Is Higher Subjective Fear Predictive of Post-Traumatic Stress Symptoms in a Sample of the Chinese General Public?

Background: COVID-19 has taken a huge toll on medical resources and the economy, and will inevitably have an impact on public mental health. PTSD, as the most common mental illness after epidemic, must be seriously addressed. This study aimed to investigate the subjective fear of the Chinese general public during COVID-19 and to explore how it affected the development of PTSD. Methods: An online questionnaire survey was conducted among 1,009 people from Jan. 30 to Feb. 14, 2020 (about 1 month after the COVID-19 outbreak). The subjective fear was measured by a self-reported single choice question. Four items from the Pittsburgh Sleep Quality Index (PSQI) were selected to measure subjects’ sleep quality, and their post-traumatic stress symptoms (PTSS) were measured by PTSD Checklist for DSM-5 (PCL-5). Pearson correlation, hierarchical multivariate regression analysis, multiple mediator model, and bootstrapping were used in statistical analyses. Results: Different people showed different levels of subjective fear in response to the outbreak. There was a significant positive correlation between subjective fear and the total score of PCL-5 (R=0.513, p<0.01), meaning that the higher degree of subjective fear, the more severe the symptoms of post-traumatic stress. Subjective fear was an important predictor of PTSS, accounting for 24.3% of variance. The total effect of subjective fear on PCL-5 scores was significant (total effect =7.426, SE =0.405, 95% CI = 6.631 to 8.221). The total indirect effect of subjective fear on PCL-5 scores through sleep quality was also significant (total indirect effect =1.945, SE =0.258, 95% CI = 1.436 to 2.470). Conclusions: Subjective fear has an important predictive effect on PTSS. In addition to the direct effect, our findings firstly demonstrate the mediating role of sleep quality in the relationship of subjective fear and PTSS.