Since the coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) had been reported in December 2019 (Zhu et al., 2020), it has gained wide attention rapidly. SARS-CoV-2 is highly contagious (Fang et al., 2020), and it could develop into a severe even fatal respiratory system disease (Guan et al., 2020; Huang et al., 2020), as well as develop neurological disorders (Wenting et al., 2020; Taquet et al., 2021).

Studies show clear signs of the harmful consequences, both mentally and psychologically, of COVID-19 in the general population (e.g., anxiety and depression; World Health Organization, 2020; de Vroege and van den Broek, 2021).

Being similar to other coronaviruses (Mak et al., 2009), patients with COVID-19 might show mental pressure, anxiety and depression syndromes, psychiatric dysfunction, and other such problems (Li et al., 2020a; Liu et al., 2020; Pappa et al., 2020; Qi et al., 2020; Torales et al., 2020; Zhang et al., 2020), even in the long term after the disease (Taquet et al., 2021). It is possibly because the patients experienced fear of the consequences of severe disease and the contagion (Xiang et al., 2020). Furthermore, strict quarantine and mandatory contact-tracing policy by the health authorities could cause societal rejection, financial loss, discrimination, and stigmatization (Balsamo and Carlucci, 2020; Brooks et al., 2020; Carlucci et al., 2020; Shigemura et al., 2020; Vindegaard and Benros, 2020). Some patients even committed suicide after experiencing anxiety and insomnia in the beginning of the hospitalization. In Italy, since the beginning of the COVID-19 quarantine, domestic homicides, and murder suicides registered to date increased (Balsamo and Carlucci, 2020). But it remains unclear whether the risks are attributable to viral infections per se or the host immune response (Troyer et al., 2020).

Therefore, accurate assessment of the mental status of patients is especially important (Epstein et al., 2020), which can avoid wastage of the limited mental health resources, and patients can be supported through less intense ways. On the contrary, it can also reduce the burden of medical workers. Previous studies showed that there were differences between self-rating and professional evaluation results, and the depression rate reported through self-rating scale was significantly higher than those through clinical interview (Lim et al., 2018). For the slightly depression conditions, more depression symptoms can be generated through self-rating (Rush et al., 1987).

Professional evaluation and self-rating are two common clinical scales, and can provide important information for clinical doctors (Möller, 2000). Self-rating, which is economical and practical, is widely used for survey and screening procedures, especially for slight diseases such as anxiety (Maier et al., 1990). The problem is the self-awareness of the patients may not reflect reality. It's hard to complete for some patients lack of reading ability (Hamilton, 1976). While professional evaluation is a comprehensive evaluation to the symptoms of the patients by clinically trained professionals with experience, which is still the golden standard for mental disorder diagnosis (Dunstan et al., 2017).

The self-rating anxiety scale (SAS) and self-rating depression scale (SDS) of Zung are the widely used for anxiety and depression evaluation (Zung, 1965, 1971; Möller, 2000). The Hamilton Anxiety (HAMA) and the Hamilton Depression (HAMD) rating scales are commonly used in evaluating anxiety and depression (Hamilton, 1959, 1960). They are the golden standard in the depression evaluation (Bagby et al., 2004). During the COVID-19 pandemic, it was widely used to investigate the psychological status of the different population (Li et al., 2020b).

Most of the researches on the psychological evaluation of patients with COVID-19 used self-rating scales (Guo et al., 2020), and the application of the professional evaluations is rare. Besides, the rare research has reported the difference between self-rating and professional evaluation in the patients with COVID-19. This study conducted that both self-rating and professional evaluation in COVID-19 cluster cases, and compared the results obtained by these two methods.

A total of 65 patients participated in this study, and 58 patients had finished both the self-rating and the professional evaluation.

The self-rating is inconsistent with the professional evaluation as Figure 1 shows Kappa Consistence.

By introducing the concept of gap, this study discussed the discrepancy between self-rating and professional evaluation in the COVID-19 cluster cases for the first time. It showed that SAS and SDS scores in the same dimension were significantly higher than the HAMA and HAMD, indicating that there were significant differences between the self-rating and the professional evaluation. This was consistent with the previous reports (Rush et al., 1987; Enns et al., 2014; Krebber et al., 2014; Lim et al., 2018).

Moreover, the male subgroup and the subgroup with higher income had higher self-rating scores in the mental anxiety dimension, which might be due to the fact that they assume more family and social responsibilities, so that they were more likely to worry about the impact of illness on themselves, family life, and the career. Notably, as compared with the indirect contact with Xinfadi, where COVID-19 broke out, the patients with direct contact had higher self-rating of the somatic anxiety, who might be more in need of the attention of doctors (Troyer et al., 2020), which is possibly because the cluster disease increased their feelings of fear and guilt to some extent.

In terms of depression, patients who were non-insured were more likely to have higher self-rating of anxiety/somatic status, which might be due to their fear of bearing high-medical costs. The patients without a history of physical disease had a higher self-rating of cognitive, which might be due to the greater psychological burden of the hospitalization because they had not been hit by the disease. Compared with the patients who were divorced and widowed, the patients who were unmarried and married had higher self-rating of retardation, which might be due to their concern about the impact on their relationship or the family life. The patients with higher education level had higher self-rating of cognitive and desperation status. It was probably because the patients with better education background had better reading ability and could complete the questionnaire accurately, and also knew more about COVID-19 and understood the risk of novel coronavirus infection, which increased their depression mood. The patients with the higher income made a higher self-rating of desperation and diurnal variation, which might be caused by the fear of the disease affecting career and work, and the inability to maintain the current income level. It seemed incomprehensible that the patients without a history of depression tend to have a higher self-rating of sleeping disorder. The patients with a history of depression were able to make a more objective self-rating when they developed insomnia symptoms after being infected with the SARS-CoV-2, which was probably because they had severe insomnia before, and in particular, they had filled the similar rating scales often ever before.

Those differences may be associated with the personality and demography of the patients, which is consistent with the previous studies (Enns et al., 2014). So, when planning to assess the mental health of the patients with COVID-19 by self-rating, it is necessary to pay attention to the age, gender, work status, monthly, education level, employment status, medical history, and infection way of the patients. There may be an unobjective evaluation. For instance, the scores of the two dimensions of anxiety self-rating were both higher than those of the professional evaluation, but the patients with anxiety were not found according to the anxiety self-rating standard, which was not in accordance with the actual situation. We supposed that the SAS diagnostic threshold may need to be adjusted or improved the self-rating questionnaire when used.

Therefore, in the clinical practice, we suggest that screening can be conducted by self-rating first, then the professional evaluation should be carried for the patients with suspicious or positive results, so as to reduce unnecessary contact with the patients and the workload of the medical workers (de Vroege and van den Broek, 2021).

The limitations are the limited number of cases included in the study and the lack of a control group. Fortunately, the included cases were cluster cases, all from Xinfadi where COVID-19 broke, with relatively consistent background and mild condition. As a result those cases are highly homogeneous. It, to some extent, proves something. However, whether self-rating can accurately and effectively assess mental status of the patients and the reasons for the difference between the self-rating and professional evaluation will likely require the closer examination.

The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author/s.

The studies involving human participants were reviewed and approved by the Ethics Committee of Beijing Ditan Hospital affiliated to Capital Medical University. The patients/participants provided their written informed consent to participate in this study.

RS developed the ideas in the paper and provided feedback on several drafts of the paper. LL collected the data of demographic and self-rating, and wrote the paper. XW and JY evaluated the patients by HAMA and HAMD. YH conducted statistical analysis of the data in this study. DY, XD, GF, BH, CJ, JL, YL, and YW introduced the study to the patients and obtain their consent. All authors contributed to the article and approved the submitted version.

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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