More than half of participant surveyed in the immediate aftermath of the coronavirus outbreak in China reported a moderate to severe psychological impact, according to new research published in the International Journal of Environmental Research and Public Health.

The recently published study also identified several factors that were associated with the outbreak’s psychological impact on the general population.

In December 2019, an outbreak of respiratory illness caused by the novel coronavirus was identified in Wuhan, Hubei Province, China. After a sharp increase in the number of suspected COVID-19 cases, a mandatory quarantine went into effect on January 23, 2020.

The researchers conducted an online survey of 1,210 respondents from 194 cities in China from January 31 to February 2. The survey incorporated the Impact of Event Scale, a questionnaire that assesses the psychological response to a specific traumatic event and measures avoidance, intrusion, and hyperarousal. The survey also included assessments of stress, depressive symptoms, anxiety, and several other factors.

The researchers found that 53.8% of the participants rated the psychological impact of the outbreak as moderate or severe. In addition, 16.5% reported moderate to severe depressive symptoms and 28.8% reported moderate to severe anxiety symptoms.

Poor self-rated health status, a history of chronic illness, and dissatisfaction with the amount of health information available about COVID-19 were all linked to a greater psychological impact.

“The content of health information provided during the epidemic needs to be based on evidence to avoid adverse psychological reactions. Our results showed that up-to-date and accurate health information, especially on the number of recovered individuals, was associated with lower stress levels,” the researchers said.

Unsurprisingly, participants who had no confidence in their own doctor’s ability to diagnose or recognize COVID-19 were also significantly more likely to report higher levels of stress, anxiety, and depression.

The researchers also found that female participants were more likely than males to suffer a greater psychological impact as well as report higher levels of stress, anxiety, and depression.

More than half the participants reported taking precautionary measures to prevent the spread of COVID-19, and these actions were associated with a reduced psychological impact.

“Specific precautionary measures including avoidance of sharing utensils (e.g., chopsticks), hand hygiene, and wearing masks regardless of the presence or absence of symptoms were associated with lower levels of psychological impact, depression, anxiety, and stress,” the researchers wrote, adding that the behaviors may provide “confidence and sense of control in prevention.”

The study, “Immediate Psychological Responses and Associated Factors during the Initial Stage of the 2019 Coronavirus Disease (COVID-19) Epidemic among the General Population in China“, was authored by Cuiyan Wang, Riyu Pan, Xiaoyang Wan, Yilin Tan, Linkang Xu, Cyrus S. Ho, and Roger C. Ho.