COVID-19 Outbreak and Its Association with Healthcare Workers' Emotional Stress: a Cross-Sectional Study

Abstract

Background The coronavirus disease 2019 (COVID-19) outbreak has exposed healthcare workers to extreme physical workloads and psychological challenges. Thus, we aimed to assess the immediate correlates of emotional stress and to identify which specific jobs, departments, and exposure types are risk factors for emotional stress in healthcare workers. Methods In this cross-sectional study conducted from April 2 to 10, 2020, university hospital workers were administered self-reported questionnaires that covered general characteristics and included the Patient Health Questionnaire, Generalized Anxiety Disorder scale, and a visual analog scale. At-risk groups for depression and anxiety were identified, and the odds ratios for depression and anxiety were analyzed after adjusting for age, gender, education, marital status, and duration of employment. Results The data of 1,003 participants were analyzed. Of these, 14.2% worked in wards for confirmed COVID-19 cases and 15.2% had had direct contact with these patients. Treating patients with COVID-19 was associated with depression and anxiety, while dealing with COVID-19 test samples was associated with depression. Exposure to random or unspecified patients was also associated with depression. Lastly, social rejection and other negative experiences were associated with depression and anxiety. Conclusion The COVID-19 outbreak is correlated with healthcare workers' emotional stress, and specific types of jobs and duties involving close contact with these patients can be risk factors. Interestingly, even low-exposure groups reported significant depression and anxiety as a result of social stigma and uncertainty. Adequate and timely management measures for emotional stress are required for vulnerable and at-risk groups.

Factors Associated With Psychological Distress in Health-Care Workers During an Infectious Disease Outbreak: A Rapid Systematic Review of the Evidence

“…In nurses during the MERS outbreak, perceived social stigma was associated with higher stress and poorer mental health ( 108 ). Similarly, during the COVID-19 pandemic, HCW who felt stigmatized, perceived stigma concerning negative public attitudes and disclosing about one's work, experienced higher levels of depression, anxiety, and psychological distress ( 55 , 78 , 102 , 108 , 109 , 116 , 138 ). During the SARS outbreak, HCW who felt people avoided their family because of their job were twice as likely to have elevated levels of post-traumatic stress symptoms ( 83 ).…”

“…Three studies conducted during COVID-19 found that risk of contact was not associated with greater distress (53,94,132). Spending time in quarantine due to risk of being infected was associated with higher levels of burnout, depression, and psychological distress in HCW during SARS and COVID-19 (14,59,92,132), but was unrelated to posttraumatic stress symptoms and psychological distress in HCW during the MERS outbreak or the COVID-19 outbreak (78,85,109,125,156). Lastly, one study found that HCW who had colleagues who became infected, had deceased due to infection, or had been quarantined, also experienced higher levels of posttraumatic stress symptoms and acute stress during the COVID-19 outbreak (118).…”

Preparing for the Coronavirus Disease (COVID-19) Vaccination: Evidence, Plans, and Implications

“… 18 Until now, COVID-19 infection by medical staff during work has not been commonly found in Korea, 19 but it has been shown that even with low exposure risk, healthcare workers are under emotional stress. 20 Damage to medical staff due to self-isolation after exposure is also an important factor to consider.…”

Factors affecting frontline Korean nurses’ mental health during the COVID‐19 pandemic

“…Park et al (2020) reported that healthcare providers who were in charge of COVID-19 screening or exposed to confirmed cases were more likely to be depressed than workers in rare contact departments. Depressive symptoms experienced by nurses can increase turnover intention (Pang et al 2020).…”

“…During the COVID-19 outbreak, 44% of frontline nurses in emergency departments had depression (An et al 2020), which is believed to be due to the high likelihood of coming into contact with patients with suspected symptoms, such as fever. Park et al (2020) reported that healthcare providers who were in charge of COVID-19 screening or exposed to confirmed cases were more likely to be depressed than workers in rare contact departments. Depressive symptoms experienced by nurses can increase turnover intention (Pang et al 2020).…”