±0.75	1.23±0.41	39.96	6.446	<0.0001**
Paranoid ideation	1.40±0.73	1.43±0.57		0.897	0.370
Psychoticism	1.36±0.65	1.29±0.42	32.30	2.391	0.017*
Others	1.58±0.76
Overall average	1.51±0.73	1.44±0.43	32.66	2.109	0.035*

*p < 0.05;

**p < 0.0001

#percentage of medical personnel with higher SCI -90 factor scores than national normal level

3.3 The influencing factors of the psychological status of medical personnel

Stepwise linear regression was performed using the total score of mental health status as the dependent variable and 17 items of personal information as independent variables. The 17 items include: hospital, department, occupation, gender, age, highest education level, work experience, level of expertise, marital status, any children, living status, whether you have participated in training for handling of public health emergencies, whether family members support your working on the front line against coronavirus, whether you have supported in affected areas in Hubei, designated hospitals, department of infectious diseases, fever clinics or emergency department, level of concern whether you and your family have been infected, degree of suspicion that you were infected when coronavirus-related symptoms occurred, and whether you have received medical observation recently. The α-values for importing and exporting a variable in the regression equation were set to 0.10 and 0.15, respectively. Factors affecting the mental health and status of medical personnel based on their significance from high to low are: the degree of suspicion that they were infected when the novel coronavirus-related symptoms occurred, the level of concern whether they and their family members have been infected, age, whether they have supported in affected areas in Hubei Province, designated hospitals, and other places for the novel coronavirus, and whether family members support them working on the front line (p < 0.05). Details of the regression results are listed in Table 3.

Table 3

Results of multiple linear regression analysis of influencing factors of mental health status of medical personnel.

Variable	B	β	t-value	p-value
Constant	14.766		16.312	<0.0001
Degree of suspicion that you were infected when the novel coronavirus-related symptoms occurred	2.959	0.292	7.268	<0.0001
Level of concern whether you and your family have been infected	2.728	0.300	7.569	<0.0001
Age	2.787	0.125	3.417	0.001
Have you supported in affected areas in Hubei, designated hospitals, or other places?	1.541	0.121	3.201	0.001
Whether your family supports your working on the front line	6.243	-0.094	-2.513	0.012

R2 = 0.286; F = 44.830s; p = 0.001

4. Discussion and summary

4.1 Comparison of SCL-90 factor scores between medical personnel and the national norm group

COVID-19 is a fulminant infectious disease. As it is highly contagious, many people are frightened by it and even talk fearfully about coronavirus, which can also be observed in front-line medical staff. Li et al. reported how much people and medical staff suffer from vicarious traumatization and how this vicarious traumatization of non-front-line medical staff is more serious than that of front-line medical staff [10]. As in South and Southeast Asia countries, also in Italy, there are similar problems in medical staff due to high workload and intermittent lack of protective devices. In addition, some slight form of racism is demonstrated against health care professionals who potentially have a higher risk of being infected and between non-front-line medical staff towards front-line medical staff [11]. The results of the study have shown that the overall mean of the SCL-90 and the mean values of the factors (somatization, obsessive-compulsive, anxiety, phobic anxiety, and psychoticism) of medical personnel were significantly higher than that of the norm group (p < 0.05), while the average score of the interpersonal sensitivity factor of medical personnel was significantly lower than that of the norm group (p < 0.01). The results were partly similar with some research in Wuhan city [12]. More specifically, medical personnel are most of the people closest to COVID-19 patients, so they are at high risk of exposure to the disease. Moreover, they have a deep understanding of the dangers of COVID-19, so they are prone to anxiety and fear. The infection protection procedures for COVID-19 are highly complex and medical staff need to constantly change clothes and replace protective equipment, so they are more likely to establish obsessive-compulsive behaviors. Medical personnel, especially young medical staff, have less experience in the field and in dealing with difficulties and hardships in life. Therefore, when they suddenly encounter such sudden public health events, they tend to suffer anxiety and phobic anxiety, leading to physical and mental problems. That is why scores of the factors somatization, obsessive-compulsive, anxiety, phobic anxiety, and psychoticism were significantly higher than in the norm group. This result suggests that psychologists and team leaders should pay more attention to the anxiety, phobic anxiety, and psychoticism issues of the medical personnel in a team. The average score for the interpersonal sensitivity factor of medical personnel was significantly lower than that of the norm group. This shows that in the event of an infectious disease epidemic, the majority of medical personnel are united and have good professional strengths and qualities for self-regulation and self-protection. The results of this study show partial consistency with the studies of the mental health status of front-line medical personnel for SARS in 2003 [13].

4.2 Analysis of influencing factors of the mental health status of medical personnel

The results of this study have shown that the factors affecting the mental health status of medical personnel based on the significance from high to low are: the degree of suspicion that they were infected when the novel coronavirus-related symptoms occurred, the level of concern whether they and their family members have been infected, age, whether they have supported in affected areas in Hubei Province, designated hospitals, and other places for the novel coronavirus, and whether their family members support them working on the front line. Specific reasons are given in the following sections.

4.2.1 Age

Degree of suspicion that they were infected when the novel coronavirus-related symptoms occurred, the level of concern whether they and their family members have been infected, whether they have supported in affected areas in Hubei Province, designated hospitals, and other places for the novel coronavirus, and whether family members support them working on the front line.

COVID-19 patients are the main source of transmission of the disease. Patients with latent infection (i.e., asymptomatic infection) may also constitute a source of infection [14]. Medical personnel are in frequent close contact with patients during their treatment and care, hence the high risk of infection [15]. Among 138 patients admitted consecutively from January 1 to 28, 2020, to Zhongnan Hospital of Wuhan University, the proportion of medical personnel was as high as 29% [16]. A retrospective analysis of 1099 confirmed COVID-19 patients from 552 hospitals in 31 provinces (diagnosis as of January 29) found that the proportion of medical staff was 2.09% [17]. Therefore, medical staff are at high risk of infection and are under great psychological pressure. Suicidal cases were reported in India but also in other countries, Italy included, where two infected Italian nurses committed suicide in a period of a few days probably due to fear of spreading COVID-19 to patients. It is possible that fear and anxiety of falling sick or dying, helplessness will drive an increase in the 2020 suicide rates [18]. If they become infected as a result of supporting affected areas in Hubei and COVID-19 designated hospitals, it will not only affect their physical and mental health but also that of their families. Therefore, with the emergence of symptoms and the increase in the level of concern, the mental health status of clinical medical staff may deteriorate. Furthermore, if their families do not support them working on the front line against the disease, then the psychological burden of the medical staff will also increase due to the resulting sense of conflict with professional ethics, resulting in further impact on their physical and mental health.

4.2.2 Age

We found that the higher the age, the higher the mental health score and the more psychological problems. Based on the age distribution of patients across the country, all ages have no resistance to the novel coronavirus, and a person of any age can be infected as long as virus transmission conditions are met [19]. An analysis of 4021 confirmed patients nationwide (diagnosis date as of January 26) also shows that people of all ages are generally vulnerable to the disease, of whom 71.45% are aged 30 to 65 years [19]. As people get older, the risk of exposure to the disease may increase in people with underlying illness such as asthma, diabetes, and heart diseases [20]. Therefore, older medical personnel have more psychological stress when dealing with COVID-19 patients. It is advised that older medical personnel receive psychological counseling before and during work to help them adjust their status as soon as possible. Despite all the above, this study believes that after such a “smokeless” war against the novel coronavirus, the psychological quality of medical personnel can be improved to a certain extent.

4.3 Research limitations and future research plans

In this study, the applicability of the results is limited by the nature of cross-sectional studies, and because of its use of convenience sampling from 12 hospitals in eight provinces and cities of China. In subsequent research in this project, a longitudinal study should be conducted that uses a wider sample and measures the mental health status of medical personnel from multiple dimensions, which can help better identify the mutual influence between demographic data and mental health status.

4.4 Summary

In the face of the catastrophic health emergency caused by COVID-19, medical staff have been affected by different kinds of subjective and objective factors. Their mental health problems are a form of human stress response, an explanatory, emotional, and defensive response within the human body, and a physiological response of the human body to the invasion of needs or injuries. In this special environment, their work, life, and emotions tend to be regularly abnormal. Due to the requirements for isolation and disinfection, medical personnel need to wear several layers of protection clothing. This increases the intensity of their work and requires great physical energy, causing severe hypoxia and physical symptoms such as headache and muscle soreness. Other symptoms such as obsessive-compulsive symptoms, interpersonal sensitivity, depression, anxiety, phobic anxiety, hostility, and paranoid ideation are all normal psychological reactions in the handling of emergencies and environmental stimuli. In face of a disaster, persons with good mental health will tend to actively take measures such as catharsis, transference, compensation, relaxation, humor, self-consolation, and rational response. The results of this study show that the overall mental health of medical staff is generally poor when dealing with COVID-19. Psychological tests show that people have a process of adaptation to catastrophic emergencies, from initial rejection, shock, and fear, to habituation, acceptance, and calm, to co-existence and living together, which is a regular process. In the face of such a sudden disaster as COVID-19, these psychological symptoms have manifested in both doctors and patients. For medical personnel, it is particularly important to pay attention to mental health conditions while fulfilling their responsibilities. In future research, it is worth exploring how to strengthen the monitoring of mental health conditions of medical personnel and establish an active, systematic, and scientific psychological defense system under such special circumstances.

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6 Apr 2020

PONE-D-20-05925

Study of the mental health status of medical personnel dealing with new coronavirus pneumonia

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Reviewer #1: The manuscript investigates an interesting topic that is becoming a challenging issue worldwide. The design limitations (lack of longitudinal design) could be tolerate due to the urge to disseminate research on the COVID19 pandemic. However, some modifications are requested to make the text more readable and some theoretical and background pitfalls should be addressed.

The manuscript focuses on mental health status, and the main message is that mental health problems are a consequence of the emergency condition, and psychological strain linked to the fear of the disease plays a central role. However, more international references and literature on occupational stress, burnout and psychology of emergencies should be implemented in the introduction and in the discussion.

Could you insert references of the Chinese adaptation of the SCL 90?

Please explain in the text what does the hospital class means.

Could you provide in table 2 the number or the percentage of staff members who scored higher than the national norm cut off for each scl90 subscale and for the total score? This would give the reader a synthetic idea of the mental health status of the personnel.

Regression analysis. Could you move the description of the stepwise model in the method paragraph, including table 3? You may keep the model results, including table 4, in the results section. This would make the results clearer and more readable.

Reviewer #2: Interesting paper. Research subjects and methods are correct.

Discussion must be improved. These papers can be intersting and related with your paper:

Montemurro N.

The emotional impact of COVID-19: from medical staff to common people.

Brain Behav Immun. 2020 Mar 30. pii: S0889-1591(20)30411-6. doi: 10.1016/j.bbi.2020.03.032. [Epub ahead of print]

Li Z, Ge J, Yang M et al.

Vicarious traumatization in the general public, members, and non-members of medical teams aiding in COVID-19 control.

Brain Behav Immun. 2020 Mar 10. pii: S0889-1591(20)30309-3. doi: 10.1016/j.bbi.2020.03.007. [Epub ahead of print]

Huang J, Liu F, Teng Z et al.

Care for the psychological status of frontline medical staff fighting against COVID-19.

Clin Infect Dis. 2020 Apr 3. pii: ciaa385. doi: 10.1093/cid/ciaa385. [Epub ahead of print]

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Reviewer #1: Yes: Filippo Rapisarda

Reviewer #2: No

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files to be viewed.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email us at figures@plos.org. Please note that Supporting Information files do not need this step.

16 Apr 2020

Journal Requirements:

When submitting your revision, we need you to address these additional requirements:

1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at http://www.plosone.org/attachments/PLOSOne_formatting_sample_main_body.pdf and http://www.plosone.org/attachments/PLOSOne_formatting_sample_title_authors_affiliations.pdf

Answer: We have checked the link and revise the manuscript according the PLOS ONE's style.

2. Please include in your Methods section (or in Supplementary Information files) the participating hospitals/institutions.

Answer: We have added the participating hospitals in the method section as following: The 12 hospitals including the 1st Affiliated Hospital of Harbin Medical University, the 2nd Affiliated Hospital of Harbin Medical University, Changchun Central Hospital, Liaoning Provincial People's Hospital, Qilu Hospital of Shandong University, the Second Hospital of Tianjin Medical University, People's Hospital of Inner Mongolia Autonomous Region, the First Hospital of Ningbo, the Second Hospital of Ningbo, Guizhou Provincial People's Hospital, Sichuan Provincial People's Hospital, and Wuhan University People's Hospital.

3. Please include additional information regarding the survey or questionnaire used in the study and ensure that you have provided sufficient details that others could replicate the analyses. If you developed and/or translated a questionnaire as part of this study and it is not under a copyright license more restrictive than Creative Commons Attribution (CC-BY), please include a copy, in both the original language and English, as Supporting Information.

Answer: we have added the details: It had been translated into Chinese version and used in the study. Both the original language and English version have been attached as supporting information.

4. We note that you have reported significance probabilities of 0 in places. Since p=0 is not strictly possible, please correct this to a more appropriate limit, eg 'p<0.0001'.

Answer: Thank you so much for your suggestion. We have use the p<0.0001 instead of the p=0

5. Thank you for stating the following financial disclosure:

"The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript"

At this time, please address the following queries:

a. Please clarify the sources of funding (financial or material support) for your study. List the grants or organizations that supported your study, including funding received from your institution.

b. State what role the funders took in the study. If the funders had no role in your study, please state: “The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.”

c. If any authors received a salary from any of your funders, please state which authors and which funders.

d. If you did not receive any funding for this study, please state: “The authors received no specific funding for this work.”

Please include your amended statements within your cover letter; we will change the online submission form on your behalf.

Answer: Thank your so much for your suggestion. The study did not receive any funding. So we state: d “The authors received no specific funding for this work.” We have added the statement in our cover letter.

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We will update your Data Availability statement on your behalf to reflect the information you provide.

Answer: Thank you so much for your direction. We have revised the content as following: All relevant data are within the manuscript and its Supporting Information files. And upload the data in the attachment. Thanks for your suggestion.

7. PLOS requires an ORCID iD for the corresponding author in Editorial Manager on papers submitted after December 6th, 2016. Please ensure that you have an ORCID iD and that it is validated in Editorial Manager. To do this, go to ‘Update my Information’ (in the upper left-hand corner of the main menu), and click on the Fetch/Validate link next to the ORCID field. This will take you to the ORCID site and allow you to create a new iD or authenticate a pre-existing iD in Editorial Manager. Please see the following video for instructions on linking an ORCID iD to your Editorial Manager account: https://www.youtube.com/watch?v=_xcclfuvtxQ

Answer: Thank you so much for your direction. I have had the ORCID ID in the past. When I validated it in Editorial Manager according the direction. The web showed the content as following:

But when I entered in the submit system. The web showed as following:

So if it have been validated or what can I do next? Thanks for your directing.

8. Your ethics statement must appear in the Methods section of your manuscript. If your ethics statement is written in any section besides the Methods, please move it to the Methods section and delete it from any other section. Please also ensure that your ethics statement is included in your manuscript, as the ethics section of your online submission will not be published alongside your manuscript.

Answer: I have deleted the ethics section after the discussion and put it in the Methods section according your request. Thank for your suggestion.

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Partly

Reviewer #2: Partly

Answer: We have read the content carefully. Thanks for your direction.

2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

Answer: We have read the content carefully. Thanks for your direction.

3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

Answer: We have read the content carefully. Thanks for your direction.

4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

Answer: We have read the content carefully. Thanks for your direction.

5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: The manuscript investigates an interesting topic that is becoming a challenging issue worldwide. The design limitations (lack of longitudinal design) could be tolerate due to the urge to disseminate research on the COVID19 pandemic. However, some modifications are requested to make the text more readable and some theoretical and background pitfalls should be addressed.

Answer: We have done some modifications making the text more readable and added some backgrounds.Thanks

The manuscript focuses on mental health status, and the main message is that mental health problems are a consequence of the emergency condition, and psychological strain linked to the fear of the disease plays a central role. However, more international references and literature on occupational stress, burnout and psychology of emergencies should be implemented in the introduction and in the discussion.

Answer: Thanks for your suggestion. We have added some references relating burnout and psychology of emergencies in the discussion.

Montemurro N. The emotional impact of COVID-19: from medical staff to common people.

Brain Behav Immun. 2020 Mar 30. pii: S0889-1591(20)30411-6. doi: 10.1016/j.bbi.2020.03.032. [Epub ahead of print]

Li Z, Ge J, Yang M et al.

Vicarious traumatization in the general public, members, and non-members of medical teams aiding in COVID-19 control.

Brain Behav Immun. 2020 Mar 10. pii: S0889-1591(20)30309-3. doi: 10.1016/j.bbi.2020.03.007. [Epub ahead of print]

Huang J, Liu F, Teng Z et al.

Care for the psychological status of frontline medical staff fighting against COVID-19.

Clin Infect Dis. 2020 Apr 3. pii: ciaa385. doi: 10.1093/cid/ciaa385. [Epub ahead of print]

Goyal K, Chauhan P, Chhikara K, et al.Fear of COVID 2019: First suicidal case in India![J].Asian J Psychiatr. Published online first 27 Feb 2020. DOI: 10.1016/j.ajp.2020.101989

Could you insert references of the Chinese adaptation of the SCL 90?

Answer: Thanks for your suggestion. We have inserted the reference of the Chinese adaptation of the SCL 90 as following: It had been translated into Chinese version and used in the study[8].8.Wang YY, Jia XR, Song JQ, et al. Mental health status of medical staff during the outbreak of Coronavirus Disease 2019[J]. M edical Journal of W uhan University, Published online first 17 Mar 2020. DOI: 10. 14188/j. 1671⁃8852. 2020. 0154.

Please explain in the text what does the hospital class means.

Answer: Hospital class apply with the Chinese hierarchical hospital management. The management system divides hospitals into first, second and third levels. The division of grades is based on the number of beds: less than 100 beds are first-class hospitals; 101 beds to 500 beds are classified as second-level hospitals; More than five hundred, set as three level hospitals.

Could you provide in table 2 the number or the percentage of staff members who scored higher than the national norm cut off for each scl 90 subscale and for the total score? This would give the reader a synthetic idea of the mental health status of the personnel.

Answer: Thanks so much for your suggestion. We have added the number or the percentage of staff members who scored higher than the national norm cut off for each scl 90 subscale and for the total score in table2 according your suggestion making reader a synthetic idea of the mental health status of the personnel.

Regression analysis. Could you move the description of the stepwise model in the method paragraph, including table 3? You may keep the model results, including table 4, in the results section. This would make the results clearer and more readable.

Answer: We have delete the table3 according your suggestion making the results clearer and more readable.

Reviewer #2: Interesting paper. Research subjects and methods are correct.

Discussion must be improved. These papers can be intersting and related with your paper:

Montemurro N. The emotional impact of COVID-19: from medical staff to common people.

Brain Behav Immun. 2020 Mar 30. pii: S0889-1591(20)30411-6. doi: 10.1016/j.bbi.2020.03.032. [Epub ahead of print]

Li Z, Ge J, Yang M et al.

Vicarious traumatization in the general public, members, and non-members of medical teams aiding in COVID-19 control.

Brain Behav Immun. 2020 Mar 10. pii: S0889-1591(20)30309-3. doi: 10.1016/j.bbi.2020.03.007. [Epub ahead of print]

Huang J, Liu F, Teng Z et al.

Care for the psychological status of frontline medical staff fighting against COVID-19.

Clin Infect Dis. 2020 Apr 3. pii: ciaa385. doi: 10.1093/cid/ciaa385. [Epub ahead of print]

Answer: We have inserted the references in the discussion and reference. Thanks for your direction.

6.PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: Yes: Filippo Rapisarda

Reviewer #2: No

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files to be viewed.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email us at figures@plos.org. Please note that Supporting Information files do not need this step.

Answer: We have read the content carefully. Thanks for your direction. The manuscript have no figures just tables.

Submitted filename: Response to Reviewers.doc

Click here for additional data file.

30 Apr 2020

Study of the mental health status of medical personnel dealing with new coronavirus pneumonia

PONE-D-20-05925R1

Dear Dr. Sun,

We are pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it complies with all outstanding technical requirements.

Within one week, you will receive an e-mail containing information on the amendments required prior to publication. When all required modifications have been addressed, you will receive a formal acceptance letter and your manuscript will proceed to our production department and be scheduled for publication.

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Stephan Doering, M.D.

Academic Editor

PLOS ONE

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #2: All comments have been addressed

**********

2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #2: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #2: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #2: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #2: Yes

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #2: This paper showed the relationship between personality traits and mental health conditions of medical personnel to provide a basis and reference for the implementation of targeted education on mental health. Interesting paper. Authors answered to all comments. Well done!

**********

7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #2: No

4 May 2020

PONE-D-20-05925R1

Study of the mental health status of medical personnel dealing with new coronavirus pneumonia

Dear Dr. sun:

I am pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department.

If your institution or institutions have a press office, please notify them about your upcoming paper at this point, to enable them to help maximize its impact. If they will be preparing press materials for this manuscript, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org.

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With kind regards,

PLOS ONE Editorial Office Staff

on behalf of

Professor Stephan Doering

Academic Editor

PLOS ONE