A nationwide survey of psychological distress among Chinese people in the COVID‐19 epidemic: implications and policy recommendations

A nationwide survey of psychological distress among Chinese people in the COVID‐19 epidemic: implications and policy recommendations Jianyin Qiu Bin Shen Min Zhao Zhen Wang Bin Xie Yifeng Xu

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A nationwide survey of psychological distress among Chinese people in the COVID‐19 epidemic: implications and policy recommendations 2020 General Psychiatry 10.1136/gpsych-2020-100213 qiu2020-a-nationwide-survey-of-psychologic qiu2020-a-nationwide-survey-of-psychologic.txt, the project's staged copy 9f60b3b590a4bd3793dc5a48e2c3362248bfe4ef cc-by-nc health-psychology

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0 spans located by searching the stored text for the quote's exact words, allowing any whitespace between them peritraumatic psychological distress in the Chinese general population during the first weeks of the COVID-19 epidemic - measured by an index built for the occasion Quotation withheld because this record is not cleared for redistribution. how prevalent and how severe the distress was, and which groups carried most of it Quotation withheld because this record is not cleared for redistribution. the first nationwide distress survey of the epidemic, 52,730 responses, and a new instrument - the COVID-19 Peritraumatic Distress Index Quotation withheld because this record is not cleared for redistribution. existence Quotation withheld because this record is not cleared for redistribution. a population-scale distress signal during a quarantine, varying by sex, age, education, occupation and region Quotation withheld because this record is not cleared for redistribution. survey survey Quotation withheld because this record is not cleared for redistribution. the explanations offered are all social rather than clinical - information exposure for the young, morbidity risk for the elderly, transport and lost income for migrant workers, health self-awareness for the educated - and every one is hedged in the authors' own words Quotation withheld because this record is not cleared for redistribution. the decline over time is attributed to the government's control measures, alongside the observation that the lowest point fell on a festival - two candidate causes for one curve, neither separated from the other Quotation withheld because this record is not cleared for redistribution. THE INSTRUMENT DID NOT EXIST BEFORE THE SURVEY. The CPDI was `DESIGNED` for this epidemic and fielded from `31 January 2020, the day when the WHO announced` the PHEIC - built, validated and deployed inside the window it measures Quotation withheld because this record is not cleared for redistribution. AND ITS CUT-OFFS ARE ASSERTED RATHER THAN DERIVED: `A score between 28 and 51 indicates mild to moderate distress. A SCORE >= 52 INDICATES SEVERE DISTRESS.` No derivation, no comparison against an existing scale, no ROC analysis Quotation withheld because this record is not cleared for redistribution. the validation offered does not address the threshold: content validity by psychiatrists, and a Cronbach's alpha of 0.95, WHICH IS AN INTERNAL-CONSISTENCY STATISTIC AND SAYS NOTHING ABOUT WHERE A CUT-OFF SHOULD SIT Quotation withheld because this record is not cleared for redistribution. the sample is self-selected through QR codes on an online platform `openly accessible to the general public`, and it is 64.73% female against a population near 49% - a skew the paper reports and does not adjust for Quotation withheld because this record is not cleared for redistribution. THE PAPER CARRIES NO LIMITATIONS SECTION AT ALL. It ends on four policy recommendations. For a 1,156-word letter that is a fact about the genre rather than about the authors, and it is why the caveats above had to be read out of the methods Quotation withheld because this record is not cleared for redistribution. the regional comparison uses Shanghai as a case where high exposure risk did NOT produce high distress, and attributes the difference to the public health system eliminates: exposure risk alone as the explanation of the regional pattern - the paper names a case that cuts against it and offers a mechanism · outcome: held Quotation withheld because this record is not cleared for redistribution. whether the CPDI cut-offs correspond to anything outside the CPDI eliminates: nothing - the validation is content validity and internal consistency, neither of which addresses where the threshold sits · outcome: failed Quotation withheld because this record is not cleared for redistribution. whether the respondents represent the population the prevalence is quoted for eliminates: nothing - recruitment was by open QR code and the sample is 64.73% female; the skew is reported and not adjusted for · outcome: failed Quotation withheld because this record is not cleared for redistribution. CPDI CPDI Quotation withheld because this record is not cleared for redistribution. content validity content validity Quotation withheld because this record is not cleared for redistribution. peritraumatic psychological distress peritraumatic psychological distress Quotation withheld because this record is not cleared for redistribution. psychological distress - AS OPERATIONALISED HERE, A SCORE ABOVE 28 ON A SCALE THAT DID NOT EXIST TEN DAYS EARLIER. The headline `almost 35% of the respondents experienced psychological distress` IS THAT THRESHOLD, restated as a prevalence, and the prevalence is what 4,481 papers cite Quotation withheld because this record is not cleared for redistribution. CPDI - a 0-100 index over anxiety, depression, specific phobias, cognitive change, avoidance, compulsive behaviour, physical symptoms and loss of social functioning in the past week. EIGHT DOMAINS COLLAPSED INTO ONE NUMBER, and the number carries the diagnosis Quotation withheld because this record is not cleared for redistribution. the validation - CONTENT VALIDITY plus alpha 0.95. Alpha measures whether the items hang together, not whether the scale measures distress and not whether 28 is the right place to cut it. A HIGH ALPHA ON A NEW SCALE SAYS THE QUESTIONS RESEMBLE EACH OTHER Quotation withheld because this record is not cleared for redistribution. supports → previous research finding women more vulnerable to stress and more likely to develop post-traumatic stress disorder Quotation withheld because this record is not cleared for redistribution. supports → the effectiveness of the Chinese government's control measures, offered as the explanation for the declining distress curve Quotation withheld because this record is not cleared for redistribution. a CPDI score of 28-51 indicates mild to moderate distress, and 52 or more severe distress a CPDI score of 28-51 indicates mild to moderate distress, and 52 or more severe distress Quotation withheld because this record is not cleared for redistribution. THE INSTRUMENT DID NOT EXIST BEFORE THE SURVEY - the questionnaire was DESIGNED for this epidemic and fielded from the day the WHO declared a PHEIC THE INSTRUMENT DID NOT EXIST BEFORE THE SURVEY - the questionnaire was DESIGNED for this epidemic and fielded from the day the WHO declared a PHEIC Quotation withheld because this record is not cleared for redistribution. the CPDI's content validity was verified by psychiatrists, and its Cronbach's alpha is 0.95 the CPDI's content validity was verified by psychiatrists, and its Cronbach's alpha is 0.95 Quotation withheld because this record is not cleared for redistribution. 52,730 valid responses from 36 provinces, autonomous regions and municipalities, 64.73% of them from women 52,730 valid responses from 36 provinces, autonomous regions and municipalities, 64.73% of them from women Quotation withheld because this record is not cleared for redistribution. migrant workers experienced the highest distress of any occupation, mean 31.89, with transport exposure and lost income offered as the explanation migrant workers experienced the highest distress of any occupation, mean 31.89, with transport exposure and lost income offered as the explanation Quotation withheld because this record is not cleared for redistribution. Shanghai's distress level is not spiking, probably because of its strong public health system Shanghai's distress level is not spiking, probably because of its strong public health system Quotation withheld because this record is not cleared for redistribution. an index of the frequency of anxiety, depression, specific phobias, cognitive change, avoidance and compulsive behaviour, physical symptoms and loss of social functioning in the past week, ranging from 0 to 100 CPDI Quotation withheld because this record is not cleared for redistribution. the CPDI score at or above which distress is called SEVERE - asserted, not derived 52 Quotation withheld because this record is not cleared for redistribution. the sample's mean CPDI, with SD 15.45 - below the 28 threshold the prevalence is counted from 23.65 Quotation withheld because this record is not cleared for redistribution. valid responses, of which 64.73% from women 52 730 Quotation withheld because this record is not cleared for redistribution. Cronbach Cronbach Quotation withheld because this record is not cleared for redistribution. SD SD Quotation withheld because this record is not cleared for redistribution. education education Quotation withheld because this record is not cleared for redistribution.

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