Effect of Surgical Masks and N95 Respirators on Anxiety

Abstract

Purpose

Masks are designed to reduce the spread of airborne pathogens, such as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), although wearing a mask has some adverse effects. The primary objective of this study was to explore the effects of surgical masks and N95 respirators on patients diagnosed with anxiety.

Methods

Subjects diagnosed with first-episode anxiety disorders were recruited from outpatient departments between February and July, 2023. A self-administered questionnaire was administered at baseline and at follow-up. The questionnaire addressed demographic information, Hamilton Anxiety Rating Scale (HAM-A), Hamilton Depression Rating Scale (HAM-D) and Insomnia Severity Index (ISI). Subjects were divided into three groups (n=30 each): control (no mask); surgical mask; and N95 respirator. The Kruskal–Wallis test and repeated measures analysis of variance were used to examine associations between face mask use and emotion.

Results

Ninety subjects completed the study, of whom 51 (56.67%) were male and 39 (43.33%) were female. Time and group effects were observed in HAM-A score among the 3 groups. After 4 weeks, mean (± SD) HAM-A score decreased from 32.63±13.37 to 28.07±9.33 in the control group, increased from 33.67±12.47 to 36.80±10.32 in the surgical mask group, and from 32.33±14.73 to 41.13±8.29 in the N95 respirator group, with no sex differences among the 3 groups. HAM-A score was significantly higher in the mask groups than that in the control group at follow-up. Only N95 respirator group exhibited significant time effects on HAM-D and ISI scores, with a decreasing trend in HAM-D score and an opposite trend in ISI score.

Conclusion

Prolonged mask use may exacerbate anxiety, especially among those wearing N95 respirator masks. In a post-pandemic environment, governments should improve public health beliefs regarding coronavirus disease 2019 and promote the safety of face mask use, thus reducing the physiological and psychological effects of improper mask use.

Keywords:

• anxiety
• COVID-19
• health beliefs
• mask
• N95

Data Sharing Statement

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Ethics Approval and Consent

This study was approved by the ethical review board of Chaohu Hospital of Anhui Medical University (AnHui, China, KYXM-202301-004), which conformed to the principles embodied in the Declaration of Helsinki. Informed consent was obtained from participants involved in the study.

Acknowledgments

The authors thank the Chaohu Hospital of Anhui Medical University.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis, and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

This study was supported by grants from the China International Medical Exchange Foundation (Z-2018-35-2002), the Anhui Province Outstanding Young Talents Support Program (gxyqZD2022022), the University Natural Science Research Key Project of Anhui Provincial Department of Education (2023AH050647), and the Research Fund of Anhui Medical University (2020xkj051). The funders had no role in the study design, data collection, and analysis, decision to publish, or preparation of the manuscript.