Response to the COVID-19 Outbreak in Urban Settings in China (preprint)

The COVID-19 outbreak in China was devastating, and spread throughout the country before being contained. Stringent physical distancing recommendations and shelter-in-place were first introduced in the hardest-hit provinces, and by March, these recommendations were uniform throughout the country. In the presence of an evolving and deadly pandemic, we sought to investigate the impact of this pandemic on individual well-being and prevention practices among Chinese urban residents. From March 2-11, 2020, 4,607 individuals were recruited from 11 provinces with varying numbers of COVID-19 casers using the social networking app WeChat to complete a brief, anonymous, online survey. The analytical sample was restricted to 2,551 urban residents. Standardized scales measured generalized anxiety disorder (GAD), the primary outcome. Multiple logistic regression was conducted to identify correlates of GAD alongside assessment of community practices in response to the COVID-19 pandemic. We found that during the COVID-19 pandemic, recommended public health practices significantly (p<0.001) increased, including wearing facial mask, practicing physical distancing, handwashing, decreased public spitting, and going outside in urban communities. Overall, 40.3% of participants met screening criteria for GAD and 49.3%, 62.6%, and 55.4% reported that their work, social life, and family life were interrupted by anxious feelings, respectively. Independent correlates of having anxiety symptoms included being a healthcare provider (aOR=1.58, p<0.01), living in regions with a higher density of COVID-19 cases (aOR=2.13, p<0.01), having completed college (aOR=1.38, p=0.03), meeting screening criteria for depression (aOR=6.03, p<0.01) and poorer perceived health status (aOR=1.54, p<0.01). COVID-19 had a profound impact on the health of urban dwellers throughout China. Not only did they markedly increase their self- and community-protective behaviors, but they also experienced high levels of anxiety associated with a heightened vulnerability like depression, having poor perceived health, and the potential of increased exposure to COVID-19 such as living closer to the epicenter of the pandemic.

Pregnant Women’s Health-related Behavior Changes and Psychological Status After the Peak of COVID-19 Outbreak in China: A Cross-sectional Study (preprint)

Background: Little is known about the relationship between health-related behavior and psychological status of pregnant women during the COVID-19 outbreak. We aimed to describe the health-related behavior changes and psychological status of Chinese pregnant women, and to explore the relationship between pregnant women’s characteristics, health-related behavior and different psychological status following the peak of COVID-19 outbreak.Methods: We conducted an online survey through social media (WeChat) from March 14 to April 7. A self-designed questionnaire was used to investigate Chinese pregnant women’s health-related behavior changes. Generalized Anxiety Disorder scale, Edinburgh Postnatal Depression Scale and Perceived Stress Scale were used to assess anxiety, depression and stress among pregnant women. Wilcoxon signed-rank test was used to compare health-related behavior changes before and during the COVID-19 outbreak and Spearman’s rank correlation analysis or logistic regression analysis were used to explore the relationships between variables.Results: A total of 113 pregnant women were included in this study. Most pregnant women wore masks (98.2%), changed location or tried to stay away from those who seem to have a cold or fever (99.1%) and washed hands more often than before (96.5%). Pregnant women washed hands with soap or hand sanitizer more often and went out less often than before the outbreak. There were 41.6% pregnant women who didn’t have antenatal visits or weren’t on time for antenatal visits. Majority (77.9%) pregnant women sought help when feeling panic or anxiety, whereas few turned to psychological workers. The rates of pregnant women with anxiety, depression and health risk stress were 64.6%, 58.4% and 54.9%, respectively. Analysis of relationship between variables showed that household income, gestational age, pregnancy complications, knowledge about COVID-19 and maternal and child protection, perception of the likelihood of infection, the frequency of going out, prenatal check-up behavior, help-seeking behavior were significantly associated or correlated with psychological status.  Conclusions: Attention should be paid to the mental health of pregnant women with specific health-related behaviors changes. Screening for mental health problems and psychological interventions among pregnant women are needed.