Among the general population of China, the mental health burden — namely symptoms of depression, anxiety, insomnia, and acute stress — associated with the coronavirus disease 2019 (COVID-19) pandemic is considerable. These findings, published in JAMA Open Network, suggest that mental health intervention policies are in critical demand, particularly among some important at-risk populations.

The investigators sought to examine the prevalence of and risk factors linked to mental health symptoms in the general Chinese population during the COVID-19 outbreak. A large sample population based online survey study was conducted between February 28, 2020, and Match 11, 2020, across all 34 province-level regions in China. The self-designed online survey was released via the health page on the Chinese website Joybuy — a large ecommerce and information platform that offers online health services and products in China. All of the respondents were registered users of Joybuy.

The survey took approximately 15 minutes to complete and contained 4 parts. The first part focused on demographic information, including age, gender, rural or urban living area, marital status, level of education, monthly family income, occupation, geographic region, and medical history. The second part involved epidemic-related questions. The third part assessed social attitudes toward the COVID-19 pandemic and isolation conditions. The fourth part of the questionnaire contained 4 standardized scales: the Chinese versions of the Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, Insomnia Severity Index, and Acute Stress Disorder Scale.

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A total of 71,227 individuals clicked on the survey link. Overall, 57,006 people began taking the survey, with 74 individuals refusing to provide informed consent. Ultimately, 56,932 participants provided informed consent and submitted their questionnaires. A total of 156 questionnaires that did not include valid age information were excluded from the survey. Furthermore, 97 respondents who were <18 years of age were also excluded from the analysis.

The mean age of the participants was 35.97±8.22 years; 27,149 of them were men. During the COVID-19 pandemic, the rates of mental health symptoms among the survey respondents were as follows: 27.9% for depression (95% CI, 27.5-28.2%); 31.6% for anxiety (95% CI, 31.2-32.0%); 29.2% for insomnia (95% CI, 28.8-29.6%); and 24.4% for acute stress (95% CI, 24.0-24.7%).

Additionally, factors that were independently associated with negative mental health outcomes included having confirmed or suspected COVID-19, having a relative or a friend with confirmed or suspected COVID-19, having occupational exposure risks, being a resident of Hubei province, and experiencing both centralized and home quarantine, along with delays in returning to work.

The investigators noted that the findings demonstrate the severe mental health repercussions associated with COVID-19. Future studies are warranted in order to explore the association of the COVID-19 pandemic with mental health in other nations and the long-term outcomes of these findings.

“Population-specific mental health interventions are urgently needed to meet demand during this outbreak,” the investigators concluded.


Shi L, Lu Z-A, Que J-Y, et al. Prevalence of and risk factors associated with mental health symptoms among the general population in China during the coronavirus disease 2019 pandemic. JAMA Netw Open. 2020;3(7):e2014053. doi:10.1001/jamanetworkopen.2020.14053.