The Effects of Social Support on Sleep Quality of Medical Staff Treating Patients with Coronavirus Disease 2019 (COVID-19) in January and February 2020 in China
Identifieur interne : 000047 ( Pmc/Checkpoint ); précédent : 000046; suivant : 000048The Effects of Social Support on Sleep Quality of Medical Staff Treating Patients with Coronavirus Disease 2019 (COVID-19) in January and February 2020 in China
Auteurs : Han Xiao [République populaire de Chine] ; Yan Zhang [République populaire de Chine] ; Desheng Kong [République populaire de Chine] ; Shiyue Li [République populaire de Chine] ; Ningxi Yang [République populaire de Chine]Source :
- Medical Science Monitor : International Medical Journal of Experimental and Clinical Research [ 1234-1010 ] ; 2020.
Abstract
Coronavirus disease 2019 (COVID-19), formerly known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and 2019 novel coronavirus (2019-nCoV), was first identified in December 2019 in Wuhan City, China. Structural equation modeling (SEM) is a multivariate analysis method to determine the structural relationship between measured variables. This observational study aimed to use SEM to determine the effects of social support on sleep quality and function of medical staff who treated patients with COVID-19 in January and February 2020 in Wuhan, China.
A one-month cross-sectional observational study included 180 medical staff who treated patients with COVID-19 infection. Levels of anxiety, self-efficacy, stress, sleep quality, and social support were measured using the and the Self-Rating Anxiety Scale (SAS), the General Self-Efficacy Scale (GSES), the Stanford Acute Stress Reaction (SASR) questionnaire, the Pittsburgh Sleep Quality Index (PSQI), and the Social Support Rate Scale (SSRS), respectively. Pearson’s correlation analysis and SEM identified the interactions between these factors.
Levels of social support for medical staff were significantly associated with self-efficacy and sleep quality and negatively associated with the degree of anxiety and stress. Levels of anxiety were significantly associated with the levels of stress, which negatively impacted self-efficacy and sleep quality. Anxiety, stress, and self-efficacy were mediating variables associated with social support and sleep quality.
SEM showed that medical staff in China who were treating patients with COVID-19 infection during January and February 2020 had levels of anxiety, stress, and self-efficacy that were dependent on sleep quality and social support.
Url:
DOI: 10.12659/MSM.923549
PubMed: 32132521
PubMed Central: 7075079
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<sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">The Effects of Social Support on Sleep Quality of Medical Staff Treating Patients with Coronavirus Disease 2019 (COVID-19) in January and February 2020 in China</title>
<author><name sortKey="Xiao, Han" sort="Xiao, Han" uniqKey="Xiao H" first="Han" last="Xiao">Han Xiao</name>
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<author><name sortKey="Zhang, Yan" sort="Zhang, Yan" uniqKey="Zhang Y" first="Yan" last="Zhang">Yan Zhang</name>
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<author><name sortKey="Yang, Ningxi" sort="Yang, Ningxi" uniqKey="Yang N" first="Ningxi" last="Yang">Ningxi Yang</name>
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<front><div type="abstract" xml:lang="en"><sec><title>Background</title>
<p>Coronavirus disease 2019 (COVID-19), formerly known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and 2019 novel coronavirus (2019-nCoV), was first identified in December 2019 in Wuhan City, China. Structural equation modeling (SEM) is a multivariate analysis method to determine the structural relationship between measured variables. This observational study aimed to use SEM to determine the effects of social support on sleep quality and function of medical staff who treated patients with COVID-19 in January and February 2020 in Wuhan, China.</p>
</sec>
<sec><title>Material/Methods</title>
<p>A one-month cross-sectional observational study included 180 medical staff who treated patients with COVID-19 infection. Levels of anxiety, self-efficacy, stress, sleep quality, and social support were measured using the and the Self-Rating Anxiety Scale (SAS), the General Self-Efficacy Scale (GSES), the Stanford Acute Stress Reaction (SASR) questionnaire, the Pittsburgh Sleep Quality Index (PSQI), and the Social Support Rate Scale (SSRS), respectively. Pearson’s correlation analysis and SEM identified the interactions between these factors.</p>
</sec>
<sec><title>Results</title>
<p>Levels of social support for medical staff were significantly associated with self-efficacy and sleep quality and negatively associated with the degree of anxiety and stress. Levels of anxiety were significantly associated with the levels of stress, which negatively impacted self-efficacy and sleep quality. Anxiety, stress, and self-efficacy were mediating variables associated with social support and sleep quality.</p>
</sec>
<sec><title>Conclusions</title>
<p>SEM showed that medical staff in China who were treating patients with COVID-19 infection during January and February 2020 had levels of anxiety, stress, and self-efficacy that were dependent on sleep quality and social support.</p>
</sec>
</div>
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<article-id pub-id-type="publisher-id">923549</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Clinical Research</subject>
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<title-group><article-title>The Effects of Social Support on Sleep Quality of Medical Staff Treating Patients with Coronavirus Disease 2019 (COVID-19) in January and February 2020 in China</article-title>
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<contrib-group><contrib contrib-type="author"><name><surname>Xiao</surname>
<given-names>Han</given-names>
</name>
<xref ref-type="aff" rid="af1-medscimonit-26-e923549">1</xref>
<xref ref-type="author-notes" rid="fn1-medscimonit-26-e923549">A</xref>
<xref ref-type="author-notes" rid="fn2-medscimonit-26-e923549">B</xref>
<xref ref-type="author-notes" rid="fn5-medscimonit-26-e923549">E</xref>
<xref ref-type="author-notes" rid="fn6-medscimonit-26-e923549">F</xref>
<xref ref-type="author-notes" rid="fn8-medscimonit-26-e923549">*</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Zhang</surname>
<given-names>Yan</given-names>
</name>
<xref ref-type="aff" rid="af2-medscimonit-26-e923549">2</xref>
<xref ref-type="author-notes" rid="fn3-medscimonit-26-e923549">C</xref>
<xref ref-type="author-notes" rid="fn4-medscimonit-26-e923549">D</xref>
<xref ref-type="author-notes" rid="fn6-medscimonit-26-e923549">F</xref>
<xref ref-type="author-notes" rid="fn8-medscimonit-26-e923549">*</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Kong</surname>
<given-names>Desheng</given-names>
</name>
<xref ref-type="aff" rid="af2-medscimonit-26-e923549">2</xref>
<xref ref-type="author-notes" rid="fn5-medscimonit-26-e923549">E</xref>
<xref ref-type="author-notes" rid="fn6-medscimonit-26-e923549">F</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Li</surname>
<given-names>Shiyue</given-names>
</name>
<xref ref-type="aff" rid="af3-medscimonit-26-e923549">3</xref>
<xref ref-type="author-notes" rid="fn2-medscimonit-26-e923549">B</xref>
<xref ref-type="author-notes" rid="fn3-medscimonit-26-e923549">C</xref>
<xref ref-type="author-notes" rid="fn4-medscimonit-26-e923549">D</xref>
</contrib>
<contrib contrib-type="author" corresp="yes"><name><surname>Yang</surname>
<given-names>Ningxi</given-names>
</name>
<xref ref-type="aff" rid="af2-medscimonit-26-e923549">2</xref>
<xref ref-type="author-notes" rid="fn1-medscimonit-26-e923549">A</xref>
<xref ref-type="author-notes" rid="fn2-medscimonit-26-e923549">B</xref>
<xref ref-type="author-notes" rid="fn3-medscimonit-26-e923549">C</xref>
<xref ref-type="author-notes" rid="fn7-medscimonit-26-e923549">G</xref>
</contrib>
</contrib-group>
<aff id="af1-medscimonit-26-e923549"><label>1</label>
Department of Respiration, Xuanwu Hospital Capital Medical University, Beijing, P.R. China</aff>
<aff id="af2-medscimonit-26-e923549"><label>2</label>
College of Humanities and Social Sciences, Harbin Engineering University, Harbin, Heilongjiang, P.R. China</aff>
<aff id="af3-medscimonit-26-e923549"><label>3</label>
School of Health Sciences, Wuhan University, Wuhan, Hubei, P.R. China</aff>
<author-notes><corresp id="c1-medscimonit-26-e923549">Corresponding Author: Ningxi Yang, e-mail: <email>yangningxi@bjmu.edu.cn</email>
</corresp>
<fn id="fn1-medscimonit-26-e923549"><label>A</label>
<p>Study Design</p>
</fn>
<fn id="fn2-medscimonit-26-e923549"><label>B</label>
<p>Data Collection</p>
</fn>
<fn id="fn3-medscimonit-26-e923549"><label>C</label>
<p>Statistical Analysis</p>
</fn>
<fn id="fn4-medscimonit-26-e923549"><label>D</label>
<p>Data Interpretation</p>
</fn>
<fn id="fn5-medscimonit-26-e923549"><label>E</label>
<p>Manuscript Preparation</p>
</fn>
<fn id="fn6-medscimonit-26-e923549"><label>F</label>
<p>Literature Search</p>
</fn>
<fn id="fn7-medscimonit-26-e923549"><label>G</label>
<p>Funds Collection</p>
</fn>
<fn id="fn8-medscimonit-26-e923549"><label>*</label>
<p>Han Xiao and Yan Zhang are both first authors and contributed equally to this study</p>
</fn>
</author-notes>
<pub-date pub-type="collection"><year>2020</year>
</pub-date>
<pub-date pub-type="epub"><day>05</day>
<month>3</month>
<year>2020</year>
</pub-date>
<pub-date pub-type="epreprint"><day>03</day>
<month>3</month>
<year>2020</year>
</pub-date>
<volume>26</volume>
<fpage>e923549-1</fpage>
<lpage>e923549-8</lpage>
<history><date date-type="received"><day>16</day>
<month>2</month>
<year>2020</year>
</date>
<date date-type="accepted"><day>25</day>
<month>2</month>
<year>2020</year>
</date>
</history>
<permissions><copyright-statement>© Med Sci Monit, 2020</copyright-statement>
<copyright-year>2020</copyright-year>
<license license-type="open-access"><license-p>This work is licensed under Creative Common Attribution-NonCommercial-NoDerivatives 4.0 International (<ext-link ext-link-type="uri" xlink:href="https://creativecommons.org/licenses/by-nc-nd/4.0/">CC BY-NC-ND 4.0</ext-link>
)</license-p>
</license>
</permissions>
<abstract><sec><title>Background</title>
<p>Coronavirus disease 2019 (COVID-19), formerly known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and 2019 novel coronavirus (2019-nCoV), was first identified in December 2019 in Wuhan City, China. Structural equation modeling (SEM) is a multivariate analysis method to determine the structural relationship between measured variables. This observational study aimed to use SEM to determine the effects of social support on sleep quality and function of medical staff who treated patients with COVID-19 in January and February 2020 in Wuhan, China.</p>
</sec>
<sec><title>Material/Methods</title>
<p>A one-month cross-sectional observational study included 180 medical staff who treated patients with COVID-19 infection. Levels of anxiety, self-efficacy, stress, sleep quality, and social support were measured using the and the Self-Rating Anxiety Scale (SAS), the General Self-Efficacy Scale (GSES), the Stanford Acute Stress Reaction (SASR) questionnaire, the Pittsburgh Sleep Quality Index (PSQI), and the Social Support Rate Scale (SSRS), respectively. Pearson’s correlation analysis and SEM identified the interactions between these factors.</p>
</sec>
<sec><title>Results</title>
<p>Levels of social support for medical staff were significantly associated with self-efficacy and sleep quality and negatively associated with the degree of anxiety and stress. Levels of anxiety were significantly associated with the levels of stress, which negatively impacted self-efficacy and sleep quality. Anxiety, stress, and self-efficacy were mediating variables associated with social support and sleep quality.</p>
</sec>
<sec><title>Conclusions</title>
<p>SEM showed that medical staff in China who were treating patients with COVID-19 infection during January and February 2020 had levels of anxiety, stress, and self-efficacy that were dependent on sleep quality and social support.</p>
</sec>
</abstract>
<kwd-group><title>MeSH Keywords</title>
<kwd>Anxiety</kwd>
<kwd>SARS Virus</kwd>
<kwd>Social Support</kwd>
<kwd>Stress, Psychological</kwd>
</kwd-group>
</article-meta>
</front>
<floats-group><fig id="f1-medscimonit-26-e923549" position="float"><label>Figure 1</label>
<caption><p>The path analysis obtained from the structural equation model (SEM) of the relationships from the results of the Social Support Rate Scale (SSRS), the General Self-Efficacy Scale (GSES), the Self-Rating Anxiety Scale (SAS), the Stanford Acute Stress Reaction (SASR), and the Pittsburgh Sleep Quality Index (PSQI) of medical staff (with standardized beta weighting).</p>
</caption>
<graphic xlink:href="medscimonit-26-e923549-g001"></graphic>
</fig>
<table-wrap id="t1-medscimonit-26-e923549" position="float"><label>Table 1</label>
<caption><p>Demographic and working data of the medical staff treating patients with COVID-19 in January and February 2020 in Wuhan, China.</p>
</caption>
<table frame="hsides" rules="rows"><thead><tr><th valign="middle" align="center" rowspan="1" colspan="1">Variable</th>
<th valign="middle" align="center" rowspan="1" colspan="1">Number</th>
<th valign="middle" align="center" rowspan="1" colspan="1">%</th>
</tr>
</thead>
<tbody><tr><td colspan="3" valign="middle" align="left" rowspan="1">Gender</td>
</tr>
<tr><td valign="middle" align="left" rowspan="1" colspan="1"> Male</td>
<td valign="middle" align="right" rowspan="1" colspan="1">51</td>
<td valign="middle" align="right" rowspan="1" colspan="1">28.3</td>
</tr>
<tr><td valign="middle" align="left" rowspan="1" colspan="1"> Female</td>
<td valign="middle" align="right" rowspan="1" colspan="1">129</td>
<td valign="middle" align="right" rowspan="1" colspan="1">71.7</td>
</tr>
<tr><td colspan="3" valign="middle" align="left" rowspan="1">Education</td>
</tr>
<tr><td valign="middle" align="left" rowspan="1" colspan="1"> College degree or below</td>
<td valign="middle" align="right" rowspan="1" colspan="1">34</td>
<td valign="middle" align="right" rowspan="1" colspan="1">18.9</td>
</tr>
<tr><td valign="middle" align="left" rowspan="1" colspan="1"> Bachelor’s degree</td>
<td valign="middle" align="right" rowspan="1" colspan="1">82</td>
<td valign="middle" align="right" rowspan="1" colspan="1">45.6</td>
</tr>
<tr><td valign="middle" align="left" rowspan="1" colspan="1"> Master’s degree or above</td>
<td valign="middle" align="right" rowspan="1" colspan="1">64</td>
<td valign="middle" align="right" rowspan="1" colspan="1">35.5</td>
</tr>
<tr><td colspan="3" valign="middle" align="left" rowspan="1">Marital status</td>
</tr>
<tr><td valign="middle" align="left" rowspan="1" colspan="1"> Unmarried</td>
<td valign="middle" align="right" rowspan="1" colspan="1">41</td>
<td valign="middle" align="right" rowspan="1" colspan="1">22.8</td>
</tr>
<tr><td valign="middle" align="left" rowspan="1" colspan="1"> Married</td>
<td valign="middle" align="right" rowspan="1" colspan="1">122</td>
<td valign="middle" align="right" rowspan="1" colspan="1">67.8</td>
</tr>
<tr><td valign="middle" align="left" rowspan="1" colspan="1"> Divorced or widowed</td>
<td valign="middle" align="right" rowspan="1" colspan="1">17</td>
<td valign="middle" align="right" rowspan="1" colspan="1">9.4</td>
</tr>
<tr><td colspan="3" valign="middle" align="left" rowspan="1">Seniority</td>
</tr>
<tr><td valign="middle" align="left" rowspan="1" colspan="1"> Primary</td>
<td valign="middle" align="right" rowspan="1" colspan="1">36</td>
<td valign="middle" align="right" rowspan="1" colspan="1">20.0</td>
</tr>
<tr><td valign="middle" align="left" rowspan="1" colspan="1"> Intermediate</td>
<td valign="middle" align="right" rowspan="1" colspan="1">108</td>
<td valign="middle" align="right" rowspan="1" colspan="1">60.0</td>
</tr>
<tr><td valign="middle" align="left" rowspan="1" colspan="1"> Senior</td>
<td valign="middle" align="right" rowspan="1" colspan="1">36</td>
<td valign="middle" align="right" rowspan="1" colspan="1">20.0</td>
</tr>
<tr><td colspan="3" valign="middle" align="left" rowspan="1">Monthly income</td>
</tr>
<tr><td valign="middle" align="left" rowspan="1" colspan="1"> <6000 yuan</td>
<td valign="middle" align="right" rowspan="1" colspan="1">33</td>
<td valign="middle" align="right" rowspan="1" colspan="1">18.2</td>
</tr>
<tr><td valign="middle" align="left" rowspan="1" colspan="1"> 6000–10000 yuan</td>
<td valign="middle" align="right" rowspan="1" colspan="1">110</td>
<td valign="middle" align="right" rowspan="1" colspan="1">70.6</td>
</tr>
<tr><td valign="middle" align="left" rowspan="1" colspan="1"> >10000 yuan</td>
<td valign="middle" align="right" rowspan="1" colspan="1">37</td>
<td valign="middle" align="right" rowspan="1" colspan="1">11.2</td>
</tr>
<tr><td colspan="3" valign="middle" align="left" rowspan="1">Profession</td>
</tr>
<tr><td valign="middle" align="left" rowspan="1" colspan="1"> Doctor</td>
<td valign="middle" align="right" rowspan="1" colspan="1">82</td>
<td valign="middle" align="right" rowspan="1" colspan="1">45.6</td>
</tr>
<tr><td valign="middle" align="left" rowspan="1" colspan="1"> Nurse</td>
<td valign="middle" align="right" rowspan="1" colspan="1">98</td>
<td valign="middle" align="right" rowspan="1" colspan="1">54.4</td>
</tr>
<tr><td colspan="3" valign="middle" align="left" rowspan="1">Department</td>
</tr>
<tr><td valign="middle" align="left" rowspan="1" colspan="1"> Fever clinic or respiratory clinic</td>
<td valign="middle" align="right" rowspan="1" colspan="1">86</td>
<td valign="middle" align="right" rowspan="1" colspan="1">47.8</td>
</tr>
<tr><td valign="middle" align="left" rowspan="1" colspan="1"> COVID-19 pneumonia isolation Hospital ward</td>
<td valign="middle" align="right" rowspan="1" colspan="1">52</td>
<td valign="middle" align="right" rowspan="1" colspan="1">28.9</td>
</tr>
<tr><td valign="middle" align="left" rowspan="1" colspan="1"> Intensive Care Unit (ICU)</td>
<td valign="middle" align="right" rowspan="1" colspan="1">42</td>
<td valign="middle" align="right" rowspan="1" colspan="1">23.3</td>
</tr>
<tr><td colspan="3" valign="middle" align="left" rowspan="1">Working experience</td>
</tr>
<tr><td valign="middle" align="left" rowspan="1" colspan="1"> <2 years</td>
<td valign="middle" align="right" rowspan="1" colspan="1">26</td>
<td valign="middle" align="right" rowspan="1" colspan="1">14.4</td>
</tr>
<tr><td valign="middle" align="left" rowspan="1" colspan="1"> 2–5 years</td>
<td valign="middle" align="right" rowspan="1" colspan="1">33</td>
<td valign="middle" align="right" rowspan="1" colspan="1">18.3</td>
</tr>
<tr><td valign="middle" align="left" rowspan="1" colspan="1"> >5 years</td>
<td valign="middle" align="right" rowspan="1" colspan="1">121</td>
<td valign="middle" align="right" rowspan="1" colspan="1">67.2</td>
</tr>
</tbody>
</table>
</table-wrap>
<table-wrap id="t2-medscimonit-26-e923549" position="float"><label>Table 2</label>
<caption><p>The relationships between the Social Support Rate Scale (SSRS), the General Self-Efficacy Scale (GSES), the Stanford Acute Stress Reaction (SASR) questionnaire, the Self-Rating Anxiety Scale (SAS), and the Pittsburgh Sleep Quality Index (PSQI) of the medical staff treating patients with COVID-19.</p>
</caption>
<table frame="hsides" rules="rows"><thead><tr><th valign="middle" align="center" rowspan="1" colspan="1"></th>
<th valign="middle" align="center" rowspan="1" colspan="1">Mean</th>
<th valign="middle" align="center" rowspan="1" colspan="1">Standard deviation</th>
<th valign="middle" align="center" rowspan="1" colspan="1">SSRS</th>
<th valign="middle" align="center" rowspan="1" colspan="1">GSES</th>
<th valign="middle" align="center" rowspan="1" colspan="1">SAS</th>
<th valign="middle" align="center" rowspan="1" colspan="1">SASR</th>
<th valign="middle" align="center" rowspan="1" colspan="1">PSQI</th>
</tr>
</thead>
<tbody><tr><td valign="middle" align="left" rowspan="1" colspan="1">SSRS</td>
<td valign="middle" align="right" rowspan="1" colspan="1">34.172</td>
<td valign="middle" align="right" rowspan="1" colspan="1">10.263</td>
<td valign="middle" align="center" rowspan="1" colspan="1">1</td>
<td valign="middle" align="center" rowspan="1" colspan="1"></td>
<td valign="middle" align="center" rowspan="1" colspan="1"></td>
<td valign="middle" align="center" rowspan="1" colspan="1"></td>
<td valign="middle" align="center" rowspan="1" colspan="1"></td>
</tr>
<tr><td valign="middle" align="left" rowspan="1" colspan="1">GSES</td>
<td valign="middle" align="right" rowspan="1" colspan="1">2.267</td>
<td valign="middle" align="right" rowspan="1" colspan="1">0.767</td>
<td valign="middle" align="center" rowspan="1" colspan="1">.405<xref ref-type="table-fn" rid="tfn1-medscimonit-26-e923549">**</xref>
</td>
<td valign="middle" align="center" rowspan="1" colspan="1">1</td>
<td valign="middle" align="center" rowspan="1" colspan="1"></td>
<td valign="middle" align="center" rowspan="1" colspan="1"></td>
<td valign="middle" align="center" rowspan="1" colspan="1"></td>
</tr>
<tr><td valign="middle" align="left" rowspan="1" colspan="1">SAS</td>
<td valign="middle" align="right" rowspan="1" colspan="1">55.256</td>
<td valign="middle" align="right" rowspan="1" colspan="1">14.183</td>
<td valign="middle" align="center" rowspan="1" colspan="1">−.565<xref ref-type="table-fn" rid="tfn1-medscimonit-26-e923549">**</xref>
</td>
<td valign="middle" align="center" rowspan="1" colspan="1">−.351<xref ref-type="table-fn" rid="tfn1-medscimonit-26-e923549">**</xref>
</td>
<td valign="middle" align="center" rowspan="1" colspan="1">1</td>
<td valign="middle" align="center" rowspan="1" colspan="1"></td>
<td valign="middle" align="center" rowspan="1" colspan="1"></td>
</tr>
<tr><td valign="middle" align="left" rowspan="1" colspan="1">SASR</td>
<td valign="middle" align="right" rowspan="1" colspan="1">77.589</td>
<td valign="middle" align="right" rowspan="1" colspan="1">29.525</td>
<td valign="middle" align="center" rowspan="1" colspan="1">−.391<xref ref-type="table-fn" rid="tfn1-medscimonit-26-e923549">**</xref>
</td>
<td valign="middle" align="center" rowspan="1" colspan="1">−.277<xref ref-type="table-fn" rid="tfn1-medscimonit-26-e923549">**</xref>
</td>
<td valign="middle" align="center" rowspan="1" colspan="1">.397<xref ref-type="table-fn" rid="tfn1-medscimonit-26-e923549">**</xref>
</td>
<td valign="middle" align="center" rowspan="1" colspan="1">1</td>
<td valign="middle" align="center" rowspan="1" colspan="1"></td>
</tr>
<tr><td valign="middle" align="left" rowspan="1" colspan="1">PSQI</td>
<td valign="middle" align="right" rowspan="1" colspan="1">8.583</td>
<td valign="middle" align="right" rowspan="1" colspan="1">4.567</td>
<td valign="middle" align="center" rowspan="1" colspan="1">−.413<xref ref-type="table-fn" rid="tfn1-medscimonit-26-e923549">**</xref>
</td>
<td valign="middle" align="center" rowspan="1" colspan="1">−.483<xref ref-type="table-fn" rid="tfn1-medscimonit-26-e923549">**</xref>
</td>
<td valign="middle" align="center" rowspan="1" colspan="1">.489<xref ref-type="table-fn" rid="tfn1-medscimonit-26-e923549">**</xref>
</td>
<td valign="middle" align="center" rowspan="1" colspan="1">.457<xref ref-type="table-fn" rid="tfn1-medscimonit-26-e923549">**</xref>
</td>
<td valign="middle" align="center" rowspan="1" colspan="1">1</td>
</tr>
</tbody>
</table>
<table-wrap-foot><fn id="tfn1-medscimonit-26-e923549"><label>**</label>
<p><italic>P</italic>
<0.01.</p>
</fn>
<fn id="tfn2-medscimonit-26-e923549"><p>The data shown represent the scores of the questionnaires.</p>
</fn>
</table-wrap-foot>
</table-wrap>
<table-wrap id="t3-medscimonit-26-e923549" position="float"><label>Table 3</label>
<caption><p>The normalized path coefficients for the Social Support Rate Scale (SSRS), the General Self-Efficacy Scale (GSES), the Stanford Acute Stress Reaction (SASR) questionnaire, the Self-Rating Anxiety Scale (SAS), and the Pittsburgh Sleep Quality Index (PSQI) of the medical staff treating patients with COVID-19.</p>
</caption>
<table frame="hsides" rules="rows"><thead><tr><th colspan="3" valign="middle" align="center" rowspan="1">Path</th>
<th valign="middle" align="center" rowspan="1" colspan="1">Standardization coefficient</th>
<th valign="middle" align="center" rowspan="1" colspan="1">Unstandardized coefficient</th>
<th valign="middle" align="center" rowspan="1" colspan="1">Standard error</th>
<th valign="middle" align="center" rowspan="1" colspan="1">Critical ratio</th>
<th valign="middle" align="center" rowspan="1" colspan="1">P-value</th>
</tr>
</thead>
<tbody><tr><td valign="middle" align="left" rowspan="1" colspan="1">SAS</td>
<td valign="middle" align="center" rowspan="1" colspan="1"><---</td>
<td valign="middle" align="center" rowspan="1" colspan="1">SSRS</td>
<td valign="middle" align="right" rowspan="1" colspan="1">−0.565</td>
<td valign="middle" align="right" rowspan="1" colspan="1">−0.781</td>
<td valign="middle" align="center" rowspan="1" colspan="1">0.085</td>
<td valign="middle" align="right" rowspan="1" colspan="1">−9.165</td>
<td valign="middle" align="center" rowspan="1" colspan="1"><xref ref-type="table-fn" rid="tfn3-medscimonit-26-e923549">***</xref>
</td>
</tr>
<tr><td valign="middle" align="left" rowspan="1" colspan="1">SASR</td>
<td valign="middle" align="center" rowspan="1" colspan="1"><---</td>
<td valign="middle" align="center" rowspan="1" colspan="1">SSRS</td>
<td valign="middle" align="right" rowspan="1" colspan="1">−0.245</td>
<td valign="middle" align="right" rowspan="1" colspan="1">−0.704</td>
<td valign="middle" align="center" rowspan="1" colspan="1">0.233</td>
<td valign="middle" align="right" rowspan="1" colspan="1">−3.015</td>
<td valign="middle" align="center" rowspan="1" colspan="1">0.003</td>
</tr>
<tr><td valign="middle" align="left" rowspan="1" colspan="1">GSES</td>
<td valign="middle" align="center" rowspan="1" colspan="1"><---</td>
<td valign="middle" align="center" rowspan="1" colspan="1">SSRS</td>
<td valign="middle" align="right" rowspan="1" colspan="1">0.304</td>
<td valign="middle" align="right" rowspan="1" colspan="1">0.023</td>
<td valign="middle" align="center" rowspan="1" colspan="1">0.006</td>
<td valign="middle" align="right" rowspan="1" colspan="1">3.723</td>
<td valign="middle" align="center" rowspan="1" colspan="1"><xref ref-type="table-fn" rid="tfn3-medscimonit-26-e923549">***</xref>
</td>
</tr>
<tr><td valign="middle" align="left" rowspan="1" colspan="1">SASR</td>
<td valign="middle" align="center" rowspan="1" colspan="1"><---</td>
<td valign="middle" align="center" rowspan="1" colspan="1">SAS</td>
<td valign="middle" align="right" rowspan="1" colspan="1">0.259</td>
<td valign="middle" align="right" rowspan="1" colspan="1">0.539</td>
<td valign="middle" align="center" rowspan="1" colspan="1">0.169</td>
<td valign="middle" align="right" rowspan="1" colspan="1">3.189</td>
<td valign="middle" align="center" rowspan="1" colspan="1">0.001</td>
</tr>
<tr><td valign="middle" align="left" rowspan="1" colspan="1">GSES</td>
<td valign="middle" align="center" rowspan="1" colspan="1"><---</td>
<td valign="middle" align="center" rowspan="1" colspan="1">SAS</td>
<td valign="middle" align="right" rowspan="1" colspan="1">−0.179</td>
<td valign="middle" align="right" rowspan="1" colspan="1">−0.010</td>
<td valign="middle" align="center" rowspan="1" colspan="1">0.004</td>
<td valign="middle" align="right" rowspan="1" colspan="1">−2.184</td>
<td valign="middle" align="center" rowspan="1" colspan="1">0.029</td>
</tr>
<tr><td valign="middle" align="left" rowspan="1" colspan="1">PSQI</td>
<td valign="middle" align="center" rowspan="1" colspan="1"><---</td>
<td valign="middle" align="center" rowspan="1" colspan="1">SAS</td>
<td valign="middle" align="right" rowspan="1" colspan="1">0.257</td>
<td valign="middle" align="right" rowspan="1" colspan="1">0.082</td>
<td valign="middle" align="center" rowspan="1" colspan="1">0.023</td>
<td valign="middle" align="right" rowspan="1" colspan="1">3.514</td>
<td valign="middle" align="center" rowspan="1" colspan="1"><xref ref-type="table-fn" rid="tfn3-medscimonit-26-e923549">***</xref>
</td>
</tr>
<tr><td valign="middle" align="left" rowspan="1" colspan="1">PSQI</td>
<td valign="middle" align="center" rowspan="1" colspan="1"><---</td>
<td valign="middle" align="center" rowspan="1" colspan="1">SASR</td>
<td valign="middle" align="right" rowspan="1" colspan="1">0.255</td>
<td valign="middle" align="right" rowspan="1" colspan="1">0.039</td>
<td valign="middle" align="center" rowspan="1" colspan="1">0.010</td>
<td valign="middle" align="right" rowspan="1" colspan="1">3.937</td>
<td valign="middle" align="center" rowspan="1" colspan="1"><xref ref-type="table-fn" rid="tfn3-medscimonit-26-e923549">***</xref>
</td>
</tr>
<tr><td valign="middle" align="left" rowspan="1" colspan="1">PSQI</td>
<td valign="middle" align="center" rowspan="1" colspan="1"><---</td>
<td valign="middle" align="center" rowspan="1" colspan="1">SSRS</td>
<td valign="middle" align="right" rowspan="1" colspan="1">−0.046</td>
<td valign="middle" align="right" rowspan="1" colspan="1">−0.020</td>
<td valign="middle" align="center" rowspan="1" colspan="1">0.033</td>
<td valign="middle" align="right" rowspan="1" colspan="1">−0.616</td>
<td valign="middle" align="center" rowspan="1" colspan="1">0.538</td>
</tr>
<tr><td valign="middle" align="left" rowspan="1" colspan="1">PSQI</td>
<td valign="middle" align="center" rowspan="1" colspan="1"><---</td>
<td valign="middle" align="center" rowspan="1" colspan="1">GSES</td>
<td valign="middle" align="right" rowspan="1" colspan="1">−0.308</td>
<td valign="middle" align="right" rowspan="1" colspan="1">−1.820</td>
<td valign="middle" align="center" rowspan="1" colspan="1">0.380</td>
<td valign="middle" align="right" rowspan="1" colspan="1">−4.788</td>
<td valign="middle" align="center" rowspan="1" colspan="1"><xref ref-type="table-fn" rid="tfn3-medscimonit-26-e923549">***</xref>
</td>
</tr>
</tbody>
</table>
<table-wrap-foot><fn id="tfn3-medscimonit-26-e923549"><label>***</label>
<p>P<0.001 The data shown represent the scores of the questionnaires.</p>
</fn>
</table-wrap-foot>
</table-wrap>
<table-wrap id="t4-medscimonit-26-e923549" position="float"><label>Table 4</label>
<caption><p>Result of the bootstrap indirect effects analysis of the Social Support Rate Scale (SSRS), the General Self-Efficacy Scale (GSES), the Stanford Acute Stress Reaction (SASR) questionnaire, the Self-Rating Anxiety Scale (SAS), and the Pittsburgh Sleep Quality Index (PSQI) of the medical staff treating patients with COVID-19.</p>
</caption>
<table frame="hsides" rules="rows"><thead><tr><th valign="middle" rowspan="2" align="center" colspan="1">Mediation effect path</th>
<th valign="middle" rowspan="2" align="center" colspan="1">Standardization coefficient</th>
<th valign="middle" rowspan="2" align="center" colspan="1">Unstandardized coefficients</th>
<th valign="middle" rowspan="2" align="center" colspan="1">Standard error</th>
<th colspan="2" valign="middle" align="center" rowspan="1">95% CI</th>
<th valign="middle" rowspan="2" align="center" colspan="1">P-value</th>
</tr>
<tr><th valign="middle" align="center" rowspan="1" colspan="1">Lower</th>
<th valign="middle" align="center" rowspan="1" colspan="1">Upper</th>
</tr>
</thead>
<tbody><tr><td valign="middle" align="left" rowspan="1" colspan="1">SSRS→SAS→PSQI</td>
<td valign="middle" align="center" rowspan="1" colspan="1">−0.145</td>
<td valign="middle" align="center" rowspan="1" colspan="1">−0.064</td>
<td valign="middle" align="center" rowspan="1" colspan="1">0.019</td>
<td valign="middle" align="center" rowspan="1" colspan="1">−0.107</td>
<td valign="middle" align="center" rowspan="1" colspan="1">−0.031</td>
<td valign="middle" align="center" rowspan="1" colspan="1">0.000</td>
</tr>
<tr><td valign="middle" align="left" rowspan="1" colspan="1">SSRS→GSES→PSQI</td>
<td valign="middle" align="center" rowspan="1" colspan="1">−0.094</td>
<td valign="middle" align="center" rowspan="1" colspan="1">−0.041</td>
<td valign="middle" align="center" rowspan="1" colspan="1">0.014</td>
<td valign="middle" align="center" rowspan="1" colspan="1">−0.075</td>
<td valign="middle" align="center" rowspan="1" colspan="1">−0.018</td>
<td valign="middle" align="center" rowspan="1" colspan="1">0.000</td>
</tr>
<tr><td valign="middle" align="left" rowspan="1" colspan="1">SSRS→SASR→PSQI</td>
<td valign="middle" align="center" rowspan="1" colspan="1">−0.062</td>
<td valign="middle" align="center" rowspan="1" colspan="1">−0.028</td>
<td valign="middle" align="center" rowspan="1" colspan="1">0.012</td>
<td valign="middle" align="center" rowspan="1" colspan="1">−0.056</td>
<td valign="middle" align="center" rowspan="1" colspan="1">−0.009</td>
<td valign="middle" align="center" rowspan="1" colspan="1">0.002</td>
</tr>
<tr><td valign="middle" align="left" rowspan="1" colspan="1">SSRS→SAS→GSES→PSQI</td>
<td valign="middle" align="center" rowspan="1" colspan="1">−0.031</td>
<td valign="middle" align="center" rowspan="1" colspan="1">−0.014</td>
<td valign="middle" align="center" rowspan="1" colspan="1">0.007</td>
<td valign="middle" align="center" rowspan="1" colspan="1">−0.030</td>
<td valign="middle" align="center" rowspan="1" colspan="1">−0.002</td>
<td valign="middle" align="center" rowspan="1" colspan="1">0.025</td>
</tr>
<tr><td valign="middle" align="left" rowspan="1" colspan="1">SSRS→SAS→SASR→PSQI</td>
<td valign="middle" align="center" rowspan="1" colspan="1">−0.037</td>
<td valign="middle" align="center" rowspan="1" colspan="1">−0.016</td>
<td valign="middle" align="center" rowspan="1" colspan="1">0.008</td>
<td valign="middle" align="center" rowspan="1" colspan="1">−0.037</td>
<td valign="middle" align="center" rowspan="1" colspan="1">−0.005</td>
<td valign="middle" align="center" rowspan="1" colspan="1">0.002</td>
</tr>
</tbody>
</table>
</table-wrap>
</floats-group>
</pmc>
<affiliations><list><country><li>République populaire de Chine</li>
</country>
<region><li>Hubei</li>
</region>
<settlement><li>Pékin</li>
<li>Wuhan</li>
</settlement>
<orgName><li>Université de Wuhan</li>
</orgName>
</list>
<tree><country name="République populaire de Chine"><noRegion><name sortKey="Xiao, Han" sort="Xiao, Han" uniqKey="Xiao H" first="Han" last="Xiao">Han Xiao</name>
</noRegion>
<name sortKey="Kong, Desheng" sort="Kong, Desheng" uniqKey="Kong D" first="Desheng" last="Kong">Desheng Kong</name>
<name sortKey="Li, Shiyue" sort="Li, Shiyue" uniqKey="Li S" first="Shiyue" last="Li">Shiyue Li</name>
<name sortKey="Yang, Ningxi" sort="Yang, Ningxi" uniqKey="Yang N" first="Ningxi" last="Yang">Ningxi Yang</name>
<name sortKey="Zhang, Yan" sort="Zhang, Yan" uniqKey="Zhang Y" first="Yan" last="Zhang">Yan Zhang</name>
</country>
</tree>
</affiliations>
</record>
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