Psychological Reactions of Healthcare Workers Deployed to Wuhan from Shanxi Province and How They Cope During the COVID-19 Outbreak

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Psychological Reactions of Healthcare Workers Deployed to Wuhan from Shanxi Province and How They Cope During the COVID-19 Outbreak

When COVID-19 exploded in Wuhan in early 2020, thousands of healthcare workers (HCWs) from across China volunteered to travel to the epicenter. For many, this was their first time confronting a crisis of such magnitude—and the mental strain was unavoidable. A 2021 study by Li-Na Dong and colleagues from Shanxi Provincial People’s Hospital and affiliated institutions explored the emotional challenges faced by HCWs from Shanxi Province deployed to Wuhan, along with the strategies they used to cope.

The Study: Who and How

The research ran from January 26 to February 20, 2020, as Shanxi’s HCWs were deployed to care for COVID-19 patients in Hubei. A total of 500 HCWs completed questionnaires, with 456 responses valid for analysis. The survey covered four areas:

  1. Demographics: Age, sex, marital status.
  2. Emotional state: Measured using the Depression Anxiety Stress Scale (DASS), a validated tool that scores feelings of depression, anxiety, and stress on a 0–3 scale (from “not at all” to “most of the time”).
  3. Stress sources: 20 items grouped into three categories—epidemic-related (fear of infection, PPE shortages), social (communication barriers, family concerns), and work capacity (inexperience, intense workload).
  4. Coping methods: Five domains, including professional training, hobbies, peer communication, social support, and relaxation.

Key Emotional Challenges

The average age of participants was 37.1 years, and 68% were nurses—the group closest to patients and often with the highest exposure risk. Anxiety was the most common emotional struggle:

  • 34.6% reported anxiety (19.7% mild, 10.5% moderate, 4.4% severe/extremely severe).
  • 21.5% experienced stress, and 20.2% had depression.
  • Insomnia plagued 30.7%—a common sign of unmanaged stress.

What Drove Stress?

HCWs’ biggest worries tied directly to the unique pressures of COVID-19:

  1. Fear of contagion: 79.4% worried about getting sick—understandable given the virus’s novelty and transmissibility.
  2. Protective equipment issues: 57.5% said PPE (like full-body suits and masks) interfered with providing quality care, while 54.4% feared running out of supplies.
  3. Inexperience: Nearly half (49.6%) felt unprepared to treat a disease they’d never encountered before.
  4. Communication barriers: 42.5% struggled to connect with patients—often due to masks muffling speech or language differences.

These factors weren’t just “feelings”—they were statistically linked to higher anxiety, stress, and depression scores. For example, HCWs who arrived later in Wuhan (when the crisis was peaking) reported more stress than those who came earlier, likely due to increased pressure and less time to adapt.

How HCWs Coped

When asked what helped, HCWs prioritized practical support and peer connection:

  • Sufficient rest/time off: 86% said this was the most effective stress reliever—critical given 12+ hour shifts.
  • Adequate sleep: 83.3% relied on sleep to recharge.
  • Talking to fellow Shanxi HCWs: 83.8% found comfort in bonding with colleagues who shared their experience (more so than chatting with family or friends).
  • Social encouragement: 77.2% felt uplifted by public praise—reminding them their work mattered.
  • Skills training: 75.4% said hands-on training (not just textbook knowledge) boosted their confidence and reduced stress.

Why Experience and Training Mattered

Two key findings stood out:

  1. Nurses vs. doctors: Nurses reported more stress than doctors—a trend seen in past outbreaks like SARS. The reason? Nurses have more direct, prolonged contact with patients, increasing both infection risk and emotional labor.
  2. Prior emergency experience: HCWs who’d worked in crises before had lower anxiety and depression scores. Similarly, those with public health training were less likely to feel depressed. This suggests pre-deployment training—especially for emergency response—could be a game-changer for mental health.

Putting It All Together

The study aligns with global research: During COVID-19, HCWs faced a “double blow” of physical exhaustion and psychological pressure. What made this crisis unique? The scale of the outbreak, shortages of critical supplies, and the sheer novelty of COVID-19—all of which amplified feelings of helplessness.

But the findings also offer hope: Actionable support works. Skills training (not just lectures) helped HCWs feel competent. Peer communication reduced isolation. Rest and sleep gave them the energy to keep going.

What This Means for Future Crises

Dong and colleagues’ research highlights a gap: In 2020, China had no formal psychological support plans for HCWs deployed to crisis zones. Yet studies from other countries (like one on SARS in Hong Kong) show that pre-deployment counseling and ongoing mental health checks can reduce long-term distress.

For healthcare systems, the takeaway is clear: To protect HCWs, invest in emergency preparedness training (so they feel ready) and peer support networks (so they don’t feel alone). And for the public? Recognize that even heroes need rest—and a little praise goes a long way.

The original study was published in the Chinese Medical Journal in 2021 by Li-Na Dong, Ya-Li Zhao, Yi Liu, Yu-Zhi Wu, and Jun-Ping Wang—all affiliated with Shanxi Provincial People’s Hospital and related institutions.

doi:10.1097/CM9.0000000000001201

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