Acessibilidade / Reportar erro

Anxiety and depression in healthcare workers during the COVID-19 pandemic

Ansiedade e depressão em profissionais da saúde durante a pandemia da COVID-19

Abstract

Objective

To investigate the prevalence and associated factors of depression and anxiety among hospital healthcare workers during the COVID-19 pandemic in the extreme south of Brazil.

Method

Cross-sectional study was conducted with 264 healthcare workers, between August and December 2020. Depression and anxiety were assessed using the Patient Health Questionnaire and the Generalized Anxiety Scale. Multivariable linear regression analysis was performed.

Results

The prevalence of depression and anxiety among healthcare workers was 32.4% and 26.2%, respectively. The profession of nursing technician, having a family member who had lost a job, being responsible for family income, being 50 or more years old, being divorced or widowed, having a test for COVID-19, having suffered a traumatic event in life and having received psychological counseling at work were associated with depression and anxiety.

Conclusion

In this study, receiving psychological counseling at work was a protective factor for anxiety and depression.

Keywords:
GAD-7; Health personnel; Mental disorders; PHQ-9; SARS-CoV-2

Resumo

Objetivo

Investigar a prevalência e os fatores associados à depressão e ansiedade entre profissionais de saúde durante a pandemia de COVID-19 no extremo sul do Brasil.

Método

Estudo transversal realizado com 264 profissionais de saúde, entre agosto e dezembro de 2020. Depressão e ansiedade foram avaliadas por meio do Questionário de Saúde do Paciente e da Escala de Ansiedade Generalizada. Foi realizada análise de regressão linear multivariável.

Resultados

A prevalência de depressão e ansiedade entre os profissionais de saúde foi de 32,4% e 26,2%, respectivamente. Ser técnico de enfermagem, ter familiar que tenha perdido o emprego, ser responsável pela renda familiar, ter 50 anos ou mais, ser divorciado/viúvo, ter feito exame para COVID-19, ter sofrido evento traumático na vida e ter recebido aconselhamento psicológico no trabalho esteve associado a depressão e ansiedade.

Conclusão

Neste estudo, receber aconselhamento psicológico no trabalho foi um fator de proteção para ansiedade e depressão.

Palavras-chave:
GAD-7; Pessoal de Saúde; Transtornos mentais; PHQ-9; SARS-CoV-2

The first case of the new coronavirus was identified in December 2019, in the city of Wuhan, Hubei province, China, and later spread around the world (The Novel Coronavirus Pneumonia Emergency Response Epidemiology Team, 2020The Novel Coronavirus Pneumonia Emergency Response Epidemiology Team . (2020). The Epidemiological Characteristics of an Outbreak of 2019 Novel Coronavirus Diseases (COVID-19) - China, 2020. China CDC Weekly, 2(8), 113-122. https://doi.org/10.46234/ccdcw2020.032
https://doi.org/10.46234/ccdcw2020.032 ...
). In Brazil, the first case of COVID-19 was notified on February 26, 2020. Four years later, in February 2024, the country had registered more than 38 million cases and more than 708 thousand deaths, being among the five countries with the highest number of cases in the world. Globally, there were more than 774 million cases and more than 7 million deaths at the beginning of 2024 (World Health Organization, 2024World Health Organization. (2024, February). Coronavírus (COVID-19) Dashboard. https://data.who.int/dashboards/covid19/cases?n=c
https://data.who.int/dashboards/covid19/...
).

The COVID-19 pandemic has caused an increase in demand for health services and this has impacted the mental health of workers in these services. A Chinese study found that in the year 2020 during the COVID-19 pandemic, a considerable proportion of health professionals reported symptoms of depression (50.4%), anxiety (44.6%), insomnia (34.0%), and stress (71.5%) (Lai et al., 2020Lai, J., Ma, S., Wang, Y., Cai, Z., Hu, J., Wei, N., Wu, J., Du, H., Chen, T., Li, R., Tan, H., Kang, L., Yao, L., Huang, M., Wang, H., Wang, G., Liu, Z., & Hu, S. (2020). Factors associated with mental health outcomes among health care workers exposed to Coronavirus Disease 2019. JAMA Network Open, 3(3), e203976. https://doi.org/10.1001/jamanetworkopen.2020.3976
https://doi.org/10.1001/jamanetworkopen....
). Another study also carried out in China, detected a prevalence of 34.4% of common mental disorders (depression, anxiety, and stress), with 28.6% of these professionals having moderate to severe symptoms shortly after the onset of the pandemic (Kang et al., 2020Kang, L., Ma, S., Chen, M., Yang, J., Wang, Y., Li, R., Yao, L., Bai, H., Cai, Z., Xiang Yang, B., Hu, S., Zhang, K., Wang, G., Ma, C., & Liu, Z. (2020). Impact on mental health and perceptions of psychological care among medical and nursing staff in Wuhan during the 2019 novel coronavirus disease outbreak: A cross-sectional study. Brain, Behavior, and Immunity, 87, 11-17. https://doi.org/10.1016/j.bbi.2020.03.028
https://doi.org/10.1016/j.bbi.2020.03.02...
). Furthermore, Lu et al. (2020Lu, W., Wang, H., Lin, Y., & Li, L. (2020). Psychological status of medical workforce during the COVID-19 pandemic: A cross-sectional study. Psychiatry Research, 288, 112936. https://doi.org/10.1016/j.psychres.2020.112936
https://doi.org/10.1016/j.psychres.2020....
) described that frontline medical staff, in close contact with patients infected with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), were twice as likely to suffer from anxiety and depression (Lu et al., 2020Lu, W., Wang, H., Lin, Y., & Li, L. (2020). Psychological status of medical workforce during the COVID-19 pandemic: A cross-sectional study. Psychiatry Research, 288, 112936. https://doi.org/10.1016/j.psychres.2020.112936
https://doi.org/10.1016/j.psychres.2020....
).

Despite the importance of this topic, data on the mental health of Brazilian health professionals before the pandemic were scarce, which limited the discussion and knowledge about this population. Therefore, this study aimed to investigate the prevalence and factors associated with depression and anxiety in healthcare workers in the extreme south of Brazil, during the COVID-19 pandemic.

Method

Participants

This is a cross-sectional study nested in a longitudinal study of 264 health professionals (physicians, nurses, nursing technicians, radiology technicians, and physiotherapists) from two hospitals in the city of Rio Grande, in the extreme south of Brazil. According to data from the Brazilian Institute of Geography and Statistics, the municipality has an estimated population of 210,005 inhabitants (Instituto Brasileiro de Geografia e Estatística, 2022Instituto Brasileiro de Geografia e Estatística. (2022). Cidades e Estados. https://www.ibge.gov.br/cidades-e-estados.html
https://www.ibge.gov.br/cidades-e-estado...
). In total, the two hospitals in the Rio Grande provided 20 Intensive Care Unit (ICU) beds exclusively for COVID-19, 63 beds in the inpatient unit exclusively for COVID-19, 6 emergency room beds exclusively for COVID-19, and 4 exclusive pediatric ICU beds for COVID-19.

Procedures

Data collection was carried out between August and December 2020. The departments were randomly sampled in the two hospitals, and all health professionals in these departments were invited to participate in this study.

Instruments

The questionnaire consisted of five parts: sociodemographic characteristics (gender, age, skin color, marital status, responsible for the family income); occupational characteristics (profession, length of occupation, weekly working hours, workplace); variables related to the COVID-19 pandemic (having a family member who lost their job during the pandemic, having received psychological counseling at work during the pandemic, having been tested for COVID-19, having been diagnosed with COVID-19), prior risk (having chronic diseases and having suffered a traumatic event in life) and mental health assessment (anxiety and depression). The degree of depression and anxiety symptoms was assessed by the Brazilian versions of the 9-item Patient Health Questionnaire (PHQ-9) and the 7-item Generalized Anxiety Disorder Scale (GAD-7), respectively. The PHQ-9 contains nine items with Likert scale responses (Santos et al., 2013Santos, I. S., Tavares, B. F., Munhoz, T. N., Almeida, L. S. P., Silva, N. T. B., Tams, B. D., Patella, A. M., & Matijasevich, A. (2013). Sensibilidade e especificidade do Patient Health Questionnaire-9 (PHQ-9) entre adultos da população geral. Cadernos de Saúde Pública, 29(8), 1533-1543. https://doi.org/10.1590/0102-311X00144612
https://doi.org/10.1590/0102-311X0014461...
). The GAD-7 has seven items with answers on a Likert scale (Bártolo et al., 2017Bártolo, A., Monteiro, S., & Pereira, A. (2017). Factor structure and construct validity of the Generalized Anxiety Disorder 7-item (GAD-7) among Portuguese college students. Cadernos de Saúde Pública, 33(9). https://doi.org/10.1590/0102-311x00212716
https://doi.org/10.1590/0102-311x0021271...
).

Statistical Analysis

Data analysis was performed using the statistical software Stata version 14.2 (StataCorp). The significance level was set at α = 0.05. To determine the possible factors associated with symptoms of depression and anxiety in the participants, a linear regression analysis was performed, and the associations between the associated factors and the results were presented as a beta coefficient and a 95% confidence interval after adjusting for factors of confusion, including gender, age, skin color, marital status, being responsible for the family income, profession, time of occupation, weekly working hours, place of work, having a family member who lost their job during the pandemic, having received psychological counseling during the pandemic, having been tested for COVID-19, having been diagnosed with COVID-19, having chronic illnesses and having suffered a traumatic life event.

This study was approved by the Research Ethics Committee of the Federal University of Rio Grande and by the National Research Ethics Committee under number 33018720.5.0000.5324 (presentation certificate of ethical appreciation). Verbal informed consent was provided by all research participants prior to their participation.

Results

Of the 264 health professionals recruited, 78.8% were female, 73.8% were white and 70.1% were between 30 and 49 years old. Regarding profession, 47.7% of the sample consisted of nursing technicians, 53.4% had less than five years of occupation, 56.3% worked up to 40 hours a week and 31.6% worked in two or more places. During the period of the COVID-19 pandemic, 21.2% said they had a family member who had lost their job, 65% had not received psychological guidance at work and 24.1% had not been tested for COVID-19. Among the professionals tested, 19.8% had positive results. In addition, 24.2% of professionals had chronic diseases (diabetes, hypertension or asthma) and 63.9% had already suffered a traumatic event in their lives (Table 1).

Table 1
Description of sample characteristics (n = 264)

Prevalence and Factors Associated with Depression

Of the research participants, 32.4% had symptoms of depression. In the crude analysis, the variables profession, having a family member who lost their job during the pandemic, having received psychological guidance at work during the pandemic, having taken the COVID-19 test, and having suffered a traumatic event in life were associated with the outcome. In the adjusted analysis, the association was maintained.

Nursing technicians had an average of 3.78 points higher in the depression score when compared to radiology technicians. Professionals who had a family member who lost their job during the COVID-19 pandemic averaged 2.94 points higher in their depression score compared to those who did not have a family member who lost their job during the COVID-19 pandemic. COVID-19 pandemic. Those who received psychological counseling at work had an average of 2.00 points lower on their depression score compared to those who did not receive psychological counseling at work. Professionals tested for COVID-19 had an average of 2.47 points higher in depression score compared to those who were not tested for COVID-19. In addition, professionals who had already suffered a traumatic event in their life had an average of 2.25 points higher in the depression score than those who had not suffered a traumatic event in their life (Table 2).

Table 2
The linear regression coefficient of depression and anxiety scores according to sociodemographic characteristics, occupational characteristics, variables related to the COVID-19 pandemic, and previous risk, of healthcare workers during the COVID-19 pandemic in southern Brazil in 2020 (n = 264)

Prevalence and Factors Associated with Anxiety

Of the study participants, 26.2% had anxiety symptoms. In the crude analysis, having a family member who lost their job during the pandemic, having received psychological counseling at work, having been tested for COVID-19, and having suffered a traumatic life event were associated with the outcome. In the adjusted analysis, age, being responsible family income and marital status was associated with the outcome. In addition, having received psychological counseling at work, having been tested for COVID-19, and having suffered a traumatic life event maintained an association with the anxiety outcome. However, having a family member lose their job during the COVID-19 pandemic lost association with the outcome.

Professionals aged 50 years or older had an average of 3.18 points less in the anxiety score when compared to professionals aged 20 to 29 years; the anxiety score decreased with increasing age. Divorced or widowed professionals had an average of 3.59 points less in the anxiety score when compared to professionals who were married or lived with a partner. Those who received counseling at work during the pandemic averaged 1.77 points lower on their anxiety score compared to those who did not receive counseling at work. Professionals who are solely responsible for family income had an average of 1.81 points higher in the anxiety score compared to those who are not solely responsible for family income. Professionals tested for COVID-19 had an average of 2.52 points higher in the anxiety score when compared to those not tested. In addition, professionals who had already suffered a traumatic event in their lives had an average of 2.54 points higher in the anxiety score than those who had not suffered a traumatic event in their life (Table 2).

Discussion

Since the beginning of the COVID-19 pandemic, several countries have been concerned about the working conditions of their health professionals. Some countries already had protocols for these situations, due to previous epidemics. However, other countries, such as Brazil, did not have previous studies that investigated the psychological characteristics of health professionals exposed to an event such as an endemic/pandemic. The uncertain scenario of the pandemic in Brazil and the rapid increase in cases and deaths from COVID-19 could contribute to the emergence of psychological symptoms. In this study, the prevalence of depression and anxiety in health professionals was 32.4% and 26.2%, respectively. These prevalences were higher than those found in other studies that also used the GAD-7 and PHQ-9 scales (Naser et al., 2020Naser, A. Y., Dahmash, E. Z., Al‐Rousan, R., Alwafi, H., Alrawashdeh, H. M., Ghoul, I., Abidine, A., Bokhary, M. A., AL‐Hadithi, H. T., Ali, D., Abuthawabeh, R., Abdelwahab, G. M., Alhartani, Y. J., al Muhaisen, H., Dagash, A., & Alyami, H. S. (2020). Mental health status of the general population, healthcare professionals, and university students during 2019 coronavirus disease outbreak in Jordan: A cross‐sectional study. Brain and Behavior, 10(8). https://doi.org/10.1002/brb3.1730
https://doi.org/10.1002/brb3.1730...
; Rossi et al., 2020Rossi, R., Socci, V., Pacitti, F., di Lorenzo, G., di Marco, A., Siracusano, A., & Rossi, A. (2020). Mental Health Outcomes Among Frontline and Second-Line Health Care Workers During the Coronavirus Disease 2019 (COVID-19) Pandemic in Italy. JAMA Network Open, 3(5), e2010185. https://doi.org/10.1001/jamanetworkopen.2020.10185
https://doi.org/10.1001/jamanetworkopen....
; Zhu et al., 2020Zhu, Z., Xu, S., Wang, H., Liu, Z., Wu, J., Li, G., Miao, J., Zhang, C., Yang, Y., Sun, W., Zhu, S., Fan, Y., Chen, Y., Hu, J., Liu, J., & Wang, W. (2020). COVID-19 in Wuhan: Sociodemographic characteristics and hospital support measures associated with the immediate psychological impact on healthcare workers. eClinicalMedicine, 24, 100443. https://doi.org/10.1016/j.eclinm.2020.100443
https://doi.org/10.1016/j.eclinm.2020.10...
), and a prevalence combined with a systematic review carried out with 13 studies (Pappa et al., 2020Pappa, S., Ntella, V., Giannakas, T., Giannakoulis, V. G., Papoutsi, E., & Katsaounou, P. (2020). Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis. Brain, Behavior, and Immunity, 88, 901-907. https://doi.org/10.1016/j.bbi.2020.05.026
https://doi.org/10.1016/j.bbi.2020.05.02...
). However, our results on the prevalence of anxiety and depression are lower than those found by other studies that also used the same scales (AlAteeq et al., 2020AlAteeq, D. A., Aljhani, S., Althiyabi, I., & Majzoub, S. (2020). Mental health among healthcare providers during coronavirus disease (COVID-19) outbreak in Saudi Arabia. Journal of Infection and Public Health, 13(10), 1432-1437. https://doi.org/10.1016/j.jiph.2020.08.013
https://doi.org/10.1016/j.jiph.2020.08.0...
; Gu et al., 2022Gu, Y., Zhu, Y., & Xu, G. (2022). Factors associated with mental health outcomes among healthcare workers in the Fangcang shelter hospital in China. International Journal of Social Psychiatry, 68(1), 64-72. https://doi.org/10.1177/0020764020975805
https://doi.org/10.1177/0020764020975805...
; Lai et al., 2020Lai, J., Ma, S., Wang, Y., Cai, Z., Hu, J., Wei, N., Wu, J., Du, H., Chen, T., Li, R., Tan, H., Kang, L., Yao, L., Huang, M., Wang, H., Wang, G., Liu, Z., & Hu, S. (2020). Factors associated with mental health outcomes among health care workers exposed to Coronavirus Disease 2019. JAMA Network Open, 3(3), e203976. https://doi.org/10.1001/jamanetworkopen.2020.3976
https://doi.org/10.1001/jamanetworkopen....
).

Some of the characteristics of these studies may have contributed to the differences in prevalence. For example, a Chinese study found a prevalence of depression and anxiety of 50.4% and 44.6%, respectively, in approximately 60.5% of professionals working in Wuhan and 41.5% on the frontlines of COVID-19, in the initial period of the pandemic (i.e. January and February 2020) (Lai et al., 2020Lai, J., Ma, S., Wang, Y., Cai, Z., Hu, J., Wei, N., Wu, J., Du, H., Chen, T., Li, R., Tan, H., Kang, L., Yao, L., Huang, M., Wang, H., Wang, G., Liu, Z., & Hu, S. (2020). Factors associated with mental health outcomes among health care workers exposed to Coronavirus Disease 2019. JAMA Network Open, 3(3), e203976. https://doi.org/10.1001/jamanetworkopen.2020.3976
https://doi.org/10.1001/jamanetworkopen....
). This may have overestimated the prevalence in this population, given that, during this period, China found an increase in cases and hospitalizations due to the disease, and studies are still being conducted to understand the mechanism and etiology of SARS-CoV-2. Meanwhile, a study in Jordan, which found a prevalence of 21.2% and 11.3% for depression and anxiety, respectively, described a profile of health professionals, where 48.2% were doctors and only 53.1% were directly involved in the COVID-19 pandemic (Naser et al., 2020Naser, A. Y., Dahmash, E. Z., Al‐Rousan, R., Alwafi, H., Alrawashdeh, H. M., Ghoul, I., Abidine, A., Bokhary, M. A., AL‐Hadithi, H. T., Ali, D., Abuthawabeh, R., Abdelwahab, G. M., Alhartani, Y. J., al Muhaisen, H., Dagash, A., & Alyami, H. S. (2020). Mental health status of the general population, healthcare professionals, and university students during 2019 coronavirus disease outbreak in Jordan: A cross‐sectional study. Brain and Behavior, 10(8). https://doi.org/10.1002/brb3.1730
https://doi.org/10.1002/brb3.1730...
). These differences in prevalence can be explained by the different cutoff points adopted, cultural differences between countries, and the pandemic situation.

It is important to mention that the literature related to psychosocial care in an emergency context highlights that the first months after the event are essential for emergency preventive actions, considering that in this period individuals may present common (Fundação Oswaldo Cruz, 2020Fundação Oswaldo Cruz. (2020). Saúde Mental e Atenção Psicossocial na Pandemia da Covid-19. Recomendações Gerais. https://www.fiocruzbrasilia.fiocruz.br/wp-content/uploads/2020/04/Sa%C3%BAde-Mental-e-Aten%C3%A7%C3%A3o-Psicossocial-na-Pandemia-Covid-19-recomenda%C3%A7%C3%B5es-gerais.pdf
https://www.fiocruzbrasilia.fiocruz.br/w...
). However, the different phases of the pandemic may have increased the period of these responses; at a time when European countries, for example, were experiencing a decrease in COVID-19 cases and deaths, Brazil reached its peak. The anxiety and depressive symptoms found in this study from August to December 2020 represent a period in which the region faced an increase in the number of cases and deaths (Ministério da Saúde, 2021Ministério da Saúde (Brasil). (2021, December). Painel Coronavírus. Available from: https://covid.saude.gov.br/
https://covid.saude.gov.br/ ...
), but they had already been on alert since March 2020 with the initiation of COVID-19 prevention measures. Although it was not possible to identify whether these symptoms were classified as common reactions or were already chronic, it is important to understand that there are other factors related to these symptoms.

Regarding these associated factors, professionals aged 50 years or older had lower anxiety scores than their younger counterparts. This result is similar to that found in other studies during the COVID-19 pandemic (AlAteeq et al., 2020AlAteeq, D. A., Aljhani, S., Althiyabi, I., & Majzoub, S. (2020). Mental health among healthcare providers during coronavirus disease (COVID-19) outbreak in Saudi Arabia. Journal of Infection and Public Health, 13(10), 1432-1437. https://doi.org/10.1016/j.jiph.2020.08.013
https://doi.org/10.1016/j.jiph.2020.08.0...
; Naser et al., 2020Naser, A. Y., Dahmash, E. Z., Al‐Rousan, R., Alwafi, H., Alrawashdeh, H. M., Ghoul, I., Abidine, A., Bokhary, M. A., AL‐Hadithi, H. T., Ali, D., Abuthawabeh, R., Abdelwahab, G. M., Alhartani, Y. J., al Muhaisen, H., Dagash, A., & Alyami, H. S. (2020). Mental health status of the general population, healthcare professionals, and university students during 2019 coronavirus disease outbreak in Jordan: A cross‐sectional study. Brain and Behavior, 10(8). https://doi.org/10.1002/brb3.1730
https://doi.org/10.1002/brb3.1730...
). However, only 10.2% of the professionals in our study were over 50 years old, which may have led to underestimating the anxiety scores of these participants; age was not associated with depressive symptoms, demonstrating that the sample size may not be the only explanation. Length of work experience may have contributed to the lower anxiety scores of professionals aged > 50 years.

Single and divorced/widowed health professionals had lower anxiety scores. It is possible that in the context of the COVID-19 pandemic, the fear of transmitting the virus to family members may have contributed to this result, as concern for the family is greater in individuals who are married or live with a partner. During the SARS epidemic of 2003, exposure to the virus and the possibility of infecting friends and family were risk factors for developing psychological symptoms (Wong et al., 2005Wong, T. W., Yau, J. K. Y., Chan, C. L. W., Kwong, R. S. Y., Ho, S. M. Y., Lau, C. C., Lau, F. L., & Lit, C. H. (2005). The psychological impact of severe acute respiratory syndrome outbreak on healthcare workers in emergency departments and how they cope. European Journal of Emergency Medicine, 12(1), 13-18. https://doi.org/10.1097/00063110-200502000-00005
https://doi.org/10.1097/00063110-2005020...
).

In this study, other points that indicated that concern for the family may be related to psychological symptoms during the pandemic period were the association between depression and having a family member who lost their job, and the association between anxiety and being responsible for family income. A study conducted with US citizens during the COVID-19 pandemic showed that greater job insecurity was associated with an increase in depressive symptoms (Wilson et al., 2020Wilson, J. M., Lee, J., Fitzgerald, H. N., Oosterhoff, B., Sevi, B., & Shook, N. J. (2020). Job Insecurity and Financial Concern during the COVID-19 pandemic are associated with worse mental health. Journal of Occupational & Environmental Medicine, 62(9), 686-691. https://doi.org/10.1097/JOM.0000000000001962
https://doi.org/10.1097/JOM.000000000000...
). Another study in southern Brazil showed that participants who experienced economic losses during the COVID-19 pandemic were 1.4 times more likely to be at risk of anxiety and depression (Duarte et al., 2020Duarte, M. Q., Santo, M. A. S., Lima, C. P., Giordani, J. P., & Trentini, C. M. (2020). COVID-19 e os impactos na saúde mental: uma amostra do Rio Grande do Sul, Brasil. Ciência & Saúde Coletiva, 25(9), 3401-3411. https://doi.org/10.1590/1413-81232020259.16472020
https://doi.org/10.1590/1413-81232020259...
). If concern for family and financial conditions are added, the professional may feel even more overwhelmed during this stressful period. These results are consistent with guidelines related to the pandemic, which state that concerns for the family can cause the onset of psychological symptoms (Ayanian, 2020Ayanian, J. Z. (2020). Mental Health Needs of Health Care Workers Providing Frontline COVID-19 Care. JAMA Health Forum, 1(4), e200397. https://doi.org/10.1001/jamahealthforum.2020.0397
https://doi.org/10.1001/jamahealthforum....
).

Regarding profession, most of the sample in this study comprised nursing technicians who had higher depression scores. A higher proportion of nursing technicians may have overestimated the association in this study. However, these results are consistent with those of previous studies (Dal’Bosco et al., 2020Dal’Bosco, E. B., Floriano, L. S. M. , Skupien, S. V., Arcaro, G., Martins, A. R., & Anselmo, A. C. C. (2020). Mental health of nursing in coping with COVID-19 at a regional university hospital. Revista Brasileira de Enfermagem, 73, e20200434. https://doi.org/10.1590/0034-7167-2020-0434
https://doi.org/10.1590/0034-7167-2020-0...
; Wong et al., 2005Wong, T. W., Yau, J. K. Y., Chan, C. L. W., Kwong, R. S. Y., Ho, S. M. Y., Lau, C. C., Lau, F. L., & Lit, C. H. (2005). The psychological impact of severe acute respiratory syndrome outbreak on healthcare workers in emergency departments and how they cope. European Journal of Emergency Medicine, 12(1), 13-18. https://doi.org/10.1097/00063110-200502000-00005
https://doi.org/10.1097/00063110-2005020...
). Previously, during the SARS epidemic, nurses and health aides had higher levels of distress than physicians (Wong et al., 2005Wong, T. W., Yau, J. K. Y., Chan, C. L. W., Kwong, R. S. Y., Ho, S. M. Y., Lau, C. C., Lau, F. L., & Lit, C. H. (2005). The psychological impact of severe acute respiratory syndrome outbreak on healthcare workers in emergency departments and how they cope. European Journal of Emergency Medicine, 12(1), 13-18. https://doi.org/10.1097/00063110-200502000-00005
https://doi.org/10.1097/00063110-2005020...
), which may have been caused by increased contact with patients. A Brazilian study conducted among nursing professionals during the COVID-19 pandemic showed that technicians had a higher prevalence of anxiety (Dal’Bosco et al., 2020Dal’Bosco, E. B., Floriano, L. S. M. , Skupien, S. V., Arcaro, G., Martins, A. R., & Anselmo, A. C. C. (2020). Mental health of nursing in coping with COVID-19 at a regional university hospital. Revista Brasileira de Enfermagem, 73, e20200434. https://doi.org/10.1590/0034-7167-2020-0434
https://doi.org/10.1590/0034-7167-2020-0...
).

In this study, 35% of the professionals reported having received psychological guidance at work (brochures, online materials, or books), and these participants had lower scores for depression and anxiety. These results can be compared with those of a Chinese study (Kang et al., 2020Kang, L., Ma, S., Chen, M., Yang, J., Wang, Y., Li, R., Yao, L., Bai, H., Cai, Z., Xiang Yang, B., Hu, S., Zhang, K., Wang, G., Ma, C., & Liu, Z. (2020). Impact on mental health and perceptions of psychological care among medical and nursing staff in Wuhan during the 2019 novel coronavirus disease outbreak: A cross-sectional study. Brain, Behavior, and Immunity, 87, 11-17. https://doi.org/10.1016/j.bbi.2020.03.028
https://doi.org/10.1016/j.bbi.2020.03.02...
) in which health professionals with severe mental disorders accessed fewer psychological materials and resources available in the media. Additionally, professionals with mild symptoms expressed interest in accessing psychological counseling materials (Kang et al., 2020Kang, L., Ma, S., Chen, M., Yang, J., Wang, Y., Li, R., Yao, L., Bai, H., Cai, Z., Xiang Yang, B., Hu, S., Zhang, K., Wang, G., Ma, C., & Liu, Z. (2020). Impact on mental health and perceptions of psychological care among medical and nursing staff in Wuhan during the 2019 novel coronavirus disease outbreak: A cross-sectional study. Brain, Behavior, and Immunity, 87, 11-17. https://doi.org/10.1016/j.bbi.2020.03.028
https://doi.org/10.1016/j.bbi.2020.03.02...
). It is important to mention that these results demonstrate the importance of offering psychological guidance materials to health professionals, whether in person or digitally, as a method of promoting workers' mental health.

Approximately 75.9% of the health professionals were tested for COVID-19 and these professionals had higher depression and anxiety scores than those who were not tested. This result may be related to the fear of becoming infected because performing the test can demonstrate real proximity to the virus. However, there was no significant difference when the professionals were diagnosed with COVID-19. One possible explanation may be related to the sample size, which may have underestimated the association. In addition, professionals who were diagnosed with COVID-19 had already returned from the isolation period and probably felt calmer because they had already recovered, whereas those who tested negative continued to face an unpredictable prognosis.

Finally, one of the variables that was most associated with psychological outcomes in our study population was having experienced a traumatic event in life. This finding is consistent with the scientific literature, where the prevalence of exposure to a traumatic event in life ranged from 40% to 60% in previous studies (Breslau, 1991Breslau, N. (1991). Traumatic Events and Posttraumatic Stress Disorder in an Urban Population of Young Adults. Archives of General Psychiatry, 48(3), 216. https://doi.org/10.1001/archpsyc.1991.01810270028003
https://doi.org/10.1001/archpsyc.1991.01...
; Kessler, 1995Kessler, R. C. (1995). Posttraumatic Stress Disorder in the National Comorbidity Survey. Archives of General Psychiatry, 52(12), 1048. https://doi.org/10.1001/archpsyc.1995.03950240066012
https://doi.org/10.1001/archpsyc.1995.03...
; Norris, 1992Norris, F. H. (1992). Epidemiology of trauma: Frequency and impact of different potentially traumatic events on different demographic groups. Journal of Consulting and Clinical Psychology, 60(3), 409-418. https://doi.org/10.1037/0022-006X.60.3.409
https://doi.org/10.1037/0022-006X.60.3.4...
; Resnick et al., 1993Resnick, H. S., Kilpatrick, D. G., Dansky, B. S., Saunders, B. E., & Best, C. L. (1993). Prevalence of civilian trauma and posttraumatic stress disorder in a representative national sample of women. Journal of Consulting and Clinical Psychology, 61(6), 984-991. https://doi.org/10.1037/0022-006X.61.6.984
https://doi.org/10.1037/0022-006X.61.6.9...
). In this study, 63.9% of health professionals reported having suffered some traumatic event in their lives. An American study demonstrated that acute stress events were associated with depression; individuals who experienced traumatic life events had higher depression scores than those who did not experience a traumatic life event (Muscatell et al., 2009Muscatell, K. A., Slavich, G. M., Monroe, S. M., & Gotlib, I. H. (2009). Stressful Life Events, Chronic Difficulties, and the Symptoms of Clinical Depression. Journal of Nervous & Mental Disease, 197(3), 154-160. https://doi.org/10.1097/NMD.0b013e318199f77b
https://doi.org/10.1097/NMD.0b013e318199...
). In the context of the COVID-19 pandemic, health professionals face challenges related to life and death more frequently and intensely, and having already suffered a traumatic event may have further aggravated their symptoms.

Working conditions play a crucial role in individuals' quality of life and mental health and may work either as protective or risk factors (International Labour Organization & World Health Organization, 2022International Labour Organization, & World Health Organization. (2022). Mental Health at Work: Policy Brief. Geneva: WHO. https://www.who.int/publications/i/item/9789240057944
https://www.who.int/publications/i/item/...
). The constant fear caused by the pandemic and concerns about financial conditions added to the lack of adequate protective equipment and relationship problems with coworkers. According to the guidelines and recommendations for mental health at work, it is necessary to prevent exposure to mental health risks, promote mental health and well-being, and support those who already have a mental health condition (International Labour Organization & World Health Organization, 2022International Labour Organization, & World Health Organization. (2022). Mental Health at Work: Policy Brief. Geneva: WHO. https://www.who.int/publications/i/item/9789240057944
https://www.who.int/publications/i/item/...
). A lack of support can interfere with the professional capacity of the worker, who alone is prone to greater illness and worse service delivery. Among all the factors associated with mental health outcomes in this study, few were related to individual characteristics (e.g., age), demonstrating that mental health promotion, prevention, and support services can achieve important results.

This study should be interpreted in light of its design limitations, as it is not possible to determine whether symptoms were absent prior to exposure to the pandemic; therefore, the results are subject to reverse causality. In addition, there may have been a sampling bias, as 47.7% of the professionals were nursing technicians. However, these professionals comprise a large proportion of health professionals who work on the frontlines in different parts of the country. Furthermore, this study was conducted in person during a period of difficult access and stress for the professionals. It is necessary to highlight the importance of this study, which is one of the first to investigate the mental health of Brazilian health workers during the COVID-19 pandemic. This study contributes to the most diverse areas of psychological science, mainly those that transition through the psychology of emergencies, workers' mental health, and collective mental health, providing scientific evidence about the population studied and the period itself.

Conclusion

This study identified a high prevalence of anxiety and depression among health professionals working in hospitals. One of the most relevant findings of this study was that receiving psychological guidance at work was a protective factor against anxiety and depression. Considering the unprecedented pandemic in Brazil, these results can aid the development of interventions and care protocols for Brazilian professionals after the pandemic period. Considering that health workers face major challenges inherent to their profession, continuous actions to support and prevent mental health problems are essential to improve the working conditions and quality of life of these professionals.

Acknowledgments

We are grateful for the support of the teaching and research department of Hospital Dr. Miguel Riet Correa Jr., under the management of the Brazilian Company of Hospital Services (EBSERH). We thank the health professionals who participated in this study and worked during the COVID-19 pandemic.

References

  • AlAteeq, D. A., Aljhani, S., Althiyabi, I., & Majzoub, S. (2020). Mental health among healthcare providers during coronavirus disease (COVID-19) outbreak in Saudi Arabia. Journal of Infection and Public Health, 13(10), 1432-1437. https://doi.org/10.1016/j.jiph.2020.08.013
    » https://doi.org/10.1016/j.jiph.2020.08.013
  • Ayanian, J. Z. (2020). Mental Health Needs of Health Care Workers Providing Frontline COVID-19 Care. JAMA Health Forum, 1(4), e200397. https://doi.org/10.1001/jamahealthforum.2020.0397
    » https://doi.org/10.1001/jamahealthforum.2020.0397
  • Bártolo, A., Monteiro, S., & Pereira, A. (2017). Factor structure and construct validity of the Generalized Anxiety Disorder 7-item (GAD-7) among Portuguese college students. Cadernos de Saúde Pública, 33(9). https://doi.org/10.1590/0102-311x00212716
    » https://doi.org/10.1590/0102-311x00212716
  • Breslau, N. (1991). Traumatic Events and Posttraumatic Stress Disorder in an Urban Population of Young Adults. Archives of General Psychiatry, 48(3), 216. https://doi.org/10.1001/archpsyc.1991.01810270028003
    » https://doi.org/10.1001/archpsyc.1991.01810270028003
  • Dal’Bosco, E. B., Floriano, L. S. M. , Skupien, S. V., Arcaro, G., Martins, A. R., & Anselmo, A. C. C. (2020). Mental health of nursing in coping with COVID-19 at a regional university hospital. Revista Brasileira de Enfermagem, 73, e20200434. https://doi.org/10.1590/0034-7167-2020-0434
    » https://doi.org/10.1590/0034-7167-2020-0434
  • Duarte, M. Q., Santo, M. A. S., Lima, C. P., Giordani, J. P., & Trentini, C. M. (2020). COVID-19 e os impactos na saúde mental: uma amostra do Rio Grande do Sul, Brasil. Ciência & Saúde Coletiva, 25(9), 3401-3411. https://doi.org/10.1590/1413-81232020259.16472020
    » https://doi.org/10.1590/1413-81232020259.16472020
  • Fundação Oswaldo Cruz. (2020). Saúde Mental e Atenção Psicossocial na Pandemia da Covid-19. Recomendações Gerais https://www.fiocruzbrasilia.fiocruz.br/wp-content/uploads/2020/04/Sa%C3%BAde-Mental-e-Aten%C3%A7%C3%A3o-Psicossocial-na-Pandemia-Covid-19-recomenda%C3%A7%C3%B5es-gerais.pdf
    » https://www.fiocruzbrasilia.fiocruz.br/wp-content/uploads/2020/04/Sa%C3%BAde-Mental-e-Aten%C3%A7%C3%A3o-Psicossocial-na-Pandemia-Covid-19-recomenda%C3%A7%C3%B5es-gerais.pdf
  • Gu, Y., Zhu, Y., & Xu, G. (2022). Factors associated with mental health outcomes among healthcare workers in the Fangcang shelter hospital in China. International Journal of Social Psychiatry, 68(1), 64-72. https://doi.org/10.1177/0020764020975805
    » https://doi.org/10.1177/0020764020975805
  • Instituto Brasileiro de Geografia e Estatística. (2022). Cidades e Estados https://www.ibge.gov.br/cidades-e-estados.html
    » https://www.ibge.gov.br/cidades-e-estados.html
  • International Labour Organization, & World Health Organization. (2022). Mental Health at Work: Policy Brief Geneva: WHO. https://www.who.int/publications/i/item/9789240057944
    » https://www.who.int/publications/i/item/9789240057944
  • Kang, L., Ma, S., Chen, M., Yang, J., Wang, Y., Li, R., Yao, L., Bai, H., Cai, Z., Xiang Yang, B., Hu, S., Zhang, K., Wang, G., Ma, C., & Liu, Z. (2020). Impact on mental health and perceptions of psychological care among medical and nursing staff in Wuhan during the 2019 novel coronavirus disease outbreak: A cross-sectional study. Brain, Behavior, and Immunity, 87, 11-17. https://doi.org/10.1016/j.bbi.2020.03.028
    » https://doi.org/10.1016/j.bbi.2020.03.028
  • Kessler, R. C. (1995). Posttraumatic Stress Disorder in the National Comorbidity Survey. Archives of General Psychiatry, 52(12), 1048. https://doi.org/10.1001/archpsyc.1995.03950240066012
    » https://doi.org/10.1001/archpsyc.1995.03950240066012
  • Lai, J., Ma, S., Wang, Y., Cai, Z., Hu, J., Wei, N., Wu, J., Du, H., Chen, T., Li, R., Tan, H., Kang, L., Yao, L., Huang, M., Wang, H., Wang, G., Liu, Z., & Hu, S. (2020). Factors associated with mental health outcomes among health care workers exposed to Coronavirus Disease 2019. JAMA Network Open, 3(3), e203976. https://doi.org/10.1001/jamanetworkopen.2020.3976
    » https://doi.org/10.1001/jamanetworkopen.2020.3976
  • Lu, W., Wang, H., Lin, Y., & Li, L. (2020). Psychological status of medical workforce during the COVID-19 pandemic: A cross-sectional study. Psychiatry Research, 288, 112936. https://doi.org/10.1016/j.psychres.2020.112936
    » https://doi.org/10.1016/j.psychres.2020.112936
  • Ministério da Saúde (Brasil). (2021, December). Painel Coronavírus Available from: https://covid.saude.gov.br/
    » https://covid.saude.gov.br/
  • Muscatell, K. A., Slavich, G. M., Monroe, S. M., & Gotlib, I. H. (2009). Stressful Life Events, Chronic Difficulties, and the Symptoms of Clinical Depression. Journal of Nervous & Mental Disease, 197(3), 154-160. https://doi.org/10.1097/NMD.0b013e318199f77b
    » https://doi.org/10.1097/NMD.0b013e318199f77b
  • Naser, A. Y., Dahmash, E. Z., Al‐Rousan, R., Alwafi, H., Alrawashdeh, H. M., Ghoul, I., Abidine, A., Bokhary, M. A., AL‐Hadithi, H. T., Ali, D., Abuthawabeh, R., Abdelwahab, G. M., Alhartani, Y. J., al Muhaisen, H., Dagash, A., & Alyami, H. S. (2020). Mental health status of the general population, healthcare professionals, and university students during 2019 coronavirus disease outbreak in Jordan: A cross‐sectional study. Brain and Behavior, 10(8). https://doi.org/10.1002/brb3.1730
    » https://doi.org/10.1002/brb3.1730
  • Norris, F. H. (1992). Epidemiology of trauma: Frequency and impact of different potentially traumatic events on different demographic groups. Journal of Consulting and Clinical Psychology, 60(3), 409-418. https://doi.org/10.1037/0022-006X.60.3.409
    » https://doi.org/10.1037/0022-006X.60.3.409
  • Pappa, S., Ntella, V., Giannakas, T., Giannakoulis, V. G., Papoutsi, E., & Katsaounou, P. (2020). Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis. Brain, Behavior, and Immunity, 88, 901-907. https://doi.org/10.1016/j.bbi.2020.05.026
    » https://doi.org/10.1016/j.bbi.2020.05.026
  • Resnick, H. S., Kilpatrick, D. G., Dansky, B. S., Saunders, B. E., & Best, C. L. (1993). Prevalence of civilian trauma and posttraumatic stress disorder in a representative national sample of women. Journal of Consulting and Clinical Psychology, 61(6), 984-991. https://doi.org/10.1037/0022-006X.61.6.984
    » https://doi.org/10.1037/0022-006X.61.6.984
  • Rossi, R., Socci, V., Pacitti, F., di Lorenzo, G., di Marco, A., Siracusano, A., & Rossi, A. (2020). Mental Health Outcomes Among Frontline and Second-Line Health Care Workers During the Coronavirus Disease 2019 (COVID-19) Pandemic in Italy. JAMA Network Open, 3(5), e2010185. https://doi.org/10.1001/jamanetworkopen.2020.10185
    » https://doi.org/10.1001/jamanetworkopen.2020.10185
  • Santos, I. S., Tavares, B. F., Munhoz, T. N., Almeida, L. S. P., Silva, N. T. B., Tams, B. D., Patella, A. M., & Matijasevich, A. (2013). Sensibilidade e especificidade do Patient Health Questionnaire-9 (PHQ-9) entre adultos da população geral. Cadernos de Saúde Pública, 29(8), 1533-1543. https://doi.org/10.1590/0102-311X00144612
    » https://doi.org/10.1590/0102-311X00144612
  • The Novel Coronavirus Pneumonia Emergency Response Epidemiology Team . (2020). The Epidemiological Characteristics of an Outbreak of 2019 Novel Coronavirus Diseases (COVID-19) - China, 2020. China CDC Weekly, 2(8), 113-122. https://doi.org/10.46234/ccdcw2020.032
    » https://doi.org/10.46234/ccdcw2020.032
  • Wilson, J. M., Lee, J., Fitzgerald, H. N., Oosterhoff, B., Sevi, B., & Shook, N. J. (2020). Job Insecurity and Financial Concern during the COVID-19 pandemic are associated with worse mental health. Journal of Occupational & Environmental Medicine, 62(9), 686-691. https://doi.org/10.1097/JOM.0000000000001962
    » https://doi.org/10.1097/JOM.0000000000001962
  • Wong, T. W., Yau, J. K. Y., Chan, C. L. W., Kwong, R. S. Y., Ho, S. M. Y., Lau, C. C., Lau, F. L., & Lit, C. H. (2005). The psychological impact of severe acute respiratory syndrome outbreak on healthcare workers in emergency departments and how they cope. European Journal of Emergency Medicine, 12(1), 13-18. https://doi.org/10.1097/00063110-200502000-00005
    » https://doi.org/10.1097/00063110-200502000-00005
  • World Health Organization. (2024, February). Coronavírus (COVID-19) Dashboard https://data.who.int/dashboards/covid19/cases?n=c
    » https://data.who.int/dashboards/covid19/cases?n=c
  • Zhu, Z., Xu, S., Wang, H., Liu, Z., Wu, J., Li, G., Miao, J., Zhang, C., Yang, Y., Sun, W., Zhu, S., Fan, Y., Chen, Y., Hu, J., Liu, J., & Wang, W. (2020). COVID-19 in Wuhan: Sociodemographic characteristics and hospital support measures associated with the immediate psychological impact on healthcare workers. eClinicalMedicine, 24, 100443. https://doi.org/10.1016/j.eclinm.2020.100443
    » https://doi.org/10.1016/j.eclinm.2020.100443
  • 1
    Article based on the thesis doctoral of T. G. PERES, entitled “Saúde Mental e COVID-19: como os profissionais de saúde vivenciaram a pandemia?”. Universidade Federal do Rio Grande, 2024.
  • Support:

    Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (Capes) (001), and PROBIC/FAPERGS 2020-2021.

Edited by

Editor:

Wanderlei Abadio de Oliveira

Publication Dates

  • Publication in this collection
    22 Apr 2024
  • Date of issue
    2024

History

  • Received
    21 Jan 2022
  • Reviewed
    09 Feb 2023
  • Accepted
    12 Apr 2023
Programa de Pós-Graduação em Psicologia, Pontifícia Universidade Católica de Campinas Núcleo de Editoração SBI - Campus II, Av. John Boyd Dunlop, s/n. Prédio de Odontologia, 13060-900 Campinas - São Paulo Brasil, Tel./Fax: +55 19 3343-7223 - Campinas - SP - Brazil
E-mail: psychologicalstudies@puc-campinas.edu.br