Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
, 17 (5)

Immediate Psychological Responses and Associated Factors During the Initial Stage of the 2019 Coronavirus Disease (COVID-19) Epidemic Among the General Population in China


Immediate Psychological Responses and Associated Factors During the Initial Stage of the 2019 Coronavirus Disease (COVID-19) Epidemic Among the General Population in China

Cuiyan Wang et al. Int J Environ Res Public Health.


Background: The 2019 coronavirus disease (COVID-19) epidemic is a public health emergency of international concern and poses a challenge to psychological resilience. Research data are needed to develop evidence-driven strategies to reduce adverse psychological impacts and psychiatric symptoms during the epidemic. The aim of this study was to survey the general public in China to better understand their levels of psychological impact, anxiety, depression, and stress during the initial stage of the COVID-19 outbreak. The data will be used for future reference. Methods: From 31 January to 2 February 2020, we conducted an online survey using snowball sampling techniques. The online survey collected information on demographic data, physical symptoms in the past 14 days, contact history with COVID-19, knowledge and concerns about COVID-19, precautionary measures against COVID-19, and additional information required with respect to COVID-19. Psychological impact was assessed by the Impact of Event Scale-Revised (IES-R), and mental health status was assessed by the Depression, Anxiety and Stress Scale (DASS-21). Results: This study included 1210 respondents from 194 cities in China. In total, 53.8% of respondents rated the psychological impact of the outbreak as moderate or severe; 16.5% reported moderate to severe depressive symptoms; 28.8% reported moderate to severe anxiety symptoms; and 8.1% reported moderate to severe stress levels. Most respondents spent 20-24 h per day at home (84.7%); were worried about their family members contracting COVID-19 (75.2%); and were satisfied with the amount of health information available (75.1%). Female gender, student status, specific physical symptoms (e.g., myalgia, dizziness, coryza), and poor self-rated health status were significantly associated with a greater psychological impact of the outbreak and higher levels of stress, anxiety, and depression (p < 0.05). Specific up-to-date and accurate health information (e.g., treatment, local outbreak situation) and particular precautionary measures (e.g., hand hygiene, wearing a mask) were associated with a lower psychological impact of the outbreak and lower levels of stress, anxiety, and depression (p < 0.05). Conclusions: During the initial phase of the COVID-19 outbreak in China, more than half of the respondents rated the psychological impact as moderate-to-severe, and about one-third reported moderate-to-severe anxiety. Our findings identify factors associated with a lower level of psychological impact and better mental health status that can be used to formulate psychological interventions to improve the mental health of vulnerable groups during the COVID-19 epidemic.

Keywords: anxiety; coronavirus; depression; epidemic; knowledge; precaution; psychological impact; respiratory symptoms; stress.

Conflict of interest statement

The authors declare no conflict of interest.


Figure 1
Figure 1
National epidemic trend of the 2019 coronavirus disease (COVID-19) outbreak in China from 7 January to 2 February 2020.

Similar articles

See all similar articles


    1. Wang C. A novel coronavirus outbreak of global health concern. Lancet. 2020;395:470–473. doi: 10.1016/S0140-6736(20)30185-9. - DOI - PubMed
    1. Hawryluck L. SARS control and psychological effects of quarantine, Toronto, Canada. Emerg. Infect. Dis. 2004;10:1206–1212. doi: 10.3201/eid1007.030703. - DOI - PMC - PubMed
    1. Nishiura H. The Extent of Transmission of Novel Coronavirus in Wuhan, China, 2020. J. Clin. Med. 2020;9:330 doi: 10.3390/jcm9020330. - DOI - PMC - PubMed
    1. Mahase E. China coronavirus: WHO declares international emergency as death toll exceeds 200. BMJ Clin. Res. Ed. 2020;368:m408. doi: 10.1136/bmj.m408. - DOI - PubMed
    1. Paules C.I., Marston H.D., Fauci A.S. Coronavirus Infections-More Than Just the Common Cold. JAMA. 2020 doi: 10.1001/jama.2020.0757. - DOI - PubMed

MeSH terms

Supplementary concepts