Analysis of public psychological status and related factors in Yichang during the closing of initial Covid-19

Objective: To investigate the psychological health status and influencing factors of the public during the epidemic of Covid-19 in Yichang, Hubei, and provide evidence for future psychological intervention. Methods: This study used snowball sampling, SCL-90 scale, and SSRS to conduct a questionnaire survey of 563 residents. Results: The state of public mental health during the closure of Covid-19 was worse than the national norm. Gender, age, and culture have an impact on mental health. There was a significant correlation between social support and the level of mental health. The effects of various variables on the public mental state from big to small: objective support, gender, occupation. Conclusion: The psychological problems of the public during the closure of the city of Covid-19 deserve attention. According to different influencing factors, corresponding measures should be implemented to improve the public’ s psychological endurance and respond to public health emergencies with a healthy mentality.


Background
Coronavirus Disease (Covid-19) was launched in December 2019 in Wuhan, Hubei [1]. Covid-19 is not only highly infectious and has a long incubation period, but also is susceptible to infection in all populations. Because of the unknown disease, the harm of the disease and other factors, to people caused a lot of pressure. Yichang, Hubei Province, is located in the core area of the epidemic, which may cause certain psychological pressure on the public.
The day when the city was closed, the traffic in the urban areas was suspended, first the airport, the railway station, the expressway, and then the bus, subway and private car in the city. In the end, we stayed at home. However, the day when the city was closed was also a traditional Chinese festival, the Spring Festival. In the first few days, we saw a shortage of materials on the Internet, all kinds of help seeking, all kinds of incomprehension, all kinds of abuse on the network, patients all over the city and the collapse of the whole city. Our city is collapsing soundlessly. We start from panic, anger, numbness, waiting, self healing. No one was left out of the disaster.
The purpose of this study is to investigate the mental health status and influencing factors of the public in Yichang City during the Covid-19 closure period, so as to provide theoretical basis for psychological intervention, social support and health education of public health emergencies in the future.

Participants
In February 2020, due to taking a series of measures such as closing the city during the epidemic period, this study used snowball sampling method, and selected 563 people in Yichang area of Hubei Province for questionnaire survey. All invitees completed the questionnaire online via Questionnaire Star (https://www.wjx.cn). Their demographic characteristics are presented in Table 1.

Procedure
Questionnaire survey was used. During the epidemic period of Covid-19, due to the closure of the city and restrictions on the flow of people, it is not practical to conduct a paper questionnaire survey. In order to ensure the research quality of the psychological health of the public during the Covid-19 closure period, this study adopts wechat, QQ and other ways to conduct online questionnaire survey.

Measures
After online guidance and interviews, the research group conducted a questionnaire survey. The questionnaire content includes the following: general information；Covid-19 common sense evaluation; SCL-90; Social support scale. SCL-90 has the nine symptom dimensions. The nine symptom dimensions are Somatization, Obsessive-Compulsive, Interpersonal Sensitivity, Depression, Anxiety, Hostility, Phobic Anxiety,Paranoid Ideation, and Psychoticism. SCL-90 is the most widely used scale in the field of mental health research in China. SCL-90 is suitable for all kinds of people and has high reliability and validity [2]. Social support scale (SSRS), compiled by Chinese scholar Xiao Shuiyuan, is a common tool to evaluate the degree and utilization of social support. SSRS has the three dimensions:objective support, subjective support, utilization of support [3].

Statistical analysis
SPSS statistics version 21.0 (IBM, Armonk, NY) was used for analysis. T test, analysis of variance and regression analysis were mainly used, and P<0.05 was considered to be statistically significant.

Results
The general mental health status of the public In addition to somatization and Interpersonal Sensitivity, the scores of other factors of the survey population were higher than the Chinese norm. The nine symptom dimensions from high to low were Obsessive-Compulsive, Interpersonal Sensitivity, Depression, Phobic Anxiety, Anxiety, Psychoticism, Paranoid Ideation, Hostility and somatization. In addition to somatization, Interpersonal Sensitivity and Hostility, the difference was statistically significant , as shown in Table 2. It shows that Covid-19 has brought great psychological pressure to the general public during the epidemic period.And the mental health status of Covid-19 has declined significantly.

Main mental health problems
The number of people greater than 2 and 3 in nine symptom dimensions was showed in Table 3. The score of each factor greater than 2 indicates mild mental health problems, and the score of each factor greater than 3 indicates moderate mental health problems [4]. It can be seen from table 3 that the main mental health problems of  the  public  during  the  prevalence  of  Covid-19 are Obsessive-Compulsive, Phobic Anxiety, Interpersonal Sensitivity and Depression.

Regression analysis
Research shows that different gender, age and academic degrees have an impact on mental health [5,6]. Therefore, according to the mental health scores of the public in SCL-90 , regression analysis was carried out on gender, age, education level, occupation, etc. The results are shown in Table 4. The research shows that in terms of gender, except Somatization, Interpersonal Sensitivity and Paranoid Ideation, gender and SCL-90 show significant negative correlation; age is positively correlated with Somatization and Phobic Anxiety, and age is negatively correlated with Obsessive-Compulsive, Interpersonal Sensitivity and Depression; in terms of education level, except for Obsessive-Compulsive and Depression, culture and other factor scores of SCL-90 present negative correlation. In terms of occupation, except Somatization and Paranoid Ideation, there was a negative correlation between occupation and other factors of SCL-90.

Mental health and social support
Some studies have shown that there is a significant correlation between social support and mental health, which can predict individual physical and mental health [7,8]. Therefore, according to the public mental health score of SCL-90 , this study conducted regression analysis on the total score, objective support degree, subjective support degree and utilization degree of SSRS. The results are shown in Table 5. In terms of total score of SSRS, except Somatization, it showed significant negative correlation with the factor scores of SCL-90; in terms of objective support, it showed significant negative correlation with all the factor scores of SCL-90; in terms of subjective support, except for Phobic Anxiety and Paranoid Ideation, it showed significant negative correlation with other factor scores of SCL-90, had positive correlation with somatization. In terms of the utilization of support, except for Obsessive-Compulsive, Interpersonal Sensitivity and Hostility, it was negatively correlated with other factors of SCL-90, but positively correlated with somatization.

Affecting factors
In this study, the total score of SCL-90 scale was used as the dependent variable, and gender, age, education level, occupation, objective support, subjective support and utilization of support were used as independent variables, and multiple linear regression analysis was conducted. The stepwise regression method was used for variable selection. The results showed that objective support, gender and occupation entered the regression equation, excluding age, education level, subjective support and utilization of support. The determination coefficient R2 of the three models were 0.122, 0.140 and 0.144 respectively, among which the determination coefficient of model 3 was the largest, so its goodness of fit was the largest, F=32.486, P < 0.05. The regression equation fitted was statistically significant, and the specific parameters are shown in Table 6.

Discussion
Public health emergencies, which are complex, uncertain, and difficult to predict, lead to public anxiety, panic and other emotions, seriously affect the public's mental health, and have a certain impact on the public's normal life order [9]. The Covid-19 pandemic has been a social illness and has resulted in radical changes in the societies. The pandemic dimension of Covid-19 causes psychological and behavioral consequences on the whole population    [10].This study investigated the psychological status of the public during the Covid-19 closure period in Yichang City, Hubei Province, and analyzed the overall mental health status of the public and the related factors during the Covid-19 epidemic period. In this study, SCL-90 was applied to the public during the epidemic period of Covid-19. The SCL-90 is one of the most comprehensive and widely used scales addressing this purpose internationally.Except for somatization and Interpersonal Sensitivity, the scores were higher than the Chinese norm, indicating that during the period it brought great psychological pressure to the general public and significantly reduced their mental health. Among them, Obsessive-Compulsive, Interpersonal Sensitivity, Depression, Phobic Anxiety and Anxiety were the main psychological problems of the public, which were similar to the main problems of the public during the SARS epidemic period [11], but compared with the proportion during the SARS epidemic period, the decline of the public mental health status was more obvious during the Covid-19 period, which may be due to the fact that Yichang, Hubei Province, belongs to the severe disaster area, with a large number of confirmed cases. Since late 2019, the world has faced the coronavirus disease 2019 (Covid-19) pandemic, which has brought about profound societal changes. The measures taken by governments to reduce exposure to viral particles, such as the closure of public places, home isolation, and social distancing, are also factors associated with psychological disturbances, such as depression, stress, anger, and confusion [12].The transmission route of Covid-19 has not been fully mastered in January that everyone stays at home [13].
Many factors can affect the mental health of the public. The results show that the higher the age and the higher the culture, the lower score of SCL-90 , which indicates that the better the mental health of the public is. In our study, analysis indicated that men suggesting a smaller possibility of biological rhythm disorder and a lower level of somatization symptoms of psychological distress against the background of Covid-19 pandemic. Compared with men, we should pay more attention to women's mental health. Women usually suppress themselves, and their emotions are generally self-regulated, so they are prone to produce negative emotions, which should be focused on [14]. Studies in many countries also indicated that a much higher proportion of people with lower education levels or the elderly had high anxiety during the pandemic because they often faced more severe health threats, insufficient financial capacity, etc [15]. To a certain extent, occupation can reflect the economic level of individuals, which is one of the risk factors of public mental health problems. In addition, residents with different monthly household income have different psychological burdens, higher household income means less impact from the panel, which was consistent with the study [16] found that people with higher household income had lower levels of depression. Some studies have shown that the lower the income, the more likely it is to produce negative social events [17]. Therefore, during this period, we should focus on the low-income group.
In addition to somatization, the better the social support, the lower score of SCL-90 , indicating the better mental health of the public. Social support play an important role in mental health. Some studies have shown that good social support can reduce individual's psychological stress , have a certain buffer effect on the stress response in the face of public health emergencies, and improve the individual's confidence in stress [18]. Good social support can not only reduce the pressure of life during the epidemic period, but also increase the public's confidence in resisting the epidemic. The outbreak of Covid-19 has shown many problems with the provision of psychological intervention in China [10]. Here we have suggested ways that the government could establish and improve the intervention system based on sound scientific advice, to effectively deal with the mental health problems caused by public health emergencies.Timely and effective social support is of great significance for public health emergencies.
The multiple correlation coefficient is 0.385, and the explanation variance is 0.148, which means that objective support, gender and occupation can predict the variation of public psychological status to a certain extent. This shows that objective support, gender and occupation can predict the mental health status of the public to a certain extent. However, the rest of the variation has not been involved in this study, and it needs to be further studied and explored in the future. Therefore, according to the different gender, occupation of the public how to use objective support to deal with public health emergencies, improve psychological endurance, and face the epidemic with healthy psychology and mentality.
During the epidemic period of Covid-19, the public had more serious mental health problems. Good psychological status can not only relieve the tension, but also has been proved that good psychological state can make the body in the best immune state [17]. Therefore, we should not only carry out all-round epidemic prevention work, but also pay attention to public mental health.In the future, corresponding measures should be taken to improve the mental health of the public. For example, experts introduce relevant knowledge, provide relevant and preventive measures; provide psychological consultation, treatment and mental health education according to the characteristics of gender, age and education level; timely provide hotline for psychological consultation, encourage the public to express their psychological worries, and release the uncomfortable things.
The limitations of this study lie in the following two points: first, the sample size is small. Second, this study is a cross-sectional survey, which can explore the dynamic changes and influencing factors of public psychological status after the epidemic.