Mental health of nursing professionals during the COVID-19 pandemic: a cross-sectional study

Kantorski, Luciane Prado; Oliveira, Michele Mandagará de; Treichel, Carlos Alberto dos Santos; Bakolis, Ioannis; Alves, Poliana Farias; Coimbra, Valéria Cristina Christello; Cavada, Gustavo Pachon; Sperb, Lilian Cruz Souto de Oliveira; Guedes, Ariane da Cruz; Antonacci, Milena Hohmann; Willrich, Janaína Quinzen

doi:10.11606/s1518-8787.2022056004122

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Brasil

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Sumário

Original Article • Rev. Saúde Pública 56 • 2022 • https://doi.org/10.11606/s1518-8787.2022056004122 copy

Mental health of nursing professionals during the COVID-19 pandemic: a cross-sectional study

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

OBJECTIVE

To identify the prevalence of and factors associated with: (1) major depressive episodes; (2) minor psychiatric disorders (MPDs); and (3) suicidal ideation among nursing professionals from a municipality in southern Brazil.

METHODS

Using a cross-sectional design, we recruited 890 nursing professionals linked to 50 Primary Care units, 2 walk-in clinics, 2 hospital services, 1 emergency room service, 1 mobile emergency care service, and 1 teleconsultation service, in addition to the municipal epidemiological surveillance service and the vacancy regulation center between June and July 2020. We used the Patient Health Questionnaire-9 and the Self-Reporting Questionnaire to evaluate the studied outcomes. Associations between the outcomes and variables related to sociodemographic profile, work, health conditions, and daily life were explored using Poisson regression models with robust variance estimators.

RESULTS

The observed prevalence of depression, MPDs, and suicidal ideation were 36.6%, 44%, and 7.4%, respectively. MPDs were associated with the assessment of support received by the service as ‘regular’ (PR: 1.48; 95% CI: 1.19–1.85) or ‘poor’ (PR: 1.54; 95% CI: 1.23–1.94), with a reported moderate (PR: 1.63; 95% CI: 1.29–2.07), or heavy (PR: 2.54; 95% CI: 2.05–3.15) workload, and with suspected COVID-19 infection (PR: 1.44; 95% CI: 1.25–1.66). Major depressive episodes were associated with a reported lack of personal protective equipment (PR: 1.20; 95% CI: 1.01–1.42), whereas suicidal ideation was inversely related to per capita income > 3 minimum monthly wages (PR: 0.28; 95% CI: 0.11–0.68), and positively related to the use of psychotropic drugs (PR: 3.14; 95% CI: 1.87–5.26).

CONCLUSION

Our results suggest that nursing professionals’ working conditions are associated with their mental health status. The need to improve working conditions through adequate dimensioning, support and proper biosafety measures is only heightened in the context of the COVID-19 pandemic.

Nursing, Team, psychology; COVID-19, nursing; Mental Disorders, epidemiology; Mental Health; Occupational Health; Cross-Sectional Studies

	n	%
Gender
Female	755	84.8
Male	135	15.2
Ethnicity
White	665	74.7
Brown	122	13.7
Black	103	11.6
Age
Up to 30	117	13.2
31 to 40	365	41.0
41 to 50	292	32.8
≥ 51	116	13.0
Education level
High School	330	37.1
Undergraduate	212	23.8
Graduate	348	39.1
Per capita income
Up to 1 minimum wage	205	25.3
Up to 2 minimum wages	305	37.7
Up to 3 minimum wages	132	16.3
> 3 minimum wages	168	20.7
Type of service
Primary Care	118	13.3
Outpatient	92	10.3
Emergency	84	9.5
Hospital	577	64.8
Administrative	19	2.1
Length of service in the nursing field
Up to 5 years	175	19.7
Up to 10 years	221	24.8
Up to 15 years	217	24.4
Up to 20 years	139	15.6
≥ 20 years	138	15.5
Nursing category
Registered Nurse	319	35.8
Nurse technician	501	56.3
Nursing assistant	70	7.9
Length of service at institution
Up to 5 years	520	58.8
Up to 10 years	160	18.1
Up to 15 years	71	8.0
≥ 15 years	134	15.1
Workload
Up to 30h	194	21.8
Up to 36h	473	53.2
36h+	223	25.0
Risk group
Does not belong to	606	68.1
Does belong to	284	31.9
Involvement with COVID-19 cases
None	288	32.4
Indirect work (e.g., administrative)	65	7.3
Contact with suspect cases	310	34.8
Contact with confirmed cases	277	25.5
COVID-19 workload proportion
None	288	32.4
Up to one third	169	19.0
Up to two thirds	166	18.6
> two thirds	267	30.0

	n	%	Crude PR (95% CI)	Adjusted^a PR (95% CI)	Adjusted^b PR (95% CI)
Gender
Female	755	39.2	1	1	1
Male	135	22.2	0.56 (0.40–0.78)^c	0.60 (0.42–0.85)^d	0.66 (0.48–0.91)^d
Ethnicity
White	665	31.1	1	1	1
Brown	122	36.9	0.99 (0.77–1.27)	1.03 (0.79–1.34)	0.88 (0.68–1.14)
Black	103	33.0	0.88 (0.66–1.19)	0.87 (0.63–1.19)	0.96 (0.73–1.26)
Age
Up to 30	117	36.7	1	1	1
31 to 40	365	43.3	1.17 (0.90–1.53)	1.07 (0.82–1.41)	0.89 (0.69–1.16)
41 to 50	292	33.6	0.91 (0.68–1.21)	0.83 (0.62–1.11)	0.69 (0.53–0.91)^d
≥ 51	116	23.3	0.63 (0.42–0.95)^d	0.61 (0.40–0.92)^d	0.55 (0.38–0.80)^d
Education level
High School	330	37.6	1	1	1
Undergraduate	212	36.3	0.96 (0.77–1.21)	1.01 (0.79–1.28)	1.04 (0.83–1.30)
Graduate	348	35.9	0.95 (0.78–1.16)	1.20 (0.95–1.50)	1.26 (1.03–1.56)^d
Per capita income
Up to 1 minimum wage	205	44.4	1	1	1
Up to 2 minimum wages	305	38.0	0.85 (0.69–1.05)	0.92 (0.75–1.14)	0.79 (0.64–0.96)^d
Up to 3 minimum wages	132	32.6	0.73 (0.54–0.98)^d	0.76 (0.57–1.01)	0.66 (0.50–0.86)^d
> 3 minimum wages	168	29.8	0.67 (0.50–0.88)^d	0.70 (0.53–0.92)^d	0.58 (0.44–0.77)^c
Type of service
Primary Care	118	33.0	1	1	1
Outpatient	92	34.8	1.05 (0.71–1.53)	0.90 (0.60–1.34)	1.10 (0.78–1.56)
Emergency	84	36.9	1.11 (0.76–1.63)	1.27 (0.87–1.86)	1.11 (0.78–1.57)
Hospital	577	37.9	1.14 (0.87–1.51)	1.12 (0.84–1.49)	1.16 (0.91–1.49)
Administrative	19	26.3	0.79 (0.35–1.76)	0.83 (0.39–1.77)	1.28 (0.61–2.65)
Length of service in the nursing field
Up to 5 years	175	38.9	1	1	1
Up to 10 years	221	39.4	1.01 (0.79–1.29)	1.02 (0.79–1.33)	0.85 (0.65–1.10)
Up to 15 years	217	37.8	0.97 (0.75–1.25)	1.06 (0.80–1.41)	0.85 (0.65–1.13)
Up to 20 years	139	37.4	0.96 (0.72–1.27)	1.27 (0.92–1.76)	0.93 (0.67–1.29)
≥ 20 years	138	26.8	0.69 (0.49–0.96)	1.13 (0.73–1.75)	0.91 (0.60–1.37)
Nursing category
Registered Nurse	319	38.6	1	1	1
Nurse technician	501	36.3	0.94 (0.78–1.12)	0.75 (0.61–0.93)^d	0.77 (0.59–1.00)
Nursing assistant	70	30.0	0.77 (0.52–1.14)	0.95 (0.63–1.44)	1.12 (0.76–1.65)
Length of service at institution
Up to 5 years	520	38.5	1	1	1
Up to 10 years	160	43.1	1.12 (0.91–1.38)	1.06 (0.85–1.31)	096 (0.79–1.18)
Up to 15 years	71	28.2	0.73 (0.49–1.07)	0.72 (0.49–1.06)	0.75 (0.52–1.08)
≥ 15 years	134	25.4	0.65 (0.47–0.89)^d	0.90 (0.63–1.29)	0.86 (0.62–1.19)
Workload
Up to 30h	194	27.3	1	1	1
Up to 36h	473	40.2	1.47 (1.13–1.89)^d	1.27 (0.97–1.65)	1.03 (0.80–1.32)
36h+	223	37.2	1.36 (1.02–1.81)^d	1.18 (0.88–1.58)	1.08 (0.83–1.40)
Second job
No	645	35.7	1	1	1
Yes	245	39.2	1.09 (0.91–1.32)	1.16 (0.95–1.41)	1.06 (0.89–1.27)
COVID-19-specific training
No	319	39.5	1	1	1
Yes	571	35.0	0.88 (0.74–1.05)	0.91 (0.76–1.09)	0.98 (0.83–1.15)
Evaluation of working conditions
Good	325	27.1	1	1	1
Regular	409	38.9	1.43 (1.15–1.78)^d	1.41 (1.13–1.75)^d	0.91 (0.72–1.15)
Poor	156	54.6	1.87 (1.47–2.36)^c	1.81 (1.42–2.31)^c	0.87 (0.64–1.19)
Evaluation of support at work
Good	263	22.8	1	1	1
Regular	363	38.6	1.69 (1.30–2.18)^c	1.71 (1.32–2.26)^c	1.46 (1.14–1.86)^d
Poor	264	47.7	2.09 (1.61–2.70)^c	2.05 (1.57–2.66)^c	1.33 (1.03–1.72)^d
Burden
Light	343	18.9	1	1	1
Moderate	262	34.0	1.79 (1.35–2.36)^c	1.83 (1.38–2.42)^c	1.67 (1.27–2.18)^c
Heavy	285	60.3	3.18 (2.50–4.04)^c	3.26 (2.55–4.16)^c	2.77 (2.16–3.54)^c
Current burden compared to that pre- COVID-19
Same or decreased	337	23.7	1	1	1
Increased	553	44.5	1.87 (1.51–2.31)^c	1.87 (1.51–2.33)^c	1.11 (0.89–1.40)
Involvement with COVID-19 cases
None	288	35.1	1	1	1
Indirect work (e.g., administrative)	65	30.8	0.87 (0.58–1.30)	0.95 (0.64–1.41)	1.07 (0.73–1.55)
Contact with suspect cases	310	35.8	1.02 (0.82–1.26)	0.97 (0.78–1.21)	0.84 (0.68–1.03)
Contact with confirmed cases	277	41.4	1.18 (0.94–1.47)	1.18 (0.94–1.49)	1.03 (0.83–1.29)
COVID-19 workload proportion
None	288	35.1	1	1	1
Up to one third	169	30.8	0.87 (0.66–1.15)	0.84 (0.63–1.12)	0.77 (0.59–0.99)^d
Up to two thirds	166	35.5	1.01 (0.78–1.31)	0.98 (0.75–1.27)	0.94 (0.73–1.19)
> two thirds	267	42.7	1.21 (0.98–1.50)	1.23 (0.99–1.53)	1.01 (0.82–1.25)
Lack of Personal Protective Equipment
No	508	30.7	1	1	1
Yes	382	44.5	1.44 (1.21–1.72)^c	1.42 (1.19–1.69)^c	1.20 (1.01–1.42)^d
Suspected COVID-19 infection
No	574	30.5	1	1	1
Yes	316	47.8	1.56 (1.32–1.85)^c	1.57 (1.32–1.87)^c	1.29 (1.09–1.53)^d
Absence from work due to suspected infection
No	746	34.6	1	1	1
Yes	144	47.2	1.36 (1.11–1.66)^d	1.35 (1.10–1.66)^d	1.06 (0.86–1.32)
Family or close friend with COVID-19
No	616	34.1	1	1	1
Yes	274	42.3	1.24 (1.04–1.48)^d	1.20 (1.00–1.44)^d	1.01 (0.85–1.20)
Degree of social distancing
Light	227	29.5	1	1	1
Moderate	568	41.2	1.39 (1.11–1.74)^d	1.35 (1.07–1.71)^d	1.24 (0.99–1.54)
Intense	95	26.3	0.89 (0.60–1.31)	0.88 (0.59–1.31)	0.88 (0.61–1.26)
Risk group
No	606	32.7	1	1	1
Yes	284	45.1	1.37 (1.16–1.63)^c	1.46 (1.22–1.74)^c	1.18 (0.99–1.40)
Problems with/abuse of alcohol
No	824	34.9	1	1	1
Yes	66	57.6	1.64 (1.31–2.06)^c	1.62 (1.28–2.05)^c	1.18 (0.94–1.47)
Tobacco use
No	748	34.4	1	1	1
Yes	142	48.6	1.41 (1.16–1.72)^c	1.45 (1.18–1.77)^c	1.32 (1.07–1.62)^d
Current use of psychotropic drugs
No	703	31.9	1	1	1
Yes	187	54.5	1.71 (1.44–2.02)^c	1.74 (1.46–2.07)^c	1.59 (1.34–1.89)^c

TOTAL	880	36.6

	n	%	Crude PR (95% CI)	Adjusted^a PR (95% CI)	Adjusted^b PR (95% CI)
Gender
Female	755	47.0	1	1	1
Male	135	26.7	0.56 (0.42–0.75)^c	0.54 (0.39–0.75)^c	0.57 (0.42–0.77)^c
Ethnicity
White	665	43.3	1	1	1
Brown	122	50.8	1.17 (0.96–1.42)	1.22 (1.00–1.50)^d	1.03 (0.85–1.24)
Black	103	39.8	0.91 (0.71–1.18)	0.91 (0.68–1.20)	0.94 (0.74–1.19)
Age
Up to 30	117	47.9	1	1	1
31 to 40	365	52.0	1.08 (0.87–1.34)	1.07 (0.85–1.34)	0.93 (0.75–1.14)
41 to 50	292	39.0	0.81 (0.64–1.03)	0.80 (0.62–1.03)	0.71 (0.56–0.90)^d
≥ 51	116	26.7	0.55 (0.39–0.79)^d	0.56 (0.39–0.82)^d	0.56 (0.40–0.78)^d
Education level
High School	330	44.2	1	1	1
Undergraduate	212	43.9	0.99 (0.81–1.20)	1.02 (0.83–1.25)	1.05 (0.87–1.26)
Graduate	348	43.7	0.98 (0.83–1.17)	1.07 (0.88–1.31)	1.12 (0.93–1.34)
Per capita income
Up to 1 minimum wage	205	49.8	1	1	1
Up to 2 minimum wages	305	42.9	0.86 (0.71–1.04)	0.94 (0.78–1.13)	0.85 (0.72–1.01)
Up to 3 minimum wages	132	40.1	0.80 (0.62–1.03)	0.84 (0.66–1.07)	0.81 (0.66–0.99)^d
> 3 minimum wages	168	39.3	0.78 (0.62–0.99)	0.83 (0.66–1.05)	0.79 (0.64–0.98)^d
Type of service
Primary Care	118	43.2	1	1	1
Outpatient	92	40.2	0.93 (0.67–1.28)	0.80 (0.57–1.12)	0.91 (0.68–1.22)
Emergency	84	32.1	0.74 (0.51–1.08)	0.80 (0.55–1.18)	0.68 (0.47–0.97)^d
Hospital	577	46.8	1.08 (0.86–1.35)	1.00 (0.80–1.26)	1.00 (0.82–1.23)
Administrative	19	31.6	0.73 (0.36–1.46)	0.74 (0.38–1.43)	1.14 (0.60–2.16)
Length of service in the nursing field
Up to 5 years	175	47.4	1	1	1
Up to 10 years	221	48.9	1.03 (0.83–1.26)	1.06 (0.84–1.33)	0.96 (0.78–1.18)
Up to 15 years	217	45.2	0.95 (0.76–1.17)	1.07 (0.84–1.37)	0.94 (0.76–1.17)
Up to 20 years	139	41.7	0.87 (0.68–1.13)	1.17 (0.88–1.56)	0.99 (0.76–1.28)
≥ 20 years	138	31.9	0.67 (0.50–0.89)^d	1.06 (0.72–1.56)	1.00 (0.71–1.42)
Nursing category
Registered Nurse	319	46.1	1	1	1
Nurse technician	501	43.9	0.95 (0.81–1.11)	0.87 (0.72–1.06)	0.86 (0.72–1.02)
Nursing assistant	70	34.3	0.74 (0.52–1.05)	0.96 (0.64–1.42)	1.11 (0.77–1.59)
Length of service at institution
Up to 5 years	520	46.1	1	1	1
Up to 10 years	160	50.6	1.09 (0.91–1.31)	1.03 (0.85–1.25)	0.97 (0.81–1.16)
Up to 15 years	71	35.2	0.76 (0.54–1.06)	0.79 (0.57–1.09)	0.80 (0.60–1.06)
≥ 15 years	134	31.3	0.67 (0.51–0.88)^d	0.97 (0.71–1.33)	0.98 (0.74–1.29)
Workload
Up to 30h	194	35.0	1	1	1
Up to 36h	473	48.2	1.37 (1.11–1.70)^d	1.21 (0.96–1.52)	0.95 (0.78–1.17)
36h+	223	42.6	1.21 (0.95–1.55)	1.10 (0.85–1.42)	0.97 (0.78–1.21)
Second job
No	645	45.1	1	1	1
Yes	245	40.8	0.90 (0.76–1.07)	0.96 (0.80–1.15)	0.87 (0.74–1.02)
COVID-19-specific training
No	319	43.9	1	1	1
Yes	571	44.0	1.00 (0.85–1.16)	1.01 (0.86–1.18)	1.10 (0.95–1.27)
Evaluation of working conditions
Good	325	29.8	1	1	1
Regular	409	47.2	1.58 (1.29–1.92)^c	1.59 (1.30–1.94)^c	1.13 (0.90–1.41)
Poor	156	64.7	2.16 (1.77–2.65)^c	2.19 (1.77–1.94)^c	1.17 (0.89–1.53)
Evaluation of support at work
Good	263	26.2	1	1	1
Regular	363	44.9	1.71 (1.35–2.15)^c	1.74 (1.37–2.20)^c	1.48 (1.19–1.85)^c
Poor	264	60.2	2.29 (1.83–2.87)^c	2.27 (1.79–2.86)^c	1.54 (1.23–1.94)^c
Burden
Light	343	23.6	1	1	1
Moderate	262	42.0	1.77 (1.40–2.25)^c	1.79 (1.40–2.29)^c	1.63 (1.29–2.07)^c
Heavy	285	70.2	2.97 (2.42–3.64)^c	3.02 (2.44–3.74)^c	2.54 (2.05–3.15)^c
Current burden compared to that pre- COVID-19
Same or decreased	337	28.8	1	1	1
Increased	553	53.2	1.84 (1.53–2.22)^c	1.87 (1.54–2.27)^c	1.16 (0.94–1.42)
Involvement with COVID-19 cases
None	288	41.3	1	1	1
Indirect work (e.g., administrative)	65	44.6	1.07 (0.79–1.46)	1.07 (0.79–1.46)	1.22 (0.92–1.61)
Contact with suspect cases	310	42.9	1.03 (0.86–1.25)	0.99 (0.81–1.19)	0.88 (0.74–1.05)
Contact with confirmed cases	277	48.5	1.17 (0.96–1.42)	1.13 (0.92–1.39)	1.01 (0.83–1.21)
COVID-19 workload proportion
None	288	41.3	1	1	1
Up to one third	169	42.6	1.03 (0.82–1.28)	0.99 (0.79–1.24)	0.94 (0.77–1.15)
Up to two thirds	166	42.7	1.03 (0.82–1.29)	0.97 (0.77–1.23)	0.95 (0.77–1.18)
> two thirds	267	48.3	1.16 (0.97–1.40)	1.14 (0.94–1.38)	0.96 (0.81–1.15)
Lack of Personal Protective Equipment
No	508	37.4	1	1	1
Yes	382	52.6	1.40 (1.21–1.63)^c	1.39 (1.19–1.62)^c	1.13 (0.98–1.31)
Suspected COVID-19 infection
No	574	35.4	1	1	1
Yes	316	59.5	1.68 (1.45–1.94)^c	1.68 (1.45–1.96)^c	1.44 (1.25–1.66)^c
Absence from work due to suspected infection
No	746	41.4	1	1	1
Yes	144	56.9	1.37 (1.16–1.62)^c	1.35 (1.14–1.61)^c	0.98 (0.82–1.17)
Family or close friend with COVID-19
No	616	39.9	1	1	1
Yes	274	52.9	1.32 (1.14–1.53)^c	1.28 (1.10–1.50)^d	1.07 (0.93–1.24)
Degree of social distancing
Light	227	36.6	1	1	1
Moderate	568	47.2	1.29 (1.06–1.56)^d	1.30 (1.05–1.59)^d	1.19 (0.99–1.44)
Intense	95	42.1	1.15 (0.86–1.54)	1.19 (0.88–1.61)	1.14 (0.87–1.50)
Risk group
No	606	40.8	1	1	1
Yes	284	50.7	1.24 (1.07–1.44)^d	1.40 (1.20–1.63)^c	1.14 (0.99–1.32)
Problems with/abuse of alcohol
No	824	42.3	1	1	1
Yes	66	63.6	1.50 (1.23–1.83)^c	1.51 (1.23–1.84)^c	1.14 (0.94–1.38)
Tobacco use
No	748	41.3	1	1	1
Yes	142	57.7	1.39 (1.18–1.64)^c	1.39 (1.17–1.65)^c	1.22 (1.03–1.45)^d
Current use of psychotropic drugs
No	703	40.3	1	1	1
Yes	187	57.7	1.43 (1.23–1.67)^c	1.46 (1.25–1.71)^c	1.34 (1.15–1.57)^c

TOTAL	880	43.9

	n	%	Crude PR (95% CI)	Adjusted^a PR (95% CI)	Adjusted^b PR (95% CI)
Gender
Female	755	7.55	1	1	1
Male	135	6.67	0.88 (0.44–1.74)	1.11 (0.53–2.34)	1.55 (0.71–3.37)
Ethnicity
White	665	7.4	1	1	1
Brown	122	6.6	0.88 (0.43–1.83)	1.06 (0.50–2.26)	0.92 (0.44–1.90)
Black	103	8.7	1.18 (0.60–2.34)	1.39 (0.71–2.69)	1.46 (0.77–2.79)
Age
Up to 30	117	8.5	1	1	1
31 to 40	365	6.8	0.80 (0.39–1.61)	0.94 (0.42–2.11)	0.83 (0.38–1.83)
41 to 50	292	7.5	0.88 (0.43–1.80)	0.97 (0.42–2.21)	0.93 (0.43–2.03)
≥ 51	116	7.8	0.90 (0.38–2.15)	1.25 (0.48–3.23)	1.45 (0.48–4.37)
Education level
High School	330	8.5	1	1	1
Undergraduate	212	8.0	0.94 (0.53–1.68)	1.04 (0.55–1.94)	1.03 (0.56–1.92)
Graduate	348	6.0	0.71 (0.41–1.22)	1.01 (0.53–1.94)	1.19 (0.61–2.29)
Per capita income
Up to 1 minimum wage	205	11.7	1	1	1
Up to 2 minimum wages	305	6.6	0.56 (0.31–0.98)	0.54 (0.30–0.98)	0.58 (0.33–1.01)
Up to 3 minimum wages	132	5.3	0.45 (0.20–1.02)	0.44 (0.19–1.00)	0.49 (0.21–1.14)
> 3 minimum wages	168	3.6	0.30 (0.12–0.72)^c	0.29 (0.12–0.69)^c	0.28 (0.11–0.68)^c
Type of service
Primary Care	118	8.5	1	1	1
Outpatient	92	4.3	0.51 (0.16–1.58)	0.47 (0.12–1.80)	0.49 (0.12–2.01)
Emergency	84	8.3	0.98 (0.38–2.48)	1.09 (0.37–3.23)	0.78 (0.24–2.45)
Hospital	577	7.8	0.92 (0.47–1.77)	1.07 (0.50–2.26)	0.75 (0.32–1.79)
Administrative	19	–	–	–	–
Length of service in the nursing field
Up to 5 years	175	5.7	1	1	1
Up to 10 years	221	9.9	1.74 (0.84–3.58)	1.88 (0.85–4.13)	1.35 (0.56–3.24)
Up to 15 years	217	7.8	1.37 (0.64–2.91)	1.76 (0.78–3.97)	1.50 (0.65–3.47)
Up to 20 years	139	7.2	1.25 (0.53–2.94)	1.54 (0.62–3.48)	1.19 (0.45–3.11)
≥ 20 years	138	5.1	0.88 (0.34–2.27)	0.81 (0.28–2.33)	0.83 (0.28–2.43)
Nursing category
Registered Nurse	319	6.0	1	1	1
Nurse technician	501	8.2	1.37 (0.81–2.32)	0.96 (0.51–1.83)	0.80 (0.40–1.56)
Nursing assistant	70	8.6	1.43 (0.59–3.47)	1.09 (0.38–3.10)	2.53 (0.80–7.97)
Length of service at institution
Up to 5 years	520	7.1	1	1	1
Up to 10 years	160	11.2	1.58 (0.92–2.69)	1.45 (0.81–2.59)	1.10 (0.61–1.98)
Up to 15 years	71	2.8	0.39 (0.09–1.60)	0.37 (0.09–1.53)	0.38 (0.10–1.49)
≥ 15 years	134	5.2	0.73 (0.33–1.61)	0.57 (0.22–1.47)	0.72 (0.30–1.68)
Workload
Up to 30h	194	6.7	1	1	1
Up to 36h	473	8.7	1.29 (0.70–2.36)	1.43 (0.72–2.86)	1.05 (0.57–1.95)
36h+	223	5.4	0.80 (0.37–1.71)	0.72 (0.30–1.76)	0.57 (0.25–1.27)
Second job
No	645	8.2	1	1	1
Yes	245	5.3	0.64 (0.35–1.16)	0.61 (0.31–1.21)	0.60 (0.32–1.13)
COVID-19-specific training
No	319	7.2	1	1	1
Yes	571	7.5	1.04 (0.64–1.70)	1.01 (0.60–1.71)	0.93 (0.55–1.56)
Evaluation of working conditions
Good	325	5.5	1	1	1
Regular	409	6.6	1.19 (0.66–2.12)	1.27 (0.68–2.36)	1.22 (0.66–2.26)
Poor	156	13.5	2.43 (1.33–4.42)^c	2.16 (1.13–4.13)^c	1.53 (0.77–3.03)
Evaluation of support at work
Good	263	6.1	1	1	1
Regular	363	6.1	0.99 (0.53–1.86)	1.10 (0.58–2.11)	0.92 (0.35–2.42)
Poor	264	10.6	1.74 (0.96–3.14)	1.58 (0.81–3.05)	0.86 (0.29–2.54)
Burden
Light	343	6.7	1	1	1
Moderate	262	5.0	0.73 (0.38–1.43)	0.96 (0.48–1.92)	0.71 (0.35–1.40)
Heavy	285	10.5	1.56 (0.93–2.64)	1.93 (1.08–3.43)^c	0.98 (0.47–2.05)
Current burden compared to that pre-COVID-19
Same or decreased	337	5.6	1	1	1
Increased	553	8.5	1.50 (0.90–2.52)	2.03 (1.13–3.64)^c	1.61 (0.88–2.96)
Involvement with COVID-19 cases
None	288	5.9	1	1	1
Indirect work (e.g., administrative)	65	9.2	1.56 (0.64–3.81)	1.84 (0.70–4.86)	1.85 (0.72–4.71)
Contact with suspect cases	310	8.1	1.36 (0.75–2.47)	1.38 (0.74–2.56)	1.20 (0.63–2.25)
Contact with confirmed cases	277	7.9	1.34 (0.70–2.54)	1.36 (0.69–2.71)	1.25 (0.60–2.61)
COVID-19 workload proportion
None	288	5.9	1	1	1
Up to one third	169	6.5	1.10 (0.52–2.29)	0.96 (0.43–2.17)	0.91 (0.37–2.20)
Up to two thirds	166	9.6	1.63 (0.84–3.14)	1.76 (0.90–3.44)	1.66 (0.86–3.21)
> two thirds	267	8.2	1.39 (0.75–2.57)	1.48 (0.77–2.86)	1.19 (0.60–2.33)
Lack of Personal Protective Equipment
No	508	6.5	1	1	1
Yes	382	8.6	1.32 (0.83–2.11)	1.10 (0.67–1.80)	0.76 (0.45–1.28)
Suspected COVID-19 infection
No	574	7.0	1	1	1
Yes	316	8.2	1.18 (0.73–1.89)	1.42 (0.84–2.37)	0.96 (0.55–1.65)
Absence from work due to suspected infection
No	746	7.6	1	1	1
Yes	144	6.2	0.81 (0.41–1.61)	0.88 (0.43–1.80)	0.65 (0.30–1.44)
Family or close friend with COVID-19
No	616	6.5	1	1	1
Yes	274	9.5	1.46 (0.91–2.34)	1.58 (0.94–2.65)	1.42 (0.84–2.41)
Degree of social distancing
Light	227	8.8	1	1	1
Moderate	568	7.6	0.85 (0.51–1.42)	0.99 (0.56–1.74)	1.03 (0.58–1.81)
Intense	95	3.2	0.35 (0.10–1.17)	0.42 (0.13–1.38)	0.53 (0.15–1.76)
Risk group
No	606	6.1	1	1	1
Yes	284	10.2	1.67 (1.05–2.66)^c	1.60 (0.96–2.65)	1.37 (0.81–2.31)
Problems with/abuse of alcohol
No	824	6.8	1	1	1
Yes	66	15.1	2.22 (1.19–4.16)^c	2.56 (1.31–4.96)^c	1.92 (0.98–3.78)
Tobacco use
No	748	6.8	1	1	1
Yes	142	10.6	1.54 (0.89–2.67)	1.42 (0.79–2.54)	1.09 (0.62–1.92)
Current use of psychotropic drugs
No	703	4.8	1	1	1
Yes	187	17.1	3.53 (2.24–5.57)^d	3.51 (2.14–5.76)^d	3.14 (1.87–5.26)^d

TOTAL	880	7.4

Faculdade de Saúde Pública da Universidade de São Paulo Avenida Dr. Arnaldo, 715, 01246-904 São Paulo SP Brazil, Tel./Fax: +55 11 3061-7985 - São Paulo - SP - Brazil
E-mail: revsp@usp.br

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[1] Correspondence: Poliana Farias Alves Rua Gomes Carneiro, nº 1, Centro 96010-610 Pelotas, RS, Brasil E-mail: polibrina@hotmail.com