24 September 2023: Clinical Research
Anxiety and Health Concerns among Healthcare Personnel Working with COVID-19 Patients: A Self-Assessment StudyKlaudia Paula Czorniej 1ABCDEFG*, Elżbieta Krajewska-Kułak 2ABCDEFG, Wojciech Kułak 1ABCDEFG
Med Sci Monit 2023; 29:e940766
BACKGROUND: Anxiety disorders are currently among the most common psychiatric diagnoses. This study aimed to analyze self-assessment of anxiety disorders, depression, and quality of life among healthcare personnel working during the COVID-19 pandemic, with a focus on sociodemographic sources and psychological indicators.
MATERIAL AND METHODS: The study covered a group of 318 healthcare professionals from Poland. The study used a self-created questionnaire, Beck Depression Inventory, WHOQOL-BREF, Generalised Anxiety Disorder Questionnaire (GAD-7), and Leibowitz Social Anxiety Scale.
RESULTS: In the study group, 71.1% of the respondents had coronavirus infection, and only 3.5% were not vaccinated. Almost half (45.6%) of the respondents in this group made independent decisions about performing work (45.6%), and 93.4% were satisfied with their work. Less than half of respondents (46.5%) felt work-related anxiety during the pandemic, 54.7% of respondents reported symptoms of depression, and 57% had a good quality of life. Nearly half (47.2%) of the respondents rated their health as good, but 53.1% feared deterioration after performing the aforementioned work, while 87.1% constantly or periodically felt anxious about their work.
CONCLUSIONS: Although the respondents usually made their own decisions about working with coronavirus-infected patients, most of them experienced anxiety related to their work during the pandemic and were afraid of damaging their health and contracting COVID-19. In self-assessment using standardized questionnaires, most respondents did not show an increase in generalized or social anxiety, but to a greater or lesser extent were diagnosed with a depressive episode. The majority of respondents had a good quality of life: the highest aspect regarded physical functioning and the lowest regarded social functioning.
Keywords: Anxiety Disorders, COVID-19, Health Personnel, Phobia, Social
Anxiety disorders are among the most common psychiatric diagnoses, representing common and disabling conditions, often beginning in childhood, adolescence, or early adulthood [1,2]. In 2019, anxiety disorders affected 301 million individuals, including 58 million adolescents and children. Characteristic features of anxiety disorders include excessive fear and worry (unrelated to recent stressful events, although it may be exacerbated in certain situations) and preoccupation, with associated behavioral disturbances . Due to these symptoms, the patients experience significant distress or significant functional impairment . More common clinical disorders include paroxysmal anxiety, social anxiety disorder, generalized anxiety disorder, separation anxiety disorder, and specific phobia [4,5].
Anxiety disorders are defined as complex conditions of currently unknown etiology.
General risk factors for their onset include female gender and a family history of anxiety, although disorder-specific risk factors have also been identified: genetic factors, smoking, alcohol consumption, occupational and environmental factors, and epigenetic associations [6–8].
Anxiety disorders commonly occur in the general population, and anxiety is part of everyday life . Research shows that mild levels of anxiety can be positive, while moderate to severe levels can, unfortunately, lead to intense anxiety; such patients should undergo treatment when affect normal functioning is affected.
In 2015, the proportion of the global population suffering from anxiety disorders was 3.6%. As in the case of depression, anxiety disorders are more common in women than in men (4.6% vs 2.6% at a global level). However, individual differences between genders may result from women being more prone to report mental health problems . Prevalence rates do not vary between age groups, although we can observe a trend toward a lower prevalence of anxiety disorders among older age groups. It should also be added that patients with anxiety disorders more frequently suffer from various illnesses .
At this point, we should emphasize that the staff had to learn to work in new, specific conditions during the pandemic’s first days. Changes in the organization of work involved, among other things, the designation of permanent teams working in a strictly defined mode to reduce contact between people, ensure adequate breaks, and designate special areas for this purpose, as well as adequate communication between teams working in the so-called clean and dirty zones. Due to the high risk of infection, personnel had to get used to working in additional uniforms. Because of the pandemic, many stayed in hotels designed for dedicated COVID-19 centers. Daily work under chronic stress, multiple hours spent analyzing cases, and information reported in the media can cause feelings of anxiety, lowered mood, symptoms of professional burnout, mental health disorders, and a crisis of social relationships. Many healthcare professionals have to face situations of hegemony, stigma, or rejection, even among family or friends. This phenomenon particularly affected the personnel working in dedicated COVID-19 hospitals and infectious disease treatment units . The outbreak of the COVID-19 pandemic created an atmosphere that exacerbated numerous factors of poor mental health .
In a systematic review from 2021, healthcare personnel were under mental stress, reporting a high prevalence of depression in this group . The prevalence of moderate depression was 21.7% across 55 studies. Individual studies estimated from 5.3% to 57.6%, and there was evidence of high between-study heterogeneity. It is well known that gender impacts the incidence of anxiety and depression. Affective disorders such as anxiety and depression are disproportionately (almost doubled) prevalent in women . The literature also supports that individual’s age predicts increases in depression and anxiety of symptoms over time .
Marital status was a significant predictor of perceived stress: being single was positively correlated with perceived stress, specifically the stresses associated with social commitments, loneliness, and economy/money. It has been demonstrated that marital status modifies depression, and married people have better mental health than single, widowed, separated, and divorced people .
A recent Indian study reported the protective factor for anxiety of healthcare workers with more than 20 years of work experience . In contrast, the length of professional experience did not correspond to the level of anxiety in a group of Polish midwives during the SARS-CoV-2 pandemic . In an Iranian study during the COVID-19pandemic, healthcare workers who had higher depression and distress, and had lower job satisfaction .
In an Indian study from 2021 , the overall prevalence of low quality of life was 45% (>40 years old). Healthcare workers were more likely to report low quality of life than younger medical staff. Furthermore, the risk of low quality of life was approximately 4 times higher among moderate to severely depressed healthcare workers. Age, gender, marital status, and direct involvement in COVID 19 care were related to moderate to severe depression. Healthcare professionals’ quality of life was moderate during the COVID-19 pandemic in Greece . Women, unmarried people, and participants with more than 11 years of work experience had higher quality of life.
Vaccination plays a crucial role in controlling coronavirus transmission and infectivity rates. Healthcare professionals are, in fact, at the greatest risk of contracting coronavirus due to their proximity and prolonged exposure to infected patients.
A study by Kejriwal and Shen  found a positive correlation between willingness to get vaccinated, hesitancy, and negative affect (in particular, those reporting more worry and anxiety reported more willingness to be vaccinated). Vaccine uptake may improve quality of life and economic outlook, enabling people to resume previous activities, become more socially active, return to working in person, or become employed.
In a similar study from China , vaccination of healthcare workers was negatively associated with higher depression, anxiety, and stress. Non-vaccinated healthcare professionals had severe anxiety, whereas, in vaccinated participants, anxiety levels were minimal. A study by Al-Obaidy et al  determined the level of depression, anxiety, and stress after receiving the COVID-19 vaccine among health care workers in Iraq. The mental health status was measured using a specific depression, anxiety, and stress scale named DASS-21. Most participants had a normal level of DASS-21 after receiving the vaccine.
In a study from the United States  with 453 167 participants studied, 52.2% had received the COVID-19 vaccine, and 26.5% and 20.3% of the participants reported anxiety and depression, respectively. Compared to those not vaccinated, the vaccinated participants had 13% lower odds of anxiety and 17% lower odds of depression.
The aim of this study was to assess the mental health (anxiety, depression, and quality of life) of healthcare workers during the COVID-19 pandemic, and evaluate the association between mental health outcomes and sociodemographic and work factors.
The following research hypotheses were set:
To verify the above hypotheses, the following research questions were formulated:
Material and Methods
STUDY DESIGN AND DATA COLLECTION:
We used a non-probability random method to select the respondents. All healthcare workers were from Podlaskie Province, and all participants worked in Białystok City, Poland. Information about the study was sent by e-mail to the directors of medical facilities in Białystok. The healthcare workers included physicians, nurses, midwives, paramedics, physiotherapists, and cosmetologists. This cross-sectional study was conducted between 30 September 2022 and 30 December 2022. Invitations to participate were sent to healthcare workers performing work during the pandemic.
Anyone willing to participate in the study was provided a link to the questionnaire and could fill it in online. The respondents’ answers were recorded using Google Forms.
The forms were anonymous. There are various following security features of Google Forms. HTTPS Encryption is used to prevent unauthorized access to the user’s data. There is password protection. Google follows strict data privacy policies and ensures that multiple layers of security protect all data collected through Google Forms. Google also allows users to customize their data-sharing settings to restrict access to sensitive data. CAPTCHA verification is used, which verifies that the user is human and not a bot, and monitoring for suspicious activity detects and blocks spam and phishing attempts. Google Forms supports two-factor authentication (2FA), an extra safety layer that requires users to provide a second form of authentication. This added layer of protection ensures that only authorized users can access the form.
GOOGLE FORMS’ SECURITY: ENSURING THE SAFETY OF YOUR DATA – NEXTDOORSEC:
Thanks to the online character of the questionnaire, the completion rate was 318 (100%) in relation to the total number of questionnaires returned (318). There were no incorrectly completed or incomplete questionnaires recorded. The participants could withdraw from the study at any time. All participants who had COVID-19 had laboratory tests of real-time reverse-transcriptase polymerase chain reaction (RT-PCR) for COVID-19.
The study involving human subjects was reviewed and approved by the Bioethics Committee of the Medical University of Białystok (resolution no: APK.002.145.2022).
In addition to health care personnel status and performing work during the pandemic, an additional inclusion criterion was the participant’s informed consent to participate in the study. Exclusion criteria included: lack of consent to participate in the study, respondents who began but did not finish the survey, occupation unrelated to health care, and not performing work during the pandemic.
The researchers used:
A self-created questionnaire included sociodemographic data (age, gender, seniority, marital status), questions on previous work in health care, assessment of substantive preparation to work with COVID-19 patients, source of knowledge about COVID-19, job satisfaction, the decision to work with coronavirus-infected patients, anxiety related to work during the pandemic, fear of becoming ill in connection with work during the pandemic, self-assessment, declaration of coronavirus infection, declaration of vaccination, declaration of using the help of a psychologist or psychiatrist in the past, and use of sedatives.
The Beck Depression Inventory (BDI), created by Aaron T. Beck, is a multiple-choice self-report inventory, one of the most widely used psychometric tests for measuring the severity of depression [27–29]. The Inventory consists of 21 points scored according to symptom intensity, from 0 to 3. Each question had a set of at least 4 possible responses, ranging in intensity. For example: (0) I do not feel sad, (1) I feel sad, (2) I am sad all the time, and I can no snap out of it, (3) I am so sad or unhappy that I can’t stand it.
At each point, the respondent has to choose one answer that, in their opinion, best describes their condition in the last 30 days before the survey. A score of 0–11 indicates the absence of depression, a score of 12–26 indicates mild depression, score of 27–49 indicates moderate depression, and a score of 50–63 indicates severe depression. The inventory was validated in Poland. The Cronbach α coefficient is 0.93 .
WHOQOL-BREF (short version) consists of 26 questions in 4 domains, as well as the global quality of life and separate self-assessment of health status [31–33]. The questionnaire assesses the quality of life of healthy and sick individuals in clinical practice. It addresses the following 4 domains of quality of life: physical functioning, mental functioning, social functioning, and environmental functioning. The respondents self-assessed: in the physical domain: activities of daily living, dependence on medication and treatment, energy and fatigue, mobility, pain and discomfort, rest and sleep, ability to work; in the psychological domain: physical appearance, negative feelings, positive feelings, self-esteem, spirituality, religion, personal faith, thinking, learning, memory, concentration; in the social relations domain: personal relationships, social support, sexual activity; in the functioning environment: financial resources, freedom, physical and psychological safety, health and health care (availability and quality), home environment, opportunities to learn new information and skills, opportunities and participation in recreation and leisure, physical environment (pollution, noise, traffic, climate), transport. WHOQOL-BREF also contains items analyzed separately: question 1 (WHO1): individual overall perception of quality of life, and question 2 (WHO2): individual overall perception of own health. Responses are included on a 5-point scale (scoring range 1–5). A maximum score of 20 can be obtained in each domain. Individual domain scores have a positive direction (the higher the score, the higher the quality of life). The questionnaire was validated in Poland. The following indicators, expressed by the Cronbach α coefficient, were obtained for the domain: physical α=0.81, psychological α=0.78, social relations α=0.77, and environment α=0.69 .
The Generalised Anxiety Disorder (GAD-7) Questionnaire is a screening instrument for self-reporting generalized anxiety disorder . It consists of 7 questions about how often symptoms of generalized anxiety disorder occurred in the past 2 weeks. The patient answers the questions with answers ranging from 0=‘not at all’ to 3=‘nearly every day’ on a 4-point scale. The possible scores are 0 to 21; the higher the patient’s score, the greater the severity of the symptoms of generalized anxiety disorder (a score >10 indicating the presence of clinically significant generalized anxiety symptoms). We used the Polish version of the GAD-7 translated by the MAPI Research Institute (www.phqscreeners.com). Cronbach’s alpha reliability coefficient for the questionnaire was α=0.94 .
The standardized Liebowitz Social Anxiety Scale is often used to assess the severity of the social anxiety disorder, also known as social phobia [37,38]. Its purpose is to assess the range of social interaction and performance situations feared by a patient to assist in the diagnosis of social anxiety disorder. The scale is composed of 24 items divided into 2 subscales, 13 concerning performance anxiety and 11 pertaining to social situations. The 24 items are first rated on a Likert Scale from 0 to 3 on the fear felt during the situations, and then the same items are rated regarding avoidance of the situation. Combining the total scores for the Fear and Avoidance sections provides an overall score with a maximum of 144 points. The clinician-administered version of the test has 4 more subscale scores, which the self-administered test does not have. These additional 4 subscales are fear of social interaction, fear of performance, avoidance of social interaction, and avoidance of performance. Usually, the sum of the total fear and total avoidance scores are used in determining the final score (thus, essentially, it uses the same numbers as the self-administered test). Research supports a cut-off point of 30, in which social phobia is unlikely. The next cut-off point is at 60, at which social phobia is probable. Scores in this range are typical of persons entering treatment for the non-generalized type of social phobia. Scores between 60 and 90 indicate that social phobia is very probable. Scores in this range are typical of persons entering treatment for the generalized type of social phobia. Scores higher than 90 indicate that social phobia is highly probable. Scores in this range often are accompanied by great distress and difficulty in social functioning, and are also commonly seen in persons entering treatment for the generalized type of social phobia [38–44]. We used the Polish version of the Leibowitz Social Anxiety Scale. Cronbach’s alpha reliability coefficient for the questionnaire was α=0.96 .
By using validated scales, we could compare the results obtained with those of similar, representative studies conducted in other countries. In addition, we could analyze correlations between the scores obtained on the different scales.
PROCEDURE AND ETHICAL CONSIDERATIONS:
The study was conducted in accordance with the recommendations and was reviewed and approved by the Bioethics Committee of the Medical University of Białystok (resolution no: APK.002.145.2022).
The data were processed using Microsoft Excel 2013 spreadsheets and analyzed using Statistica PL version 13.0. We have used descriptive statistics to present data (mean and percentages in the text and tables).
A multiple regression was used for analysis. The beta coefficient estimates result from a regression analysis where the underlying data have been standardized so that the variances of dependent and independent variables are equal to 1 . Using multiple regression, we evaluated correlations between the study variables (demographic data, job satisfaction, work experiences, anxiety, or using sedative medications) and the standardized scales (details in Tables 1 and 2).
A chi-square test was used to compare the percentages between variables (gender, place of residence, profession, years of service, marital status). A
The study covered a group of 318 healthcare workers (203 women and 115 men) performing work with coronavirus-infected patients during the pandemic. More than half of the respondents were women (P<0.001) between the ages of 26 and 29. Significantly (P<0.01) more respondents (46.5%) resided in cities of 50 000 to 100 000 inhabitants. Almost three-quarters of the respondents (67.3%) were working as a nurse. Significantly (P<0.01) more (43.4%) respondents had worked for 3 to 5 years. Most respondents (49.4%) described their marital status as ‘civil partnership’. The detailed socio-demographics of the respondents are shown in Table 3.
SOURCES OF COVID-19 KNOWLEDGE AND WORK EXPERIENCE:
According to respondents, television (71.4%) and Facebook (63.8%) were the most common sources of knowledge about COVID-19. Details are shown in Table 4.
There were 145 (45.6%) respondents who started working with coronavirus-infected patients by choice, and only 32(10.1%) had difficulty answering this question. Almost all 309 (97.2%) respondents had previously worked in healthcare facilities, and only 9 (2.8%) had not. There were 157 (49.4%) respondents who reported they were prepared to work with COVID-19 patients, 57(17.9%) thought that they were not, and 86 (27%) found it difficult to declare. Two hundred ninety-seven respondents (93.4%) were satisfied with their work, and only 16 (5%) had a different opinion. In self-assessment of health, respondents most often assessed it as good 150 (47.2%), and only 4 (1.3%) described it as poor. Deterioration of health conditions after working with COVID-19 patients was feared by 169 (53.1%) respondents, and 110 (34.6%) reported that it would depend on the situation they faced. There were 226 (71.1%) respondents who reported having coronavirus infection, and 69 (21.7%) had not been ill. Only 11 (3.5%) respondents were not vaccinated. The others were vaccinated – 95 (29.9%) had received 2 doses plus a booster dose, 74 (23.3%) had received 2 doses, 68 (21.4%) had received 3 doses, 63 (19.8%) had received a single-dose vaccine, and 7 (2.2%) had received 1 dose.
MENTAL HEALTH STATUS:
Almost half of respondents (148, 46.5%) sometimes felt work-related anxiety during the pandemic. It was experienced all the time by 129 respondents (40.6%), never by 38 respondents (11.9%), and 3 (0.9%) respondents found it difficult to declare.
Regarding their work during the pandemic, 147 (46.2%) respondents declared that they felt fear of contracting COVID-19, but to the same extent as for other diseases, and 119 (37.4%) respondents reported that they feared COVID-19 more than other diseases.
Analysis of the results from the standardized GAD-7 showed that the respondents obtained an average score of 5.5±3.6 out of 21, indicating no generalized anxiety symptoms (score >10 indicating generalized anxiety symptoms) (Table 1).
The respondents were also surveyed using the standardized Social Anxiety Depression Questionnaire and obtained a mean score of (32.6±15.3), indicating the absence of social phobia.
In the assessment using the standardized Beck Depression Inventory, the respondents obtained a mean score of 15.4±12.8, suggesting mild depression. Overall, no depression was found in 144 (45.3%) respondents, mild depression was found in 123 (38.7%) respondents, moderate depression was found in 48 (15.1%) respondents, and severe depression was found in only 3 (0.9%) respondents.
QUALITY OF LIFE ASSESSMENT:
When assessed using the standardized WHOQOL-BREF, the respondents scored in the terms:
The overall mean quality of life score was 3.58 ± 0.62, with more than half of the respondents (57%) having a good quality of life (a score of 4). A score of 2 was obtained from 8 (2.5%) respondents, a score of 3 from 122 (38.3%) respondents, and a score of 5 from 7 (2.2.0%) respondents.
USE OF PSYCHOLOGICAL SUPPORT AND MEDICATION:
Eighty-two (25.8%) respondents had used the services of a psychologist in the past, and 2 (0.6%) respondents had consulted a psychiatrist; 236 (74.2%) respondents did not use a psychologist, and 316 (99.4%) had seen a psychiatrist.
At the time of the study, 28 respondents (8.8%) were taking sedative medication, including 2–3 times a week (4 respondents – 1.3% of all the respondents and 14.3% of medication users), daily (10 respondents – 3.1% of all respondents and 35.7% of medication users), several times a month (8 respondents – 2.5% of all the respondents and 28.6% of medication users), several times a year (6 respondents – 1.9% of all the respondents and 21.4% of medication users). The declared medications were over-the-counter medications, such as Valused (15 respondents – 4.7% of all the respondents and 53.6% of medication users), Nervomix (6 respondents – 1.9% of all the respondents and 10.7% of medication users), Depresanum (4 respondents – 1.3% of all the respondents and 14.3% of medication users) and Labofarm (3 respondents – 0.9% of all the respondents and 10.7% of medication users). Medications were not being used at that time by 290 respondents (91.2%).
If necessary (eg, when feeling overwhelmed at work), 198 respondents (62.3%) would not use psychological or psychiatric help, 75 (23.6%) would go to a specialist, and 54 (14.1%) found it difficult to declare.
CORRELATIONS AND REGRESSION ANALYSIS:
The correlations between the study variables and the standardized scales (Beta coefficient, P value) are shown in Table 2. A negative significant correlation was found between gender and social anxiety. Also, a negative significant correlation was found between anxiety and quality of life. Significantly positive correlations were found between marital status and depression in the Beck Inventory and between work-related anxiety during the pandemic and social anxiety. Also, significantly positive correlations were found between anxiety and general anxiety in the GAD-7 depression on the Beck Inventory.
The correlations between the study variables and the standardized WHOQOL-BREF subscales (Beta coefficient, P value, multivariate regression analysis) are shown in Table 5.
Significant negative correlations were found between marital status and social functioning, and between years of service and environmental functioning. Significant positive correlations were found between job satisfaction and psychological functioning, and environmental functioning. Also, significant positive correlations were noted between work experience in healthcare and mental, social, and environmental functioning. A significant a positive correlation was found between coronavirus infection and social functioning.
CORRELATION BETWEEN EXPOSURE TO COVID-19 AND MENTAL HEALTH:
According to the studies analyzed in a systematic review by, among others, researchers at the Norwegian Institute of Public Health, during the COVID-19 pandemic, up to 97% of healthcare workers experienced distress stress negatively affecting their preparedness and mental state . The anxiety reaction is also the most typical manifestation of pandemic acute stress disorder.
In the present study, almost half of the respondents (46.5%) sometimes felt work-related anxiety during the pandemic. Our findings are in accordance with previous reports [42–47].
The prevalence of anxiety reported by healthcare workers in a systematic review from 2020 varied from 24.1% to 44.6% . An April 2020 survey of healthcare workers in Spain found that nearly three-fifths of the respondents reported symptoms of anxiety (59%), and nearly half of them (46%) showed symptoms of depression . A China, the cross-sectional study was carried out on a sample of 7236 respondents, 2250 of whom were healthcare professionals. The prevalence of generalized anxiety disorder in the entire survey group was 35.1%; the disorder was more common in men. Another single-center, cross-sectional study covered 2042 healthcare and 257 administrative personnel. Anxiety criteria were met by 25.5% of healthcare professionals and 18.7% of administrative staff . Another study included 2182 participants (680 physicians, 247 nurses, and 1255 non-medical professionals), showing that 13% of healthcare professionals reported anxiety compared to 8.5% of non-medical personnel . The pandemic is a period that led to a significant increase in anxiety more often in healthcare workers than non-healthcare workers. In a group of the general population in Iran, 51% showed anxiety during the COVID-19 pandemic . Contrary to our results, the study by Fukowska and Koweszko , which covered 316 healthcare workers and 302 control subjects who did not work in the health professions, found that healthcare professionals had higher levels of depression and anxiety than the control group, and nurses had the highest scores.
In the current study, 54.7% of healthcare workers were found to have depression (of varying severity). Our findings differ from those of other studies. For depression, data from 19 studies  demonstrated that the percentage of healthcare workers with depression ranged from 5% to 51%, with a median of 21%. The COVID-19 Mental Disorders Collaborators study conclude that throughout 2020 the pandemic led to a 27.6% increase in cases of major depressive disorders and a 25.6% increase in cases of anxiety disorders globally. Mental health problems of healthcare workers, which are statistically more frequently experienced by women, including nurses, also include depression’s higher prevalence [49,50]. In the study by Zhang et al , depression was noticed in 12.2% of healthcare workers and 9.5% of non-medical personnel. In another study from China , 11.8% of the medical staff presented with mild to moderate depression and 0.3% with severe depression. As compared to the administrative staff group, there was no significant difference in the severity of depression in the medical staff group .
WORK SATISFACTION AND VOLUNTARY INVOLVEMENT:
WHO data  suggest that healthcare workers accounted for 8% of all confirmed COVID-19 cases worldwide, including about 10% in the first 3 months of the pandemic. In contrast, 71.1% of respondents had coronavirus infection in the present study. All cases were confirmed by laboratory tests. Healthcare workers in Mexico were most affected by the pandemic, as by the end of September 2021, more than 278 000 infections had been reported among healthcare workers across the country, and over 4400 of them had died . Overall, healthcare workers accounted for 8% of all infected and 2% of pandemic deaths in Mexico. In comparison, in The Netherlands, the proportion of healthcare workers among all recorded infections was even higher (10%), but they accounted for a much lower proportion of all deaths (0.2%) .
Working directly with a COVID-19 patient was found to be associated with fear of infection, unpredictability of events, helplessness, loss of control, and anxiety . In the present study, 93.4% of the respondents were satisfied with their professional work, which may be related to the fact that most of the respondents decided to work with coronavirus-infected patients independently (45.6%). The study by Dymecka et al  demonstrated that stress and fear of COVID-19 perceived by physicians were related to job satisfaction. Fear of COVID-19 increased the negative impact of perceived stress on job satisfaction. In their study, Grzelak and Szwarc  surveyed a group of 65 nursing staff working in 7 hospital units. They found that the pandemic outbreak caused a change in the perception of stress in 98.5% of the respondents, and 89 noticed increased stress symptoms in themselves. After 1 year of working during the pandemic, stress remained medium to low. In the present study, 53.1% of the respondents feared health deterioration after working with COVID-19 patients, and 34.6% of such fears depended on the situation experienced.
STRESS AND COVID-19:
Active participation of healthcare workers during the COVID-19 pandemic process is clearly associated with long-term psychosocial strain. Stress, and the negative emotions associated with it, are factors that contribute to a weakened immune response when exposed to the virus [14,23]. Healthcare workers who witness their patients and their colleagues becoming ill and dying experience extreme stress, with as many as 56% of healthcare workers describing the amount of stress they had been exposed to during the COVID-19 outbreak as moderate or severe .
In the United States, a survey covering frontline healthcare workers found that more than 62% reported that the stress related to COVID-19 had negatively affected their mental health. Nearly half (49%) reported that the stress had affected their physical health, and nearly one-third reported the need for receiving (or actually receiving) mental health support due to the pandemic . In a Greek study, healthcare workers during the COVID-19 pandemic had moderate levels of quality of life. Stress was present in 30.6% of healthcare workers, 10.6% had depression, and 8.2% had anxiety .
In the present study, 49.4% of respondents felt prepared to work with COVID-19 patients and that they gained expertise mainly from television (71.4%), Facebook (63.8%), the Internet (67.6%), and radio (40.9%), rather than from credible scientific sources. It seems worrying that as many as 62.3% of those currently surveyed would not seek psychological or psychiatric support if necessary (eg, feeling significantly overwhelmed by work).
VACCINATION AGAINST SARS-COV-2:
Healthcare workers are particularly exposed to biological risk during their daily occupational activities, and during the pandemic, COVID-19 healthcare workers were particularly exposed to coronavirus infection. A Polish study in 2021  reported that healthcare workers significantly more often demonstrated their willingness to get vaccinated against the SARS-CoV-2 compared to the control group (82.95% vs 54.31%, respectively). The study revealed that depression significantly affects the willingness to get vaccinated.
A German study from 2022 , conducted at the beginning of the pandemic, determined potential changes in psychological strain experienced by healthcare workers 1 year later. It assessed whether vaccination status might modulate the psychological burden of healthcare workers. It was found that fully vaccinated personnel reported lower levels of anxiety, depression, stress, and exhaustion, suggesting vaccination’s potential positive consequences beyond the obvious protection against COVID-19 infection. Similar results on vaccination were also reported by authors from Bangladesh . Compared with unvaccinated healthcare workers, vaccinated healthcare workers had a statistically significant lower prevalence of general health problems (16.7 vs 59.1%), depression (15.6 vs 31.9%), post-traumatic stress disorder (22.3 vs 30.8%), insomnia (23.8 vs 64.9%), and loneliness symptoms (13.9 vs 21.8%).
The study has some potential limitations. Firstly, it was a cross-sectional study based solely on questionnaires, and we did not have a control group. Secondly, the study group was too small to generalize the results to the entire population of healthcare workers performing work during the pandemic. Thirdly, there was an overrepresentation nurses and paramedics in the study group, so the results should be verified in an equally large group of other healthcare professions. Another problem was that the study was performed solely based on questionnaires, even though there were standardized. Questionnaire-based studies rely on self-reporting, which can introduce bias and affect the reliability of the data.
In the future, it would be worthwhile to survey a larger group of personnel and to broaden the research to include employees of other healthcare professions and possibly psychiatric examinations. In spite of these limitations, it should be emphasized that the important value of the present study is the assessment of preparation of healthcare workers to work with COVID-19 patients, as well as analysis of the relationship between the prevalence of anxiety disorders self-assessed with a standardized questionnaire among health care personnel performing work during the pandemic and vaccination against COVID-19. The results of the present study may provide a starting point for further research into the prevalence of anxiety disorders and depression among healthcare workers performing work during the pandemic and its sociodemographic determinants.
1. Craske MG, Stein MB, Anxiety: Lancet, 2016; 388(10063); 3048-59
2. World Health Organization: Mental Disorders Available from:https://www.who.int/news-room/fact-sheets/detail/mental-disorders
3. Tyrer P, Baldwin D, Generalised anxiety disorder: Lancet, 2006; 368(9553); 2156-66
4. Bandelow B, Michaelis S: Dialogues Clin Neurosci, 2015; 17(3); 327-35
5. Humer E, Pieh C, Probst T, Metabolomic biomarkers in anxiety disorders: Int J Mol Sci, 2020; 21(13); 4784
6. Craske MG, Stein MB, Eley TC, Anxiety disorders: Nat Rev Dis Primers, 2017; 3; 17024
7. Penninx BW, Pine DS, Holmes EA, Anxiety disorders: Lancet, 2021; 397(10277); 914-27
8. Zimmermann M, Chong AK, Vechiu C, Modifiable risk and protective factors for anxiety disorders among adults:A systematic review: Psychiatry Res, 2020; 285; 112705
9. Pary R, Matuschka PR, Lewis S, Generalized anxiety disorder: South Med J, 2003; 96(6); 581-86
10. World Health Organization: Depression and other common mental disorders: Global health estimates Available from:https://apps.who.int/iris/bitstream/handle/10665/254610/WHO-MSD-MER-2017.2-eng.pdf
11. Latas M, Vučinić Latas D, Spasić Stojaković M, Anxiety disorders and medical illness comorbidity and treatment implications: Curr Opin Psychiatry, 2019; 32(5); 429-34
12. Gniadek A, Nawara W, Padykuła M, Polska pielęgniarka w czasie pandemii zakażeń SARS-CoV-2 – różne perspektywy wykonywania zawodu: Zdrowie Publiczne i Zarządzanie, 2020; 18(2); 149-54 [in Polish]
13. COVID-19 Mental Disorders Collaborators, Global prevalence and burden of depressive and anxiety disorders in 204 countries and territories in 2020 due to the COVID-19 pandemic: Lancet, 2021; 398(10312); 1700-12
14. Li Y, Scherer N, Felix L, Prevalence of depression, anxiety, and post-traumatic stress disorder in health care workers during the COVID-19 pandemic:A systematic review and meta-analysis: PLoS One, 2021; 16(3); e0246454
15. Asher M, Asnaani A, Aderka IM, Gender differences in social anxiety disorder:A review: Clinical Psychol Rev, 2017; 56; 1-12
16. Gayman MD, Turner RJ, Cui M, Physical limitations and depressive symptoms:Exploring the nature of the association: J Gerontol Psychol Sci Soc Sci, 2008; 63(4); S219-S28
17. Bulloch AGM, Williams JVA, Lavorato DH, Patten SB, The depression and marital status relationship is modified by both age and gender: J Affect Disord, 2017; 223; 65-68
18. Gupta S, Prasad AS, Dixit PK, Survey of prevalence of anxiety and depressive symptoms among 1124 healthcare workers during the coronavirus disease 2019 pandemic across India: Med J Armed Forces India, 2021; 77(Suppl 2); S404-S12
19. Gotlib J, Rzońca E, Baranowska B, Is job seniority a protective factor against anxiety among midwives during the SARS-CoV-2 pandemic?: Ann Agric Environ Med, 2021; 28(2); 352-57
20. Zhang SX, Liu J, Afshar Jahanshahi A, Nawaser K, At the height of the storm:Healthcare staff’s health conditions and job satisfaction and their associated predictors during the epidemic peak of COVID-19: Brain Behav Immun, 2020; 87; 144-46
21. Suryavanshi N, Kadam A, Dhumal G, Mental health and quality of life among healthcare professionals during the COVID-19 pandemic in India: Brain Behav, 2020; 10(11); e01837
22. Kejriwal M, Shen K, COVID-19 vaccine hesitancy is positively associated with affective wellbeing: PsyArXiv, 2021 Web
23. Latsou D, Bolosi FM, Androutsou L, Geitona M, Professional quality of life and occupational stress in healthcare professionals during the COVID-19 pandemic in Greece: Health Serv Insights 26, 2022; 15; 11786329221096042
24. Guo F, Han R, Sun Y, The associations between COVID-19 vaccination and psychological disorders among healthcare workers in China: J Affect Disord, 2022; 318; 40-47
25. Al-Obaidy LM, Attash HM, Al-Qazaz HK, Depression, anxiety and stress after COVID-19 vaccination:A retrospective cross-sectional study among health care providers: Pharmacy Practice, 2022; 20(3); 2689
26. Chen S, Aruldass AR, Cardinal RN, Mental health outcomes after SARS-CoV-2 vaccination in the United States:A national cross-sectional study: J Affect Disord, 2022; 298(Pt A); 396-99
27. Wang J, Wu X, Lai W, Prevalence of depression and depressive symptoms among outpatients:A systematic review and meta-analysis: BMJ Open, 2017; 7(8); e017173
28. Richter P, Werner J, Heerlein A, On the validity of the Beck Depression Inventory. A review: Psychopathology, 1998; 31(3); 160-68
29. Wang YP, Gorenstein C, Psychometric properties of the Beck Depression Inventory-II:A comprehensive review: Braz J Psychiatry, 2013; 35(4); 416-31
30. Zawadzki B, Popiel A, Pragłowska E, Charakterystyka psychometryczna polskiej adaptacji Kwestionariusza Depresji BDI–II Aarona T. Becka: Psychologia – Etologia – Genetyka, 2009; 19; 71-95 [in Polish]
31. Abbasi-Ghahramanloo A, Soltani-Kermanshahi M, Mansori K, Comparison of SF-36 and WHOQoL-BREF in measuring quality of life in patients with type 2 diabetes: Int J Gen Med, 2020; 13; 497-506
32. Min SK, Kim KI, Lee CI, Development of the Korean versions of WHO Quality of Life scale and WHOQOL-BREF: Qual Life Res, 2002; 11(6); 593-600
33. Siafaka V, Mavridis D, Tsonis O, The WHOQOL-BREF instrument:Psychometric evaluation of the Greek version in patients with advanced cancer and pain and associations with psychological distress: Palliat Support Care, 2022; 19; 1-11
34. Jaracz K, Kalfoss M, Górna K, Baczyk G, Quality of life in Polish respondents:Psychometric properties of the Polish WHOQOL-Bref: Scand J Caring Sci, 2006; 20(3); 251-60
35. Shevlin M, Butter S, McBride O, Measurement invariance of the Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder Scale (GAD-7) across four European countries during the COVID-19 pandemic: BMC Psychiatry, 2022; 22(1); 154
36. : The Polish version of the GAD-7 by the MAPI Research Institute www.phqscreeners.com
37. Takada K, Takahashi K, Hirao K, Measurement error in the Liebowitz Social Anxiety Scale:Results from a general adult population in Japan: Int J Psychiatry Clin Pract, 2018; 22(4); 289-95
38. Rytwinski NK, Fresco DM, Heimberg RG, Screening for social anxiety disorder with the self-report version of the Liebowitz Social Anxiety Scale: Depress Anxiety, 2009; 26; 34-38
39. Kwaśniak L, Adaptacja i walidacja LSAS: Dolnośląska Szkoła Wyższa, 2019 [in Polish]
40. Menard S, Standardized regression coefficients: The Sage Encyclopedia of Social Science Research Methods, 2004; 1069-70, Thousand Oaks, CA, USA, Sage Publications
41. Muller AE, Hafstad EV, Himmels JPW, The mental health impact of the COVID-19 pandemic on healthcare workers, and interventions to help them:A rapid systematic review: Psychiatry Res, 2020; 293; 113441
42. COVID-19 Mental Disorders Collaborators, Global prevalence and burden of depressive and anxiety disorders in 204 countries and territories in 2020 due to the COVID-19 pandemic: Lancet 6, 2021; 398(10312); 1700-12
43. Walton M, Murray E, Christian MD, Mental health care for medical staff and affiliated healthcare workers during the COVID-19 pandemic: Eur Heart J Acute Cardiovasc Care, 2020; 9(3); 241-47
44. Solecka M: Wpływ pandemii na pracowników ochrony zdrowia Available from:www.mp.pl/covid19/covid19-aktualnosci/284342,wplyw-pandemii-na-pracownikow-ochrony-zdrowia
45. Aslanidis V, Tsolaki V, Papadonta ME, The impact of the COVID-19 pandemic on mental health and quality of life in COVID-19 Department Healthcare Workers in Central Greece: J Pers Med, 2023; 13(2); 250
46. Grzelak L, Szwarc P, Wpływ pracy w czasie pandemii COVID-19 na stres personelu pielęgniarskiego: Innowacje w Pielęgniarstwie i Naukach o Zdrowiu, 2021; 1(6); 7-21 [in Polish]
47. Heitzman J, Wpływ pandemii COVID-19 na zdrowie psychiczne: Psychiatr Pol, 2020; 54(2); 187-98
48. Romero CS, Delgado C, Catalá JPSIMCOV group, COVID-19 psychological impact in 3109 healthcare workers in Spain:The PSIMCOV group: Psychol Med, 2022; 52(1); 188-94
49. Huang Y, Zhao N, Generalized anxiety disorder, depressive symptoms, and sleep quality during COVID-19 outbreak in China:A web-based cross-sectional survey: Psychiatry Res, 2020; 288; 112954
50. Vizheh M, Qorbani M, Arzaghi SM, The mental health of healthcare workers in the COVID-19 pandemic:A systematic review: J Diabetes Metab Disord, 2020; 19(2); 1967-78
51. Moghanibashi-Mansourieh A, Assessing the anxiety level of Iranian general population during COVID-19 outbreak: Asian J Psychiatr, 2020; 51; 102076
52. Fukowska M, Koweszko T, Analiza stanu psychicznego i satysfakcji z pracy personelu medycznego w okresie pandemii COVID-19: Psychiatria, 2022; 19(1); 1-10 [in Polish]
53. Lu W, Wang H, Lin Y, Psychological status of medical workforce during the COVID-19 pandemic:A cross-sectional study: Psychiatry Res, 2020; 288; 112936
54. Zhang WR, Wang K, Yin L, Mental health and psychosocial problems of medical health workers during the COVID-19 epidemic in China: Psychother Psychosom, 2020; 89(4); 242-50
55. : COVID-19 Weekly Epidemiological Update (who.int)20210202_Weekly_Epi_Update_25.pdf
56. Agren D, Understanding Mexican health worker COVID-19 deaths: Lancet, 2020; 396(10254); 807
57. Sikkema RS, Pas SD, Nieuwenhuijse DF, COVID-19 in health-care workers in three hospitals in the south of the Netherlands:A cross-sectional study: Lancet Infect Dis, 2020; 20(11); 1273-80
58. Dymecka J, Psychosocial effects of the COVID-19 pandemic: Neuropsychiatry and Neuropsychology, 2021; 16(1); 1-10
59. Do DP, Frank R, U.S. frontline workers and COVID-19 inequities: Prev Med, 2021; 153; 106833
60. Szmyd B, Karuga FF, Bartoszek A, Attitude and behaviors towards SARS-CoV-2 vaccination among healthcare workers:A cross-sectional study from Poland: Vaccines (Basel), 2021; 9(3); 218
61. Reicherts P, Zerbini G, Halms T, COVID-19 related psychological burden and potential benefits of vaccination – data from a repeated cross-sectional survey in healthcare workers: Psychiatry Res Commun, 2022; 2(3); 100054
62. Alam MD, Paul SK, Momi M, Factors associated with psychological outcomes among vaccinated and unvaccinated health care workers against COVID-19 infection in Bangladesh: Front Med (Lausanne), 2022; 9; 852922
08 Dec 2023 : Clinical ResearchAssociation Between Influenza Vaccine Uptake and Health Awareness: A Cross-Sectional Questionnaire-Based St...
Med Sci Monit In Press; DOI:
04 Dec 2023 : Animal ResearchEffects of Intrathecal Ketamine on Cerebrospinal Fluid Levels of Brain-Derived Neurotrophic Factor and Mech...
Med Sci Monit In Press; DOI:
01 Dec 2023 : Clinical ResearchRisk Factors and Clinical Outcomes of COVID-19 Infection in Multiple Sclerosis Patients: A Retrospective St...
Med Sci Monit In Press; DOI:
Most Viewed Current Articles
13 Nov 2021 : Clinical ResearchAcceptance of COVID-19 Vaccination and Its Associated Factors Among Cancer Patients Attending the Oncology ...
Med Sci Monit 2021; 27:e932788
30 Dec 2021 : Clinical ResearchRetrospective Study of Outcomes and Hospitalization Rates of Patients in Italy with a Confirmed Diagnosis o...
Med Sci Monit 2021; 27:e935379
14 Dec 2022 : Clinical ResearchPrevalence and Variability of Allergen-Specific Immunoglobulin E in Patients with Elevated Tryptase Levels
Med Sci Monit 2022; 28:e937990
08 Mar 2022 : Review articleA Review of the Potential Roles of Antioxidant and Anti-Inflammatory Pharmacological Approaches for the Man...
Med Sci Monit 2022; 28:e936292