{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T14:24:25Z","timestamp":1791469465028,"version":"4.3.4"},"reference-count":32,"publisher":"BMJ","issue":"10","license":[{"start":{"date-parts":[[2020,10,20]],"date-time":"2020-10-20T00:00:00Z","timestamp":1603152000000},"content-version":"unspecified","delay-in-days":19,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004359","name":"Vetenskapsr\u00e5det","doi-asserted-by":"publisher","award":["No. 2018-00648"],"award-info":[{"award-number":["No. 2018-00648"]}],"id":[{"id":"10.13039\/501100004359","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004912","name":"Sichuan University","doi-asserted-by":"publisher","award":["No. 2020scunCoVyingji1002"],"award-info":[{"award-number":["No. 2020scunCoVyingji1002"]}],"id":[{"id":"10.13039\/501100004912","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004912","name":"Sichuan University","doi-asserted-by":"publisher","award":["No. 2020scunCoVyingji1005"],"award-info":[{"award-number":["No. 2020scunCoVyingji1005"]}],"id":[{"id":"10.13039\/501100004912","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["No. 81801359"],"award-info":[{"award-number":["No. 81801359"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["No. 81971262"],"award-info":[{"award-number":["No. 81971262"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100013365","name":"West China Hospital","doi-asserted-by":"crossref","award":["No. HX-2019-nCoV-014"],"award-info":[{"award-number":["No. HX-2019-nCoV-014"]}],"id":[{"id":"10.13039\/501100013365","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100013365","name":"West China Hospital","doi-asserted-by":"crossref","award":["No. HX-2019-nCoV-019"],"award-info":[{"award-number":["No. HX-2019-nCoV-019"]}],"id":[{"id":"10.13039\/501100013365","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2020,10,8]]},"published-print":{"date-parts":[[2020,10]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>The COVID-19 outbreak has caused enormous strain on healthcare systems, and healthcare trainees, which comprise the future healthcare workforce, may be a vulnerable group. It is essential to assess the psychological distress experienced by healthcare trainees during the COVID-19 outbreak.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design, setting and participants<\/jats:title>\n                    <jats:p>A cross-sectional study with 4184 healthcare trainees at Sichuan University in China was implemented during 7\u201313 February 2020. Participants were grouped by training programmes (medicine, medical technology and nursing) and training stages (undergraduate, postgraduate and residency).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main outcomes<\/jats:title>\n                    <jats:p>COVID-19\u2013related psychological distress and acute stress reaction (ASR) were assessed using the Kessler 6-item Psychological Distress Scale and the Impact of Event Scale\u2013Revised, respectively. We estimated the ORs of distress by comparing trainees across programmes and training stages using multivariable logistic regression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Significant psychological distress was found in 1150 (30.90%) participants and probable ASR in 403 (10.74%). Compared with the nursing trainees, the medical trainees (OR 1.54, 95%\u2009CI 1.22 to 1.95) reported a higher burden of psychological distress during the outbreak, while the medical technology trainees (OR 1.25, 95%\u2009CI 0.97 to 1.62) reported similar symptom scores. Postgraduates (OR 1.55, 95%\u2009CI 1.16 to 2.08) in medicine had higher levels of distress than their undergraduate counterparts did, whereas the nursing residents (OR 0.38, 95%\u2009CI 0.20 to 0.71) reported a lower burden than did nursing undergraduates. A positive association was found between having active clinical duties during the outbreak and distress (OR 1.17, 95%\u2009CI 0.98 to 1.39), particularly among the medical trainees (OR 1.85, 95%\u2009CI 1.47 to 2.33) and undergraduates (OR 4.20, 95%\u2009CI 1.61 to 11.70). No clear risk patterns of ASR symptoms were observed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Medical trainees, particularly postgraduates and those with active clinical duties, were at risk for psychological distress during the COVID-19 outbreak. Stress management may be considered for high-risk healthcare trainees.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2020-041671","type":"journal-article","created":{"date-parts":[[2020,10,20]],"date-time":"2020-10-20T17:11:24Z","timestamp":1603213884000},"page":"e041671","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":24,"title":["COVID-19 outbreak\u2013related psychological distress among healthcare trainees: a cross-sectional study in China"],"prefix":"10.1136","volume":"10","author":[{"given":"Yue","family":"Wang","sequence":"first","affiliation":[{"name":"Mental Health Center, West China Hospital, Sichuan University, Chengdu, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuchen","family":"Li","sequence":"additional","affiliation":[{"name":"Mental Health Center, West China Hospital, Sichuan University, Chengdu, China"},{"name":"West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jingwen","family":"Jiang","sequence":"additional","affiliation":[{"name":"West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuying","family":"Feng","sequence":"additional","affiliation":[{"name":"Student Affairs Office, West China Hospital, Sichuan University, Chengdu, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4186-8661","authenticated-orcid":false,"given":"Donghao","family":"Lu","sequence":"additional","affiliation":[{"name":"Clinical Research Center for Breast Diseases, West China Hospital, Sichuan University, Chengdu, China"},{"name":"Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3113-9577","authenticated-orcid":false,"given":"Wei","family":"Zhang","sequence":"additional","affiliation":[{"name":"Mental Health Center, West China Hospital, Sichuan University, Chengdu, China"},{"name":"West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huan","family":"Song","sequence":"additional","affiliation":[{"name":"West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China"},{"name":"Center of Public Health Sciences, University of Iceland, Reykjavik, Iceland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2020,10,20]]},"reference":[{"key":"2025121221440526000_10.10.e041671.1","unstructured":"WHO . World Health Organization: coronavirus disease (COVID-19) outbreak situation. World Health Organization, 2020."},{"key":"2025121221440526000_10.10.e041671.2","doi-asserted-by":"crossref","first-page":"e2014053","DOI":"10.1001\/jamanetworkopen.2020.14053","article-title":"Prevalence of and risk factors associated with mental health symptoms among the general population in China during the coronavirus disease 2019 pandemic","volume":"3","author":"Shi","year":"2020","journal-title":"JAMA Netw Open"},{"key":"2025121221440526000_10.10.e041671.3","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.genhosppsych.2020.06.007","article-title":"Psychological distress, coping behaviors, and preferences for support among New York healthcare workers during the COVID-19 pandemic","volume":"66","author":"Shechter","year":"2020","journal-title":"Gen Hosp Psychiatry"},{"key":"2025121221440526000_10.10.e041671.4","doi-asserted-by":"crossref","first-page":"877","DOI":"10.1016\/j.jiph.2020.05.021","article-title":"The psychological impact of COVID-19 pandemic on health care workers in a MERS-CoV endemic country","volume":"13","author":"Temsah","year":"2020","journal-title":"J Infect Public Health"},{"key":"2025121221440526000_10.10.e041671.5","article-title":"Psychosocial burden of healthcare professionals in times of COVID-19 \u2013 a survey conducted at the University Hospital Augsburg","volume":"18","author":"Zerbini","year":"2020","journal-title":"Ger Med Sci"},{"key":"2025121221440526000_10.10.e041671.6","doi-asserted-by":"crossref","first-page":"e203976","DOI":"10.1001\/jamanetworkopen.2020.3976","article-title":"Factors associated with mental health outcomes among health care workers exposed to coronavirus disease 2019","volume":"3","author":"Lai","year":"2020","journal-title":"JAMA Netw Open"},{"key":"2025121221440526000_10.10.e041671.7","doi-asserted-by":"publisher","DOI":"10.1016\/j.bbi.2020.04.049"},{"key":"2025121221440526000_10.10.e041671.8","doi-asserted-by":"crossref","DOI":"10.1016\/S0140-6736(20)30795-9","article-title":"Medical student involvement in the COVID-19 response","volume":"395","year":"2020","journal-title":"Lancet"},{"key":"2025121221440526000_10.10.e041671.9","first-page":"1790-1791","article-title":"A bold response to the COVID-19 pandemic: medical students, national service, and public health","volume":"323","author":"Bauchner","year":"2020","journal-title":"JAMA"},{"key":"2025121221440526000_10.10.e041671.10","unstructured":"Health Commission of Sichuan Province C . The latest situation of new coronavirus pneumonia in Sichuan Province (released on February 7, 2020), 2020. Available: https:\/\/dwz.cn\/Y1p9dhTl"},{"key":"2025121221440526000_10.10.e041671.11","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1016\/j.comppsych.2015.08.011","article-title":"The 6-item Kessler psychological distress scale to survey serious mental illness among Chinese undergraduates: psychometric properties and prevalence estimate","volume":"63","author":"Kang","year":"2015","journal-title":"Compr Psychiatry"},{"key":"2025121221440526000_10.10.e041671.12","doi-asserted-by":"publisher","DOI":"10.1002\/mpr.257"},{"key":"2025121221440526000_10.10.e041671.13","doi-asserted-by":"crossref","DOI":"10.1002\/mpr.333","article-title":"Screening for serious mental illness in the general population with the K6 screening scale: results from the WHO World Mental Health (WMH) survey initiative","volume":"20","author":"Kessler","year":"2011","journal-title":"Int J Methods Psychiatr Res"},{"key":"2025121221440526000_10.10.e041671.14","doi-asserted-by":"publisher","DOI":"10.1007\/s00127-003-0611-x"},{"key":"2025121221440526000_10.10.e041671.15","article-title":"Psychometric testing of the Impact of Event Scale-Revised (IES-R) Chinese version and current status in three major types of cancer survivors in Taiwan","volume":"23","author":"Lai","year":"2014","journal-title":"Psycho-Oncology"},{"key":"2025121221440526000_10.10.e041671.16","first-page":"521","article-title":"Acute stress and depression 3 days after vaginal delivery\u2014observational, comparative study","volume":"33","author":"Imsiragi\u0107","year":"2009","journal-title":"Coll Antropol"},{"key":"2025121221440526000_10.10.e041671.17","first-page":"27","article-title":"Effects of social and policy supports on work\u2013family conflict in physicians","volume":"23","author":"HUANG","year":"2009","journal-title":"Chinese Mental Health Journal"},{"key":"2025121221440526000_10.10.e041671.18","doi-asserted-by":"crossref","DOI":"10.1017\/S0950268820001107","article-title":"The prevalence and influencing factors in anxiety in medical workers fighting COVID-19 in China: a cross-sectional survey","volume":"148","author":"Liu","year":"2020","journal-title":"Epidemiol Infect"},{"key":"2025121221440526000_10.10.e041671.19","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1159\/000507639","article-title":"Mental health and psychosocial problems of medical health workers during the COVID-19 epidemic in China","volume":"89","author":"Zhang","year":"2020","journal-title":"Psychother Psychosom"},{"key":"2025121221440526000_10.10.e041671.20","doi-asserted-by":"crossref","unstructured":"Liu ZR , Han B , Jiang RM , et al . Mental health status of doctors and nurses during COVID-19 epidemic in China (3\/4\/2020). Available: http:\/\/dxdoiorg\/102139\/ssrn3551329","DOI":"10.2139\/ssrn.3551329"},{"key":"2025121221440526000_10.10.e041671.21","doi-asserted-by":"publisher","DOI":"10.4065\/80.12.1613"},{"key":"2025121221440526000_10.10.e041671.22","doi-asserted-by":"crossref","DOI":"10.1186\/s12909-017-1064-3","article-title":"Burnout in medical students: a systematic review of experiences in Chinese medical schools","volume":"17","author":"Chunming","year":"2017","journal-title":"BMC Med Educ"},{"key":"2025121221440526000_10.10.e041671.23","doi-asserted-by":"publisher","DOI":"10.1097\/00001888-200102000-00010"},{"key":"2025121221440526000_10.10.e041671.24","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-149-5-200809020-00008"},{"key":"2025121221440526000_10.10.e041671.25","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2929.2004.01814.x"},{"key":"2025121221440526000_10.10.e041671.26","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1111\/acem.13972","article-title":"Senior medical students in the COVID-19 response: an opportunity to be proactive","volume":"27","author":"Stokes","year":"2020","journal-title":"Acad Emerg Med"},{"key":"2025121221440526000_10.10.e041671.27","unstructured":"Services CfMM . Teaching hospitals, teaching physicians and medical residents: CMS flexibilities to fight COVID-19, 2020."},{"key":"2025121221440526000_10.10.e041671.28","doi-asserted-by":"crossref","unstructured":"Sun L , Sun Z , Wu L , et al . Prevalence and risk factors of acute posttraumatic stress symptoms during the COVID-19 outbreak in Wuhan, China. medRxiv 2020.","DOI":"10.1101\/2020.03.06.20032425"},{"key":"2025121221440526000_10.10.e041671.29","doi-asserted-by":"crossref","DOI":"10.1016\/j.psychres.2020.112934","article-title":"The psychological impact of the COVID-19 epidemic on college students in China","volume":"287","author":"Cao","year":"2020","journal-title":"Psychiatry Res"},{"key":"2025121221440526000_10.10.e041671.30","doi-asserted-by":"publisher","DOI":"10.1016\/j.nedt.2011.05.007"},{"key":"2025121221440526000_10.10.e041671.31","unstructured":"Hawkins M . 2017 final year medical residents survey, 2018."},{"key":"2025121221440526000_10.10.e041671.32","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1007\/s00508-015-0786-7","article-title":"Physicians' exodus: why medical graduates leave Austria or do not work in clinical practice","volume":"127","author":"Scharer","year":"2015","journal-title":"Wien Klin Wochenschr"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2020-041671","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,13]],"date-time":"2025-12-13T05:44:17Z","timestamp":1765604657000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2020-041671"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,10]]},"references-count":32,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2020,10,20]]},"published-print":{"date-parts":[[2020,10]]}},"alternative-id":["10.1136\/bmjopen-2020-041671"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2020-041671","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,10]]}}}