From February 6th to March 16th, 2020, a group of people worked at the Xiangyang Central Hospital, the Affiliated Hospital of the Hubei University of Arts and Science in Xiangyang, China.

With an average daily outpatient reception capacity of 6,500 and a medical staff of 4,000, Xiangyang Central Hospital is one of the largest grade-A hospitals in the Northwest Hubei province.

During the COVID-19 pandemic, a random online sampling survey was conducted among the staff of Xiangyang Central Hospital to collect the psychological stress response of medical staff. 2,000 questionnaires were distributed, with 1,466 effective questionnaires recovered at a 73.3% recovery rate. All participants volunteered to participate.

The ethics committees of Xiangyang Central Hospital, the Affiliated Hospital of the Hubei University of Arts and Science in Xiangyang, China, approved the study. Before any study-related procedure, all participants were informed about the investigational nature of the study, the use of their data, and the signed informed consent form.

All subjects were questioned and tested in an anonymous online personal interview.

The online questionnaire survey method was used, and questionnaires were distributed to hospital staff anonymously by scanning Quick-Response codes from the questionnaire star platform.¹ The PQEEPH comprises 25 items divided into five dimensions: depression, neurasthenia, fear, obsessive anxiety, and hypochondria (Huang et al., 2021). The score is determined by the degree of emotional response (none, mild, moderate, and severe). The dimension score is calculated by dividing the total score for each dimension by the number of items. The theoretical maximum and minimum scores are 3 and 0, respectively. The higher a dimension’s score, the more severe the emotional reaction of the subjects on that dimension.

(1) Investigators training: The Xiangyang Central Hospital trained neurologists to ensure the consistency and accuracy of the questionnaire. (2) To ensure the authenticity and accuracy of the questionnaire, trained inspectors distributed it online to 2,000 medical workers in the hospital. (3) One-to-one coaching for medical staff who have any questions about filling out the questionnaire, to minimize errors.

Comparison of multiple groups of general data: for measurement data, a one-way ANOVA was used, and for multiple rate comparison and statistical hypothesis of count data, Joint Hypotheses Test (f-test), or Statistical Hypothesis Test was used. For confidence and significance level, the Student’s t-Test (t-test) was used to compare the measurement data (both agreed with the normal distribution), the SNK-Q test for pair comparison, and the rank-sum test for non-normal distribution. SPSS 22.0 and Origin 2019b software were used to statistically process all data, and p < 0.05 was considered statistically significant. Each value represents the mean of four replicates ± standard deviation (SD).

There were 263 (17.9%) males and 1,203 (82.1%) females among the 1,466 subjects. Age statistics: 1,015 (69.2%, young) were ≤ 44 years old, while 451 (30.8%, middle-aged) were > 44 years old. Education: 314 (21.4%) had a junior college degree or less, 840 (57.3%) had a bachelor degree, and 312 (21.3%) had a master’s degree or higher. There were 396 doctors (27.0%), 854 nurses (58.3%), 173 technicians (11.8%), and 43 administrative personnel (2.9%). COVID-19 patients’ contact history: 885 (60.4%) had no contact history, while 581 (39.6%) had contact history. Their COVID-19 infection status was as follows: 1,440 non-COVID-19 patients (98.2%) and 26 COVID-19 patients (1.8%). Departments: 174 (11.9%) in the fever outpatient department and fever ward, 119 (8.1%) in the emergency center and ED (emergency department), 448 (30.6%) in the clinical medical department, 448 (30.5%) in the internal medicine department and ward, 234 (16.0%) in the surgical department and ward, and 43 (2.9%) in the administrative department.

Figure 1 depicts the incidence of the five dimensions of the subjects, where 0 indicated emotional stress did not affect them and ≥ 1 indicated emotional stress affected them. In 1,466 subjects, the incidence of five dimensions were depression 807, accounting for 55%, neurasthenia 397, accounting for 26.7%, fear 1,392, accounting for 95%, obsessive anxiety 702, 47.9%, and hypochondria 1,016, accounting for 69%.

Depression and hypochondria were significantly different in gender (p < 0.05), with female medical workers scoring 2.82 ± 2.42, slightly higher than males scoring 1.81 ± 2.53. Female medical workers scored 1.35 ± 1.26, slightly higher than males scoring 1.21 ± 1.26. We found women to be more susceptible to depression, hypochondria, and other stress responses than men. In terms of age, there was no significant difference between the two groups of age ≤ 40 and > 40 but at 40 (p > 0.05; Table 1).

Besides obsessive anxiety, there were significant differences in the four dimensions of depression, neurasthenia, fear, and hypochondriasis between the infected and non-infected persons (p < 0.05). The scores of the infected in all five dimensions were higher than those of the uninfected persons (Table 2), indicating that the emotional stress response of COVID-19 infected persons was stronger than that of healthy persons.

In terms of contact history (Table 2), there were significant differences in the five dimensions between the two groups (p < 0.05). The scores for depression without contact history were 1.59 ± 2.30, while the scores for contact history were 2.15 ± 2.59, the scores for obsessive anxiety without contact history were 1.06 ± 1.82, and the score of contact history was 1.75 ± 2.42, the difference was extremely significant (p < 0.01). This demonstrated that exposure to novel coronavirus-infected patients adversely affected every aspect of the psychological and emotional health of medical personnel.

The results of the F-test for different educational levels showed that there was no significant difference between the bachelor group and the postgraduate or above group (p > 0.05), but there were differences in all five dimensions compared with the college or below group (p < 0.05), and the higher the educational level, the stronger the emotional stress response (Table 3). There were extremely significant differences between the two dimensions of neurasthenia and obsessive anxiety (p < 0.01).

An F-test of medical staff members in various positions revealed that the doctor and nurse groups significantly outperformed the technician and administration groups in five dimensions (p < 0.05), with an extremely significant difference in obsessive anxiety (p < 0.01; Table 3).

Depression, neurasthenia, and hypochondria were significantly different between departments (p < 0.05). The clinical medical department and fever outpatient department had the highest depression dimension scores, with 2.12 ± 2.40 and 2.04 ± 2.69, respectively. The highest scores in the neurasthenia dimension were obtained by the emergency department and the internal medicine department, which were 2.96 ± 2.81 and 2.87 ± 2.91, respectively. The fever outpatient department and the internal medicine department had the highest hypochondriasis dimension scores, with 1.43 ± 1.36 and 1.41 ± 1.23 points, respectively (Table 4).

In this study, female medical workers’ emotional stress reaction was higher than males’; because nurses are mostly female (854 nurses, including 22 males and 832 females). The study also discovered that nurses with various jobs showed significant differences in the five dimensions of emotional stress reaction, with many recent studies on psychological research showing that nurses during the outbreak reported similar findings (Abdulah et al., 2021; Walecka et al., 2021). The first reason is that the outbreak is sudden and highly infectious, and many infected clinical nurses are under great psychological pressure. Secondly, because most nurses had not participated in systematic disaster emergency training or public health emergencies, they lacked experience dealing with unexpected infectious diseases. Thirdly, nurses have extensive contact with patients as well as a heavy workload and pressure. Many medical procedures, such as venous blood collection, infusion, vital sign monitoring, and so on, necessitate close contact between nurses and patients; even minor errors can cause infection (Ottum et al., 2013). The inconvenience of wearing protective clothing (such as airtight, blurred vision, and inflexible hands after wearing gloves) caused heavy difficulties for the actual operation of nurses during the COVID-19 lockdown period.

In this study, 26 medical workers were diagnosed with COVID-19, and the intensity of their emotional stress response was greater than that of healthy medical workers. There were significant differences between the two groups in depression, fear, and hypochondria (p < 0.05). The intensity of the five dimensions of emotional stress response was higher in medical workers with a history of contact with infected people than in medical workers without a history of contact (p < 0.05). The following were the primary causes of the psychological stress reaction: (1) Novel Coronavirus hypochondriasis is a psychological condition caused by other disease symptoms, as well as a suspicion that the current symptoms of physical discomfort are caused by the novel Coronavirus. (2) Since the outbreak of the epidemic, the number of infected people across the country has risen sharply because of environmental factors, the maximum emergency response mechanism has been activated, and the entire nation has entered a state of war readiness. People who have been infected with the virus must be isolated for treatment, and anyone who has had contact with them (including family members, friends, and even strangers) must be sent to isolation sites regardless of clinical symptoms. Medical personnel were prone to anxiety and fear in such an environment. (3) In the early stages of the epidemic, a lack of understanding of the virus, as well as unreliable public opinion information and rumors, exacerbated several psychological issues, such as sensitivity, suspicion, and fear of clinical workers (Mohammed, 2021; Tindle et al., 2022).

During the SARS epidemic, some researchers studied the mental health of medical staff and discovered that there were significant differences in depression and anxiety among the medical staff in different departments (Moeller et al., 2021; Onchonga et al., 2021). Medical staff in high-risk environments had poorer mental health than those in low-risk environments, and they were nervous and lacked coping skills (Engelbrecht et al., 2021; Tolksdorf et al., 2022). The emotional stress response of medical staff in direct contact with COVID-19 patients, such as fever outpatient and ward, medical technology department (CT room, laboratory department), and emergency department, was found to be more significant than in general medicine, surgery, and functional departments (p < 0.05), according to this study. The following are some explanations: (1) At the beginning of the epidemic, many patients flooded into Xiangyang’s emergency department and fever clinic. To assist, the hospital mobilized much medical personnel from the department of non-respiratory and infectious diseases. It was natural to be nervous when meeting critically ill patients because of a lack of experience. Even experienced doctors and nurses can feel helpless in the face of death. The medical staff has seen many such tragic scenes, and psychological overload will appear on the face of the death of patients without relatives to see them off (Sun et al., 2020; Omolola et al., 2021; Tolksdorf et al., 2022). The term vicarious trauma (VT) refers to witnessing many cruel and destructive scenes, the impact of which exceeds some people’s psychological and emotional tolerance, resulting in a variety of psychological abnormalities. These abnormal phenomena, usually motivated by sympathy and empathy for the survivors and their trauma, cause serious physical and mental distress if not complete mental breakdown. According to studies, vicarious trauma is caused primarily by the personal factors of rescuers and specific environmental factors (Fernandes et al., 2021; Lankarani et al., 2021). (2) The fever clinic and ward are in different departments of the hospital, and the interaction between medical staff requires mutual understanding, support, and tolerance. Different working styles, team cultures, interpersonal pressure, and medical personnel will all cause physical and mental problems.

Based on the experience of previous SARS or Ebola outbreaks (Jefferies et al., 2020; Keshvardoost et al., 2020), and in light of the COVID-19 pandemic, the following suggestions were made to improve the psychological condition of medical staff: (1) To reduce the risk of novel coronavirus infection, hospitals can improve infection control knowledge training for medical staff and develop relevant management procedures and emergency plans. (2) Make human resource allocation and protective material scheduling more scientific and reasonable to ensure the orderly development of logistics work and reduce clinical medical workers’ psychological stress. (3) Improve medical staff’s sense of vocation and belonging through humanistic care and encouragement. (4) Understand the psychological dynamics of medical workers on time, focus on physical and mental health, and open online and offline psychological clinics for consultation and counseling regularly. (5) Update epidemic information, reduce medical staff panic, and alleviate psychological fear and anxiety.

This study has some limitations due to the online random sampling survey of medical staff. Despite the ongoing COVID-19 pandemic, future research would continue to focus on the mental health of medical staff in hospitals and expand the scope of investigations to conduct face-to-face research.