Mental Health Burden During COVID-19: Anxiety, Depression, and Poor Sleep Quality

nurse wearing mask
BANGKOK, THAILAND – APRIL 22: A member of the medical staff wearing PPE prepares a room in the COVID-19 ward in Vibhavadi Hospital as they deal with the coronavirus outbreak on April 22, 2020 in Bangkok, Thailand. The hospital is due to discharge their final coronavirus patient today as numbers of infections continue to drop across the country. The Thai government has imposed a 10pm to 4am curfew and has ordered the closure of entertainment venues, schools and parks in order to curb the spread of the COVID-19 coronavirus across the country. (Photo by Jack Taylor/Getty Images)
Prevalence of GAD and depressive symptoms was significantly higher in participants younger than 35 years as compared to those aged 35 years or older.

A web-based survey study published in Psychiatry Research demonstrated a major mental health burden during the 2019 coronavirus disease (COVID-19) pandemic among young people and healthcare workers. Anxiety surrounding the pandemic may also contribute to poor mental health.

From February 3 to February 17, 2020, investigators from Shenzhen University Health Science Center in China used a web-based cross-sectional survey to collect gender, age, and occupational data from 7236 anonymous participants. Participants completed Chinese versions of the GAD-7 scale, Center for Epidemiology Scale for Depression, and the Pittsburgh Sleep Quality Index.

Of the participants, 54.6% were females, and the mean age was 35.3±5.6 years. A total of 2250 participants (31.1%) were healthcare workers, 3155 (43.6%) spent 3 or more hours a day focusing on the pandemic, and 5702 (78.8%) had an above general knowledge of the pandemic. Overall prevalence of generalized anxiety disorder (GAD), depressive symptoms, and sleep quality were 35.1%, 20.1%, and 18.2%, respectively.

Gender was not significantly associated with prevalence of GAD, depressive symptoms, and sleep quality (P >.05). Prevalence of GAD and depressive symptoms was significantly higher in participants younger than 35 years as compared to those aged 35 years or older (P <.001). Nearly 1 in 4 healthcare workers had sleep problems, and among all occupations, healthcare workers reported the highest rate (23.6%) of poor sleep quality (P <.001).

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Age and time spent focusing on COVID-19 were significantly associated with GAD (odds ratio [OR], 1.91; 95% CI, 1.77-2.15). Similarly, age was associated with depressive symptoms (OR, 1.80; 95% CI, 1.35-2.01), but not with sleep quality. Occupation, however, was related to sleep quality (OR, 1.48; 95% CI, 1.15-1.95).

Because a web-based survey method was used to avoid possible infections, sampling was voluntary and conducted online; therefore, the possibility of selection bias should be considered. In addition, participants’ psychological conditions before the COVID-19 outbreak were not assessed.

“Ongoing surveillance and monitoring of the psychological consequences for outbreaks of epidemic-potential, life-threatening diseases, establishing early targeted mental health interventions, should become routine as part of preparedness efforts worldwide,” the investigators concluded.


Huang Y, Zhao N. Generalized anxiety disorder, depressive symptoms and sleep quality during COVID-19 outbreak in China: a web-based cross-sectional survey [published online April 12, 2020]. Psychiatry Res. 2020;288:112954.