Understanding the Mediating Role of Anxiety and Depression on the Relationship Between Perceived Stress and Sleep Quality Among Health Care Workers in the COVID-19 Response

Figures & data

Table 1 Sociodemographic Characteristics and COVID-19-Related Characteristics (N = 588)

Characteristics		N (%)
Gender
	Male	143 (24.32)
	Female	445 (75.68)
Province
	Zhejiang	355 (60.37)
	Hubei	190 (32.31)
	Others	43 (7.31)
Marital status
	Single	104 (17.69)
	Married	476 (80.95)
	Divorced	8 (1.36)
	Widowed	0 (0)
Occupational categories
	Medical doctor	239 (40.65)
	Registered nurse	266 (45.24)
	Medical technician	63 (10.71)
	Administrator	20 (3.40)
Professional title
	Unknown	21 (3.57)
	Junior	184 (31.29)
	Intermediate	284 (48.30)
	Vice-senior or senior	99 (16.84)
Educational level
	Technical secondary school or below	7 (1.19)
	College degree	59 (10.03)
	Bachelor’s degree	457 (77.72)
	Master’s degree or above	65 (11.05)
Departmental function
	Designated hospitals	266 (45.24)
	Community health centre	144 (24.49)
	Other medical institutions	178 (30.27)
If work affairs were the same as before
	Identical	134 (22.79)
	Basically consistent	297 (50.51)
	Inconsistent	157 (26.70)
Job category
	Direct contact confirmed patients	75 (12.76)
	Possible contact confirmed patients	84 (14.29)
	Direct contact suspected patients	36 (6.12)
	Possible contact suspected patients	238 (40.48)
	Non-contact	155 (26.36)
Adequate protection
	No	102 (17.35)
	Yes	486 (82.65)
Quarantined status currently
	No	533 (90.65)
	Yes	55 (9.35)
Have family care burden
	No	291 (49.49)
	Yes	297 (50.51)
Work experience in response to outbreaks
	No	491 (83.50)
	Yes	97 (16.50)

Table 2 Differences Between Groups on Sleep Quality and Perceived Stress

Characteristics	Mean [95% CI]	F	P
Sleep Quality
Departmental function		3.73	0.024
Designated hospitals	17.06 [16.19, 17.92]
Community health centre	16.24 [15.09, 17.38]
Other medical institutions	14.25 [13.08, 15.43]
Job category		4.02	0.024
Direct contact confirmed patients	18.64 [17.03, 20.25]
Possible contact confirmed patients	18.70 [16.98, 20.43]
Direct contact suspected patients	18.06 [15.77, 20.34]
Possible contact suspected patients	15.13 [14.22, 16.04]
Non-contact	14.14 [13.07, 15.21]
Have family care burden		13.86	< 0.001
No	14.72 [13.91, 15.54]
Yes	17.27 [16.42, 18.11]
Perceived Stress
Province		7.05	0.001
Zhejiang	14.29 [13.77, 14.81]
Hubei	17.14 [16.43, 17.84]
Others	17.77 [16.04, 19.50]
Occupational categories		3.14	0.025
Medical doctor	15.45 [14.76, 16.14]
Registered nurse	15.78 [15.17, 16.39]
Medical technician	13.75 [12.50, 14.99]
Administrator	16.85 [14.63, 19.07]
If work affairs were the same as before		4.31	0.014
Identical	13.95 [13.12, 14.78]
Basically consistent	15.49 [14.91, 16.07]
Inconsistent	16.71 [15.85, 17.56]
Job category		3.51	0.008
Direct contact confirmed patients	16.93 [15.73, 18.14]
Possible contact confirmed patients	17.64 [16.53, 18.75]
Direct contact suspected patients	15.39 [13.57, 17.21]
Possible contact suspected patients	14.71 [14.08, 15.34]
Non-contact	14.75 [13.92, 15.57]
Adequate protection		14.26	< 0.001
No	14.92 [14.47, 15.36]
Yes	18.06 [17.00, 19.12]
Have family care burden		10.36	0.001
No	14.57 [13.95, 15.19]
Yes	16.33 [15.77, 16.89]

Table 3 Frequency of Each Score on the GAD-2 and the PHQ-2 (N = 588)

Score	Frequency	Percent (%)	Cumulative Percent (%)
GAD-2
0	132	22.45	22.45
1	123	20.92	43.37
2	275	46.77	90.14
3	22	3.74	93.88
4	22	3.74	97.62
5	6	1.02	98.64
6	8	1.36	100.0
PHQ-2
0	154	26.19	26.19
1	108	18.37	44.56
2	265	45.07	89.63
3	32	5.44	95.07
4	16	2.72	97.79
5	6	1.02	98.81
6	7	1.19	100.0

Note: Scores ≥ 3 in bold.

Table 4 Comparisons Between Anxiety and Non-Anxiety Symptom as Well as Depression and Non-Depression Symptom Individuals

Characteristics	GAD-2		χ^2	P	PHQ-2		χ^2	P
	< 3 (%)	≥ 3 (%)			< 3 (%)	≥ 3 (%)
Province			11.640	0.003			17.807	< 0.001
Zhejiang	332 (93.52)	23 (6.48)			333 (93.80)	22 (6.20)
Hubei	162 (85.26)	28 (14.74)			160 (84.21)	30 (15.79)
Others	36 (83.72)	7 (16.28)			34 (79.07)	9 (20.93)
Professional title							9.904	0.019
Unknown					17 (80.95)	4 (19.05)
Junior					156 (84.78)	28 (15.22)
Intermediate					261 (91.90)	23 (8.10)
Vice-senior or senior					93 (93.94)	6 (6.06)
If work affairs were the same as before			8.818	0.012			10.486	0.005
Identical	129 (96.27)	5 (3.73)			129 (96.27)	5 (3.73)
Basically consistent	266 (89.56)	31 (10.44)			265 (89.23)	32 (10.77)
Inconsistent	135 (85.99)	22 (14.01)			133 (84.71)	24 (15.29)
Job category			15.300	0.004			11.477	0.022
Direct contact confirmed patients	64 (85.33)	11 (14.67)			63 (84.00)	12 (16.00)
Possible contact confirmed patients	68 (80.95)	16 (19.05)			70 (83.33)	14 (16.67)
Direct contact suspected patients	31 (86.11)	5 (13.89)			30 (83.33)	6 (16.67)
Possible contact suspected patients	223 (93.70)	15 (6.30)			220 (92.44)	18 (7.56)
Non-contact	144 (92.90)	11 (7.10)			144 (92.90)	11 (7.10)
Adequate protection			8.408	0.004			16.633	< 0.001
No	84 (82.35)	18 (17.65)			80 (78.43)	22 (21.57)
Yes	446 (91.77)	40 (8.23)			447 (91.98)	39 (8.02)

Figure 1 Final structural model (N = 588).

Table 5 Evaluation of the Goodness-of-Fit of the Model (N = 588)

GOF Index	Test Result	Recommended Value	Model Fit
Absolute measures
RMSEA (90% CI)	0.057 (0.052, 0.062)	< 0.08	Yes
SRMR	0.056	< 0.08	Yes
GFI	0.907	> 0.90	Yes
NC	2.886	< 2.0–3.0	Yes
Incremental fit measures
TLI	0.933	> 0.90	Yes
CFI	0.942	> 0.90	Yes
Parsimony measures
PGFI	0.723	> 0.50	Yes
PNFI	0.791	> 0.50	Yes

Abbreviations: GOF, goodness-of-fit; RMSEA, root mean square error of approximation; CI, confidence interval; SRMR, standardized root mean residual; GFI, goodness-of-fit index; NC, normed chi-square; TLI, Tucker-Lewis index; CFI, comparative fit index; PGFI, parsimony goodness-of-fit index; PNFI, parsimony normed fit index.