Introduction

Coronavirus Disease 2019 (COVID-19) has spread rapidly and widely to all the 31 provinces in the mainland of China since January 28, 2020 (NHC of the People’s Republic of China 2020a). More than 30 thousand people had been confirmed to be infected with COVID-19 by February 7, 2020, including about seven hundreds deaths resulting from the disease and six thousands severe cases, according to the official website of the National Health Commission (NHC of the People’s Republic of China, 2020b). Human-to-human transmissions were identified, and the number of confirmed cases and suspected cases increased rapidly. People experienced stress in response to information on COVID-19, changes in daily routines and the uncertainty regarding the future of the epidemic. The stress would lead to a psychological impact and might result in hazards that exceed the consequences of the epidemic itself (Bao et al. 2020). Investigating the psychological effects of COVID-19 would help establish a scientific and effective mental health support system.

In the past twenty years, several emergent public health events, such as SARS, MERS, Ebola and H1N1, have occurred around the world. Many studies have been conducted to explore the psychological effects of these epidemic outbreaks on various groups of people, demonstrating that the stress people experienced results in immediate mental health problems, such as anxiety and depression, as well as post-traumatic stress disorder and vicarious traumatization with long-term effects (Van Bortel et al. 2016). Infected patients and their contacts have been closely studied. They suffered from life-threatening infections and witnessed other patients die, resulting in stress during and after the outbreak (Lee et al. 2007; Rabelo et al. 2016), and some felt shame and guilt by being stigmatized by their communities (Cheung 2015; Person et al. 2004). Medical staffs have also been closely studied. Witnessing the traumatic consequences of an epidemic, medical staff experience substantial distress, mainly due to the fear of infection, loss of control and spread of the virus (Tambo et al. 2014; Wong et al. 2005). Among medical staff, those who performed MERS-related tasks in higher-risk environments experienced greater psychological impacts than those working in other environments (Lee et al. 2018; Matsuishi et al. 2012). Furthermore, they felt helpless and guilt for their inability to save patients and felt frustrated by long working hours, work overload and the lack of protective equipment (van Bortel et al. 2016).

Compared with patients, their contacts and the medical staff, the general population experienced a relatively low-risk environment. However, they also experienced fear and worried about being infected (Blakey et al. 2015; Cheung 2015; Person et al., 2004; Taylor and Asmundson 2004). They obtained information through official and unofficial channels and lacked the ability to distinguish accurate information from misinformation. They had not been trained on efficient methods of prevention. It was thought that they felt fear of the unknown (Ki 2014). The medical students have been professional trained, and they have more medical knowledge than others. Several studies have demonstrated that knowledge of the causes, prevention and treatment of a disease helps decrease the worry about an outbreak (Patel et al. 2018; Siddle et al. 2016). In addition, the medical staff improved their knowledge after educational intervention, simultaneously increasing the confidence to face the epidemic outbreak (Patel et al. 2018; Siddle et al. 2016). However, to date, there is still much unknown about COVID-19. It is still unclear whether historical medical science knowledge and skills will help them manage their fear of subsequent epidemics. On the other hand, a study conducted after a SARS outbreak showed that medical students felt more anxious and depressed than other students due to the large number of medical staff and medical students being infected (Wong et al. 2007). It is also unclear whether empathy toward the medical staff working in a high-risk environment increases stress of medical students. Thus, it is important to investigate the psychological effects of the epidemic outbreak on medical students to determine the effects of knowledge on the emotional reactions to the outbreak, which would help to increase understanding of the psychological mechanisms of stress during epidemics, and to construct an effective psychological support system for different population groups.

As summarized above, the present study attempted to measure the subjective impact of the outbreak, and the levels of anxiety and depression of both medical and non-medical students by an online survey, as well as the university students’ assessment of how risky the COVID-19 outbreak was. Based on previous studies, we hypothesized that medical students would experience a greater psychological impact than non-medical students.

Methods

Participants

The study was conducted from Feb 4, 2020, to Feb 7, 2020, and surveyed 2705 undergraduate students (Table 1). All the students were living outside Hubei, and none of them was infected by COVID-19. They voluntarily participated in this study, which was approved by the university’s Institutional Review Board. They received the linkage of the online survey by instant messengers and were instructed to complete it online. After a participant completed the survey, he or she received their score, an estimation of their mental health status and a suggestion about what they should do if the results of the questionnaire revealed that they were anxious or depressed.

Table 1 The basic information of the online-survey participants (China, Feb 4 to Feb 7, 2020)
Full size table

Questionnaire

The survey included four parts. The first part collected the basic information of the students, with major, sex, place of residence and time spent focusing on relevant information each day. The second part collected the participants’ views on COVID-19, with four descriptions of the epidemic: (1) COVID-19 is serious. It is difficult to prevent and lacks effective treatments. (2) COVID-19 will become widespread for a long time because it is highly infectious. (3) The outbreak will have catastrophic consequences. (4) The outbreak can be managed in society as a whole. These four items were developed based on risk perception theory, attempting to investigate the university students’ assessment of how risky the COVID-19 outbreak was, in terms of probabilistic estimates of the degree of situational uncertainty and how controllable that uncertainty was (Liu et al. 2006). The participants were instructed to choose the option they agreed with.

The third part used the Chinese version of the Impact of Event Scale-Revised (IES-R) to measure subjective responses to a specific traumatic event (Guo et al. Conclusion

Medical students experienced lower psychological impact of COVID-19 than non-medical students, although they thought the epidemic more serious. Time spent focusing on epidemic-related information affected the psychological effects of COVID-19, and the difference in the psychological effects experienced by medical and non-medical students increased with time prolonged. The outcome of this study suggests that providing accurate and transparent information about the epidemic and providing appropriate COVID-19-based knowledge training in accessible ways will contribute to the public's mental health during the outbreak.