In March 2020, the World Health Organization (WHO) announced coronavirus disease (COVID-19) to be a pandemic (1). Globally, to date (January 4, 2022), this destructive pandemic has spread rapidly across 226 countries/regions, and 296,496,809 confirmed cases of COVID-19 have been reported to the WHO (2). To contain this global outbreak, the Chinese government adopted a series of strict and effective public health measures, such as encouraging people to wear protective masks, self-isolation, and the cancellation of mass gatherings (3). At present, the epidemic situation in China has now largely been brought under control, and epidemic prevention and control have become the norm (4). However, there are still sporadic cases that occur in some places in China, and a higher risk of infection and stricter isolation measures were borne by the people in these areas. Due to the spread of the COVID-19 sporadic epidemic, parts of Harbin Municipality have been defined as high-risk areas of the epidemic since September 25, 2021. There was no doubt that it would seriously affect the local people's mental health and quality of life (3).

Clinicians are at the core of epidemic preparedness and control in high-risk areas during periods of sporadic epidemic situations. In contrast to the general population, front-line clinicians may have greater psychological stress in high-risk areas during the COVID-19 sporadic epidemic. Multiple past studies have demonstrated that during the Severe Acute Respiratory Syndrome (SARS), Influenza A (H1N1), and Middle East Respiratory Syndrome (MERS) outbreaks, front-line medical staff were at higher risk of psychological problems, including but not limited to anxiety, depression, and posttraumatic stress disorder (PTSD) (5–11). They are predisposed to high workloads, unpredictable work patterns, and a higher risk of infection (12–16). In addition, clinicians are easily ostracized by people around them after work because the general population easily misunderstands that clinicians are especially susceptible to carrying the virus when returning home (14). Clinicians may also be worried about becoming infected or infecting their families (14). Stress from these various sources will increase the risk for depression or anxiety if it cannot be effectively allayed (15, 17). Moreover, previous studies have shown that compared with older clinicians, young clinicians' lack of practical experience and confidence in clinical management may lead to insufficient resilience to deal with psychological problems and more serious emotional exhaustion (18, 19). Therefore, mental health conditions such as depression and anxiety may be worse among young front-line clinician populations than among senior clinician populations (20–22). In addition, the term “quality of life” (QOL) is the subjective perception of wellbeing and wholeness (23). Due to the lack of evidence-based practice related to sporadic epidemic management, even less is known about the factors that worsen or improve QOL. A study has shown that young people may have poorer QOL relative to older people during the COVID-19 epidemic (24). The mental health status and QOL of young front-line clinicians should receive more attention, so we chose this group as the main study population. Although many research articles on the psychological status and QOL of clinicians have been published during the epidemic (25–30), there has been no study on young front-line clinicians during the COVID-19 sporadic epidemic in high-risk areas.

Currently, there is a need for testimony of mental health problems during the sporadic epidemic situation to identify those at high risk and to investigate the related psychological factors and social resources that can alleviate this threat. Therefore, we carried out this study to examine depression, anxiety, QOL, and related social psychological factors among young front-line clinicians in high-risk areas during the COVID-19 sporadic epidemic in China.

To our knowledge, this is the first survey on the mental health status of young front-line clinicians in high-risk areas during the COVID-19 sporadic epidemic. In this study, we found that the prevalence rates of depression and anxiety among young clinicians were 37.7 and 26.0%, respectively. A study on the psychological status of Chinese adults during the epidemic showed that the prevalence of anxiety and depression in the general population was 7.6 and 11.3%, respectively (3). The different prevalence rates may be related to the higher risk of infection, unpredictable work patterns, and the high psychological stress of clinicians in high-risk areas during the epidemic. In addition, isolation measures lead to the absence of interpersonal communication. If anxiety and depression are more likely to occur, they worsen in the absence of interpersonal communication (45). Another meta-analysis showed that the prevalence of anxiety and depression among clinicians was 21.73 and 25.37%, respectively, during the epidemic (46). The high prevalence of anxiety and depression among young clinicians could be attributed to them having more anxiety characteristics, more difficulty relaxing, and more difficulty adapting to changes than older clinicians (20, 21). Young people show lower levels of wellbeing and optimism than older people, which may also be a risk factor for their vulnerability to anxiety and depression (22).

Our study showed a significant correlation between depression and anxiety (P < 0.01). The connection between depression and anxiety is duplex; anxiety can lead to depression, and vice versa (47, 48). This may be related to the decrease in the anterior regions of the default mode network and the increased connectivity in the posterior regions (49). Previous studies have shown that anxiety-depression comorbidity was highly prevalent during the SARS pandemic (50). In this study, the comorbidity rate of depression and anxiety disorder was 23.97%. Because of the similar pathogenesis underlying depression and anxiety (51), we speculate that anxiety-depression comorbidity may be the result of the COVID-19 sporadic epidemic in terms of mental illness.

Insomnia is more severe in individuals with depression or anxiety. According to relevant studies, insomnia can damage emotional regulation and increase the risk of depression or anxiety (52–54). However, the relationship between insomnia and depression or anxiety may be bidirectional (52). Many studies point out that depression or anxiety can reduce the quality of sleep, leading to insomnia (17, 55, 56). Serotonergic and dopaminergic dysfunctions may be the common underlying mechanism of insomnia and mental disorders (57). In addition, depression, anxiety, and insomnia may also have a common genetic basis (58). Interestingly, no correlation was found between anxiety-depression comorbidity and insomnia in this study. This is different from the results of previous studies (47, 58). The differences may be due to the use of different survey tools or different study populations. However, this was only a preliminary result that needs further confirmation from additional studies. Faced with the sporadic epidemic, the working hours and labor intensity of clinicians in high-risk areas have increased, leading to insufficient rest time and psychological distress. In conclusion, COVID-19 plays an important role in triggering or aggravating mental health conditions such as depression, anxiety, and insomnia.

Our study showed that stress is a risk factor for anxiety and/or depression. This is consistent with the findings of previous studies (59). Therefore, to promote the mental health of clinicians, it is necessary to develop personalized intervention measures to reduce stress during the COVID-19 sporadic epidemic.

Our study showed that QOL was determined by the interaction between protective factors (e.g., the belief that the vaccine could provide protection) and risk factors (e.g., severe insomnia and stress conditions). Adequate sleep and reasonable stress relief are considered indispensable elements of health, general wellbeing, and proper daily functioning. Stress and insomnia might reduce clinicians' QOL by leading to cognitive dysfunction (60), physical discomfort (61), and job burnout (62). Further studies on the sleep patterns and stress management strategies of young front-line clinicians in high-risk areas are needed to develop strategies to prevent or alleviate problems and improve the QOL.

Currently, the absence of proven treatments for COVID-19 has led the world's population to pin their hopes for vaccines (63). After the outbreak of the epidemic, the Chinese government urgently developed a vaccine, and the Chinese population reflected the strong demand and high acceptance of the importance of COVID-19 vaccines (64). A global survey of potential acceptance of the COVID-19 vaccine showed that Chinese people's acceptance of the vaccine was nearly 90% (64). Our study showed that young front-line clinicians in high-risk areas who thought that the vaccine could stop the global epidemic were less prone to anxiety and anxiety-depression comorbidity. Raising confidence in and awareness of vaccines may help address the mental health problems of young front-line clinicians in high-risk areas. Although our sample comprised young front-line clinicians, not all clinicians work in infectious diseases departments, and some have relatively poor knowledge of vaccines. The dissemination of misinformation could have a significant impact on confidence in the COVID-19 vaccine, further exacerbating mental health problems among the young front-line clinician population (65, 66). Therefore, national and local regulatory authorities need to conduct health education and outreach through authoritative sources to carefully explain the effectiveness of the vaccine, the duration of the antibody, and the importance of achieving group immunity. This increases confidence that the COVID-19 vaccine will end the global epidemic, reduce the prevalence of anxiety and/or anxiety-depression comorbidity, and effectively alleviate specific concerns or misconceptions in high-risk areas.

Our study has several limitations. First, due to the cross-sectional study design, it was difficult to make a causal inference. Second, the sample size of this study was limited, and single-area studies may have limited applicability and generalizability to clinicians in other high-risk areas. Third, due to the sudden occurrence of the COVID-19 disaster, we were unable to assess the psychological status of the respondents before the sporadic epidemic. Fourth, depression, anxiety levels, and other related factors, such as sleep disturbance and stress levels, were measured by self-report questionnaires, without objective indicators of related factors in this study. Finally, social support plays a pivotal role in reducing the likelihood of psychological impact and QOL (67), but it was not evaluated in this study.

We identified the main mental health problems of young front-line clinicians in high-risk areas during the COVID-19 sporadic epidemic in China. Depression, anxiety, anxiety-depression comorbidity, and QOL were associated with many factors, including insomnia, stress, and a portion of attitudes toward the COVID-19 vaccine. Due to the reasonable epidemic prevention and control measures and popularization of vaccination taken by the Chinese government, there has been no recent large-scale outbreak of the epidemic in China. The sporadic epidemic may become the most important problem for the prevention and control of the epidemic in the future. Therefore, establishing early targeted mental health interventions for young clinicians in high-risk areas during the COVID-19 sporadic epidemic situation should be part of global preparedness efforts.

The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.

XS and YZha contributed to the study design, analyzed the data, and wrote this manuscript. QL and YZhu did the online survey, data collection, and logical check. GZ, YL, and JZ revised the manuscript. All authors reviewed and approved the manuscript.

This work was funded by Natural Science Foundation of Shandong Province (ZR2017 LH036) and Key R & D Projects of Jining City: Psychological Rescue Mode for COVID-19 Pneumonia (2021YXNS078).

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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