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Objective@#The economic hardship brought by the coronavirus disease-2019 (COVID-2019) pandemic has caused mental health problems among people of different socioeconomic status (SES). As social support helps to buffer these problems, we investigated the association between job loss related to COVID-19 and depression, anxiety, and suicidal thoughts; the differences in the effects according to SES; and the mediating effects of social support. @*Methods@#The effects of COVID-19-related job loss on depression, anxiety, and suicidal thoughts among 1,364 people were investigated through semi-structured and self-administered questionnaires: Patient Health Questionnaire–9, General Anxiety Disorder–7, and the Functional Social Support Questionnaire. Logistic regression and subgroup analyses were performed to assess the association between job loss and mental health status, and the moderating effects of income and educational levels. Moreover, the mediating effects of perceived social support on the association between job loss and depression, anxiety, and suicidal thoughts were analyzed. @*Results@#COVID-19-related job loss increased the risk of depression and suicidal thoughts. Adults with lower income and education level were at higher risk of depression, anxiety, and suicidal thoughts; perceived social support level had significant mediating effects on the association between job loss and depression/anxiety; and income level had significant moderating effects on this mediating pathway. @*Conclusion@#COVID-19-related job loss were likely to be significantly associated with negative mental health outcomes, especially among individuals with low income and education levels. As social support had buffering effects on such outcomes, related government policies in cooperation with the governance of communities and stakeholders must be prepared.
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Purpose@#Little is known about blood markers related to eosinophils in healthy individuals. We aimed to identify blood markers from routine tests associated with blood eosinophil count (BEC) in healthy individuals. @*Methods@#Based on the complex interactions among blood markers, we used comprehensive analysis methods (regression, Bayesian network [BN], and partial correlation) and a health check-up database. To test consistency, we repeated the analysis using data from 3 check-ups of the same healthy individual. @*Results@#A total of 12,625 individuals were enrolled in this study. Four groups were defined according to sex and smoking status: nonsmoking men (n=1,737), smoking men (n=6,518), nonsmoking women (n=3,995), and smoking women (n=375). The blood bilirubin and γ-glutamyltransferase levels showed significant associations with BEC by regression analysis. However, BN analysis found that only the bilirubin node was directly connected to the BEC node. By partial correlation analysis, the blood bilirubin level showed significantly negative association with BEC. The same results were obtained across all the 3 health check-ups, except in smoking women. In addition, a lower blood bilirubin level predicted a significantly elevated BEC (especially ≥200/µL). The blood bilirubin levels measured at 3 time-points were significantly associated with BEC in men and nonsmoking women. @*Conclusion@#The blood bilirubin level, which is easily obtained by routine test in clinical practice, may be a useful marker for BEC.
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Objective@#This study aimed to observe the changes in people’s depressive levels over 9 months since the coronavirus disease of 2019 (COVID-19) outbreak as well as to identify the predictors of people’s depressive levels including COVID-19 infection fear in the context of South Korea in 2020. @*Methods@#For these purposes, four cross-sectional surveys were periodically implemented from March to December 2020. We randomly recruited 6,142 Korean adults (aged 19 to 70) by using a quota survey. Along with descriptive analysis, which included a one-way analysis of variance and correlations, multiple regression models were built to identify the predictors of people’s depressive levels during the pandemic. Results Overall, people’s depressive levels and fear of COVID-19 infection gradually increased since the COVID-19 outbreak. In addition to demographic variables (i.e., being a female, young age, unemployed, and living alone) and the duration of the pandemic, people’s COVID-19 infection fear was associated with their depressive levels. @*Conclusion@#To ameliorate these rising mental health issues, access to mental health services should be secured and expanded, particularly for individuals who present greater vulnerabilities due to socioeconomic characteristics that may affect their mental health.
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Background@#The coronavirus disease 2019 (COVID-19) outbreak and subsequent disease-containment measures (such as school closures) significantly affected the lives of adolescents. We evaluated the mental-health status and factors associated with anxiety and depression among South Korean adolescents. @*Methods@#A nationwide online survey was conducted to evaluate the mental-health status of South Korean adolescents during the COVID-19 pandemic. In total, 570 adolescents aged 13–18 years were surveyed between May 27 and June 11, 2021. The participants completed the Generalized Anxiety Disorder Scale (GAD-7) and Patient Health Questionnaire (PHQ-9) to determine anxiety and depression symptoms, respectively. Stepwise logistic regression models were constructed to determine factors related to anxiety and depression. @*Results@#Among the study participants, 11.2% and 14.2% had anxiety and depression, respectively. The results suggested that several factors, such as the experience of COVID-19 infection and quarantine of oneself, a family member or an acquaintance, physical and mental health problems, and fear of one’s local community being discriminated against as a COVID-19 area were related to anxiety and depression. @*Conclusion@#The present study identified COVID-19-related factors associated with anxiety and depression among adolescents, and provides insights regarding potential interventions to improve the mental health of adolescents. To promote the mental health of adolescents during the COVID-19 pandemic, special attention should be paid to individuals with physical or mental-health problems, and efforts should be made to reduce the negative social and emotional impacts of infection-control measures.
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Background@#The coronavirus disease 2019 (COVID-19) pandemic has caused health problems and distress among healthcare workers (HCWs), so supportive measures to promote their health and relieve distress are needed. @*Materials and Methods@#We conducted two rounds of Delphi surveys with 20 COVID-19-related frontline healthcare professionals and public officials. The surveys evaluated means of supporting HCWs’ health by improving health care systems and working environments in terms of effectiveness and urgency. The validity of the measures was assessed by calculating the content validity ratio. @*Results@#The top-priority measures to support HCWs were “secure isolation units capable of treating severe cases” in the facility infrastructure category, “secure nursing staff dedicated for patients in the intensive care units” in the personnel infrastructure category, “improve communication between central office and frontline field” in the cooperation system category, “support personal protective equipment and infection control supplies” in the aid supplies category, and “realization of hazard pay” in the physical/mental health and compensation category. @*Conclusion@#There was consensus among the experts on the validity and priorities of policies in the facility, personnel, cooperation, supplies, and compensation categories regarding measures to promote COVID-19 related HCWs’ health.
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Background@#Throughout the coronavirus disease 2019 (COVID-19) pandemic, not only medical personnel but also paramedics or emergency medical technicians (EMT) have faced multiple physical and psychological challenges while performing their duties. The current study aimed to evaluate the psychological effects of managing patients with COVID-19 on the paramedics and EMT. @*Materials and Methods@#A survey targeting paramedics and EMT in Korea was conducted in December 2020. An official letter requesting participation and with the link to an onlinebased survey was sent to the Public Emergency Medical Services. Only one response was accepted from each participant. @*Results@#A total of 326 paramedics and EMT responded to the survey. Among them, 66.3% (216/326) had experience in managing patients with COVID-19. No differences in the distribution of sex, age, working area, duration of working experience, and underlying comorbidities were observed between those who did (COVID-19 group) and did not (nonCOVID-19 group) experience managing patients with COVID-19. The percentage of participants who showed severe posttraumatic stress disorder (PTSD) symptoms was significantly higher in the COVID group than in the non-COVID group (11.1% vs. 3.6%P = 0.029). The participants in the COVID group had a significantly higher mean Global Assessment of Recent Stress Scale score than those in the non-COVID group (18.7 ± 11.1 vs. 16.1 ± 9.9, P = 0.042). The proportion of paramedics and EMT willing to leave their job if given a chance was higher in the COVID group than the non-COVID group (24.1% vs. 9.1%, P = 0.001). Additionally, paramedics and EMT in the COVID group tended to show concern regarding exposure to COVID-19 infection. @*Conclusion@#The experience of managing patients with COVID-19 resulted in psychological distress among paramedics and EMT in Korea.
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Objectives@#：This study intends to assess the associations among perceived stigma at the time of infection, coping strategies adopted 12 months later and depressive and posttraumatic symptoms 24 months later in Middle Eastern Respiratory Syndrome (MERS) survivors. @*Methods@#：A nationwide cohort study was conducted on 63 survivors of 2015 MERS outbreak. Demographic data, illness severity of MERS, depression and posttraumatic stress symptoms, coping strategies and MERS-related stigma were collected 12 and 24 months after the MERS outbreak, respectively. @*Results@#：Higher levels of perceived stigma at the time of outbreak were associated with higher levels of dysfunctional coping strategies after 12 months (p=0.003) and more severe depressive (p=0.058) and posttraumatic stress symptoms (p=0.011) after 24 months. Moreover, higher levels of dysfunctional coping strategies after 12 months were significantly associated with more severe depressive (p=0.002) and posttraumatic stress symptoms (p<0.001) after 24 months. @*Conclusions@#：Social stigma against people who have contracted an emerging infectious disease can leave a negative impact on the mental health of the survivors in the long term. In case of novel pandemics in the future, promptrectification of stigma and promotion of adaptive coping strategies in survivors are needed.
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Purpose@#: This study aimed to identify the moderating and mediating effects of resilience on the relationship between role conflict and job satisfaction among nurses working in a comprehensive nursing care service ward. @*Methods@#: Participants were 130 comprehensive nursing care service ward nurses from four hospitals. Data were collected using structured questionnaires and analyzed by t-test, ANOVA, Scheffé test, Pearson correlation coefficients, and hierarchical multiple regression analysis, using SPSS 25.0. The mediating effect of resilience on the relationship between role conflict and job satisfaction was analyzed using multiple regression analysis according to Baron and Kenny’s procedure. @*Results@#: Statistically significant negative correlations were found between role conflict and resilience (r=-.25, p<.007) and between role conflict and job satisfaction (r=-.38, p<.001). A significant positive correlation was found between resilience and job satisfaction (r=.54, p<.001). A partial mediating effect of resilience was found between role conflict and job satisfaction (Z=-2.53, p=.012) but no moderating effect was found. @*Conclusion@#: To improve the job satisfaction of comprehensive nursing care service ward nurses, interventions for alleviating role conflict and improving resilience as well as evaluations of the two variables are necessary.
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Purpose@#Many studies have shown that obesity is one of the major causes of lung function decline. However, a longitudinal study of the correlation between changes in obesity degree and lung function is still lacking. This study aimed to analyze alterations in lung function according to changes in body and abdominal fat amount over time in healthy individuals. @*Methods@#A retrospective cohort study of individuals who received annual health screening was performed. Individuals who underwent health screening at least 3 times with follow-up periods more than 5 years were included. Using a linear mixed model, we analyzed associations between the change in total body fat amount/abdominal fat ratio and lung function decline over time by dividing each quartile according to the fat change rate. @*Results@#A total of 15,484 individuals over 40 years old was enrolled prospectively. A longitudinal increase in total body fat amount over time was associated with a predicted value of forced expiratory volume in 1 second (FEV1p ; %) and predicted value of forced vital capacity (FVCp; %) declines, regardless of sex. A similar phenomenon was observed between an increase in abdominal fat ratio and FEV 1p /FVCp decline, which was predominant in males. In addition, the change in abdominal fat ratio showed a significant correlation with differences in the initial values of FEV 1p and FVCp after 40 years old. @*Conclusion@#Increases in total body fat amount and abdominal fat ratio may cause lung function decline over time.
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Objective@#The aims of this study were to explore the prevalence of and identify predictors of anxiety and depression related to coronavirus disease of 2019 (COVID-19) in South Korea. @*Methods@#The analysis is based on a quota survey design and a sampling frame that permitted recruitment of a national sample of 1,014 individuals between March 17–31, 2020. Several standardized measurements were used, including GAD-7, PHQ-9, COVID-19 related fear, restrictions in deaily life, as well as sociodemographic information and physical and psychosocial needs during the pandemic. Multiple logistic regression was conducted to analyze the influence of sociodemographic factors, fear, and physical/psychosocial needs on anxiety and depression. @*Results@#Significant numbers of the respondents were identifiable anxiety (19.0%) and depression group (17.5%), respectively. This indicates that the depression and anxiety prevalence rate after the COVID-19 is substantially high compared to the depression rate of 2.6% in 2020 and 2.8% in 2018 both reported in the Korea Community Health Survey and the anxiety rate of 5.7% reported in 2016 Survey of Mental Disorders in Korea. Multiple logistic regression results showed age, COVID-19 related fear, and the level of restrictions in daily as significant factors in understanding and predicting the anxiety group. Likfewise, the COVID-19 related fear, restrictions in daily life, and need for economic support were important predictors in predicting the depression group. @*Conclusion@#Findings on predictors for greater vulnerability to anxiety and depression has important implications for public mental health in the context of the COVID-19 pandemic.
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Objective@#The study investigated the effects of severe human rights abuses in North Korean on Posttraumatic-stress disorder (PTSD) in North Korean Refugees (NKRs). @*Methods@#The study included 300 NKRs (245 females and 55 males) who completed self-report questionnaires that assessed PTSD, experiences of imprisonment, and exposure to inhumane treatment, by authorities in North Korea. A moderation analysis was conducted using a hierarchical multiple regression model to determine whether a moderation effect existed. In the next step, a post-hoc probing procedure of the moderation effect was performed using multiple regression models that included conditional moderator variables. @*Results@#The influence of the frequency of being imprisoned on PTSD varied as a function of recurrent exposure to inhumane treatment or punishment by authorities. Experiences of imprisonment were associated with PTSD only among those who were exposed to recurrent violence, such as beating or torture, by North Korean authorities. @*Conclusion@#The present findings highlight the significant effects of human rights violations, such as the inhumane treatment of prisoners in North Korea, on the PTSD of NKRs.
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Objective@#This study aimed to validate the Korean version of a short screening tool for psychosis as the first stage in finding undiagnosed psychosis in the community. @*Methods@#The sample contained 126 consecutive psychiatric outpatients in National Medical Center, Seoul, Korea, between July 20 and July 22, 2020. The Psychosis Screener (PS) comprises 7 items covering psychotic symptoms. The presence of each psychotic symptom was determined by a trained mental health professional and coded “yes” or “no.” Two psychiatrists reviewed the medical records independently and extracted the ICD-10-based diagnoses. Any differences between the two clinicians were resolved by consensus, and the agreed diagnosis was used as a gold standard in the study. @*Results@#Among 126 psychiatric outpatients who were enrolled in a consecutive manner during the study period, the proportion of psychosis was 15.1%. The PS showed 78.9% sensitivity and 72.0% specificity when the optimal cut-off was 2, indicating that a score of 2 or more on the screener identified a likely case of psychosis. The area under the curve for the PS was 0.78 (95% CI: 0.67–0.87). @*Conclusion@#The Korean version of the PS has an ability to discriminate between those who meet the diagnostic criteria for psychosis and those who do not in a high-prevalence group.
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Objectives@#This study is designed to extract a representative variable that distinguishes psychiatric patients of North Korean Defectors and a control group by using machine learning based on measured mental health variables and physical activity variables. @*Methods@#The physical and mental activity variables of 17 North Korean defectors that previously were hospitalized or received psychiatric outpatient treatment and a control group were compared. The survey focused on mental health variables that included contents related to depression, suicidal risks, post-traumatic stress disorder, anxiety, insomnia, physical symptoms, quality of life, coping skills, social support, and drinking. Physical activity variables included the number of steps walked per day, sleep time, and sleep efficiency were measured by Fitbit. @*Results@#The 7th question of the Patient Health Questionnaire-9, “Trouble concentrating on things, such as reading the newspaper or watching television over the past two weeks,” showed the highest gain ratio by 84 percent. Based on the result of the decision tree, this single index may distinguish between the clinical and control groups. @*Conclusion@#A clinician may conduct a more effective interview with a North Korean defector by identifying in the early stages whether the patient has been having difficulty concentrating on daily tasks during the past two weeks.
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Background@#During the coronavirus disease 2019 (COVID-19) pandemic, health care workers (HCWs) have faced multiple physical and psychological challenges while carrying out their duties. In this study, we examined the experiences of specific groups of HCWs during the pandemic. @*Methods@#From 18 November to 30 December 2020, we conducted a qualitative study using semi-structured, face-to-face interviews with four groups of 14 HCWs in three cities (Seoul, Daegu, and Gwangju) in South Korea. The HCWs who participated in the focus groups included physicians, nurses, medical practitioners, and cleaning staff who directly or indirectly cared for patients during the COVID-19 epidemic. Interviews were transcribed verbatim and analyzed using the consensual qualitative research approach. @*Results@#Our qualitative data analysis revealed four main domains: work-related struggles, personal life-related struggles, psychological stress, and health-related struggles. Health care providers were challenged by working in critical situations and were overwhelmed by heavy workloads, fear of infection, lifestyle changes, and psychological and physical struggles. @*Conclusion@#Our findings could serve as a foundation for establishing health care systems and policies that help HCWs cope with occupational stress, thus increasing their ability to adapt to the ongoing COVID-19 pandemic.
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Objective@#The aims of this study were to explore the prevalence of and identify predictors of anxiety and depression related to coronavirus disease of 2019 (COVID-19) in South Korea. @*Methods@#The analysis is based on a quota survey design and a sampling frame that permitted recruitment of a national sample of 1,014 individuals between March 17–31, 2020. Several standardized measurements were used, including GAD-7, PHQ-9, COVID-19 related fear, restrictions in deaily life, as well as sociodemographic information and physical and psychosocial needs during the pandemic. Multiple logistic regression was conducted to analyze the influence of sociodemographic factors, fear, and physical/psychosocial needs on anxiety and depression. @*Results@#Significant numbers of the respondents were identifiable anxiety (19.0%) and depression group (17.5%), respectively. This indicates that the depression and anxiety prevalence rate after the COVID-19 is substantially high compared to the depression rate of 2.6% in 2020 and 2.8% in 2018 both reported in the Korea Community Health Survey and the anxiety rate of 5.7% reported in 2016 Survey of Mental Disorders in Korea. Multiple logistic regression results showed age, COVID-19 related fear, and the level of restrictions in daily as significant factors in understanding and predicting the anxiety group. Likfewise, the COVID-19 related fear, restrictions in daily life, and need for economic support were important predictors in predicting the depression group. @*Conclusion@#Findings on predictors for greater vulnerability to anxiety and depression has important implications for public mental health in the context of the COVID-19 pandemic.
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Objective@#The study investigated the effects of severe human rights abuses in North Korean on Posttraumatic-stress disorder (PTSD) in North Korean Refugees (NKRs). @*Methods@#The study included 300 NKRs (245 females and 55 males) who completed self-report questionnaires that assessed PTSD, experiences of imprisonment, and exposure to inhumane treatment, by authorities in North Korea. A moderation analysis was conducted using a hierarchical multiple regression model to determine whether a moderation effect existed. In the next step, a post-hoc probing procedure of the moderation effect was performed using multiple regression models that included conditional moderator variables. @*Results@#The influence of the frequency of being imprisoned on PTSD varied as a function of recurrent exposure to inhumane treatment or punishment by authorities. Experiences of imprisonment were associated with PTSD only among those who were exposed to recurrent violence, such as beating or torture, by North Korean authorities. @*Conclusion@#The present findings highlight the significant effects of human rights violations, such as the inhumane treatment of prisoners in North Korea, on the PTSD of NKRs.
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Objective@#This study aimed to validate the Korean version of a short screening tool for psychosis as the first stage in finding undiagnosed psychosis in the community. @*Methods@#The sample contained 126 consecutive psychiatric outpatients in National Medical Center, Seoul, Korea, between July 20 and July 22, 2020. The Psychosis Screener (PS) comprises 7 items covering psychotic symptoms. The presence of each psychotic symptom was determined by a trained mental health professional and coded “yes” or “no.” Two psychiatrists reviewed the medical records independently and extracted the ICD-10-based diagnoses. Any differences between the two clinicians were resolved by consensus, and the agreed diagnosis was used as a gold standard in the study. @*Results@#Among 126 psychiatric outpatients who were enrolled in a consecutive manner during the study period, the proportion of psychosis was 15.1%. The PS showed 78.9% sensitivity and 72.0% specificity when the optimal cut-off was 2, indicating that a score of 2 or more on the screener identified a likely case of psychosis. The area under the curve for the PS was 0.78 (95% CI: 0.67–0.87). @*Conclusion@#The Korean version of the PS has an ability to discriminate between those who meet the diagnostic criteria for psychosis and those who do not in a high-prevalence group.
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Objectives@#This study is designed to extract a representative variable that distinguishes psychiatric patients of North Korean Defectors and a control group by using machine learning based on measured mental health variables and physical activity variables. @*Methods@#The physical and mental activity variables of 17 North Korean defectors that previously were hospitalized or received psychiatric outpatient treatment and a control group were compared. The survey focused on mental health variables that included contents related to depression, suicidal risks, post-traumatic stress disorder, anxiety, insomnia, physical symptoms, quality of life, coping skills, social support, and drinking. Physical activity variables included the number of steps walked per day, sleep time, and sleep efficiency were measured by Fitbit. @*Results@#The 7th question of the Patient Health Questionnaire-9, “Trouble concentrating on things, such as reading the newspaper or watching television over the past two weeks,” showed the highest gain ratio by 84 percent. Based on the result of the decision tree, this single index may distinguish between the clinical and control groups. @*Conclusion@#A clinician may conduct a more effective interview with a North Korean defector by identifying in the early stages whether the patient has been having difficulty concentrating on daily tasks during the past two weeks.
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Background@#During the coronavirus disease 2019 (COVID-19) pandemic, health care workers (HCWs) have faced multiple physical and psychological challenges while carrying out their duties. In this study, we examined the experiences of specific groups of HCWs during the pandemic. @*Methods@#From 18 November to 30 December 2020, we conducted a qualitative study using semi-structured, face-to-face interviews with four groups of 14 HCWs in three cities (Seoul, Daegu, and Gwangju) in South Korea. The HCWs who participated in the focus groups included physicians, nurses, medical practitioners, and cleaning staff who directly or indirectly cared for patients during the COVID-19 epidemic. Interviews were transcribed verbatim and analyzed using the consensual qualitative research approach. @*Results@#Our qualitative data analysis revealed four main domains: work-related struggles, personal life-related struggles, psychological stress, and health-related struggles. Health care providers were challenged by working in critical situations and were overwhelmed by heavy workloads, fear of infection, lifestyle changes, and psychological and physical struggles. @*Conclusion@#Our findings could serve as a foundation for establishing health care systems and policies that help HCWs cope with occupational stress, thus increasing their ability to adapt to the ongoing COVID-19 pandemic.
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This study reviews the literature concerning mental health impacts faced by health care workers (HCW) during the COVID-19 pandemic and similar infectious disease outbreaks. Among HCW studied, 9.6–51% reported symptoms of post-traumatic stress disorder (PTSD), and 20–75% reported psychiatric symptoms, with a particularly high prevalence of anxiety and depression. In addition to depression and anxiety, other serious stress responses were also reported among HCW during the COVID-19 pandemic. Severe symptoms were found in 2.2–14.5% of all participants. The severity of mental health symptoms was influenced by age, sex, occupation, specialization, type of activities performed, proximity to COVID-19 patients, direct involvement in the pandemic emergency response, preventive interventions, resilience, and social support. Qualitative studies showed that positive and negative emotions among front-line nurses coexisted during the outbreak of the epidemic. In the early stage, negative emotions were dominant and positive emotions appeared gradually. Personal coping styles and psychological growth played important roles in maintaining mental health among nurses. Ambiguous roles, transitions in operating mode, unfamiliar work content, and reversal of daily schedules were the most common vocational problems. Parents’ inability to comprehend, concern for family members, and long-term isolation were the most common causes of psychological stress. Regular screening for evaluating stress, depression and anxiety, and effective interventions for health care workers should be performed by multidisciplinary psychiatry teams.