Evaluation of psychological distress, burnout and structural empowerment status of healthcare workers during the outbreak of coronavirus disease (COVID-19): a cross-sectional questionnaire-based study | BMC Psychiatry

Responses rate

An online survey was sent via email to healthcare workers (HCWs) from 48 different countries. Out of the 1030 participants, all completed the sociodemographic section, resulting in a response rate of 100%. A total of 730 participants completed the DASS-21 questionnaire (70.9%), 851 completed the MBI questionnaire (82.6%), and 712 completed the CWEQ-II questionnaire (69.1%).

Participants’ sociodemographic characteristics

The mean ± SD age of all responders (n = 1030) was 38.88 ± 9.63 years (range: 21–74 years) and 54.4% (n = 560) of them were male. The majority of participants were physicians (n = 562, 54.6%), followed by nurses (n = 279, 27.1%). Out of 1030 responders, 332 (32.2%) HCWs worked in ICU, 185 (18%) were from internal medicine, 118 (11.5%) were from emergency departments, and 109 (10.6%) were from anesthesiology. The majority of participants were working in Qatar (n = 400, 38.8%) and India (n = 161, 15.6%). The frequency of participants by other countries are available at Supplementary File 2 in Figure S1 and S2.

Among all responders (n = 1030), 763 (74.1%) of HCWs had been working in areas designated for COVID-19 patients. Out of the 763 HCWs, 692 (90.7%) had been directly involved in the care or management of COVID-19 patients for ≤ 9 months (n = 403/763, 52.8%) and for > 9 months (n = 360/763, 47.2%). During the survey period, 435 (42.2%) of HCWs received specific training for COVID-19, while 595 (57.85) did not. The sociodemographic characteristics of participants according to working in the COVID-19 area are presented in Table 1. The main significant differences between HCWs who worked in the COVID-19 area and those who did not were observed in terms of age (P < 0.001), specialty (P < 0.001), level of education (P = 0.008), working hours per week (P = 0.047), working hours per week during the COVID-19 pandemic (P < 0.001) and receipt of specific training (P = 0.034).

Table 1 Sociodemographic characteristics of participants according to working in COVID-19 area or not (n = 1030)

Total and subscales scores of questionnaires

Total and subscale scores of the DASS-21, MBI and CWEQ-II scales in all participants, as well as in HCWs who worked in the COVID-19 area or not, are presented in Table 2. Among all responders (n = 730), the median (IQR) scores of stress, anxiety and depression were 12 (6–18), 6 (2–12), and 6 (2–14), respectively. The results of subscale scores based on categories groups showed that the majority of HCWs had normal level of stress (n = 364, 49.9%), anxiety (n = 391, 53.6%) and depression (n = 433, 59.3%). The median (IQR) scores of emotional exhaustion, depersonalization and personal accomplishment in all responders (n = 852) were 22 (11–32), 6 (3–11) and 37 (31–42), respectively. The results of categorized subscales indicated that the HCWs experienced high emotional exhaustion, while low depersonalization and personal accomplishment according to MBI scale. Furthermore, the four elements of CWEQ-II showed that HWCs believed they had moderate access to opportunity and information, with median (IQR) scores of 12 (10–14) and 11 (9-12), respectively, and a low access to support and resources, with a score of 10 (9–12) and 9 (8–11), respectively. In addition, the median (IQR) total scores of DASS-21, MBI and CWEQ-II according to the HCWs who worked in the COVID-19 area or did not work in the COVID-19 area are presented in Fig. 1A to C. According to these figures, the median (IQR) of total scores of DASS-21, MBI and CWEQ-II were significantly higher in the HCWs who worked in COVID-19 area.

Table 2 The scores of questionnaires from HCWs according working in COVID-19 area or not (n = 730)
Fig. 1
figure 1

Total scores of (A) DASS-21, (B) MBI and (C) CWEQ-II according to HCWs who worked in COVID-19 area or not were expressed as median (IQR)

The median (IQR) scores of the DASS-21, MBI and CWEQ-II scales were compared between the groups of HCWs who worked in the COVID-19 area or not. The results showed that the median score of anxiety (P = 0.005), depression (P = 0.040) and total score of DASS-21 (P = 0.016), in HCWs who worked in the COVID-19 area were significantly higher than those who did not work in the COVID-19 area. Moreover, HCWs who worked in the COVID-19 area had a significantly higher median emotional exhaustion (P < 0.001), depersonalization (P < 0.001) and total score of MBI (P < 0.001) compared to those who did not work in the COVID-19 area. In terms of CWEQ-II, HCWs who worked in COVID-19 areas had a significant higher score in opportunity (P < 0.001).

Regression analysis findings

Unadjusted and adjusted binary logistic regression analysis were conducted to determine potential predictors for the total scores of DASS-21, MBI and CWEQ-II. The results are presented in Figs. 2, 3, and 4.

Fig. 2
figure 2

Unadjusted and adjusted binary logistic regression analysis of DASS-21 prognostic total scores. Forest plot showed results, after adjusting for the factors: age, gender, having children, job position, working in COVID-19 area and history of mental health issues. In addition, a comparison of respondents’ demographic variables based on high versus low-moderate DASS-21 scores is reported. Abbreviations; F/M: female/male; D/M: divorced/widowed/married; S/M: single/married, Y/N: yes/no; P/N: physician/nurse; T/N: therapist/nurse; O/N: others/nurse; I/A: internal medicine/anesthesiology; C/A: critical care/anesthesiology; S/A: surgery/anesthesiology; E/A emergency/anesthesiology; O/A others/anesthesiology; B/MD: bachelors-masters/ doctor of medicine; PhD/MD: doctor of philosophy/ doctor of medicine and OR: odds ratio

Fig. 3
figure 3

Unadjusted and adjusted binary logistic regression analysis of MBI prognostic total scores. Forest plot showed results, after adjusting for the factors: age, gender, having children, job position, working in COVID-19 area and history of mental health issues. In addition, a comparison of respondents’ demographic variables based on high versus low-moderate MBI scores is reported. Abbreviations; F/M: female/male; D/M: divorced/widowed/married; S/M: single/married, Y/N: yes/no; P/N: physician/nurse; T/N: therapist/nurse; O/N: others/nurse; I/A: internal medicine/anesthesiology; C/A: critical care/anesthesiology; S/A: surgery/anesthesiology; E/A emergency/anesthesiology; O/A others/anesthesiology; B/MD: bachelors-masters/ doctor of medicine; PhD/MD: doctor of philosophy/ doctor of medicine and OR: odds ratio

Adjusted binary logistic regression analysis for the prognostic value DASS-21 (Fig. 2) showed that the divorced/ widowed HCWs (OR: 2.274, 95% CI: 1.007–5.137, P = 0.048), those working in internal medicine (OR: 2.077, 95% CI: 1.157–3.726, P = 0.014), those working more than 27 h per week (OR: 1.723, 95% CI: 1.232–2.411, P = 0.001) and those with a history of mental illness (OR: 2.838, 95% CI: 1.345–5.987, P = 0.006) had a higher likelihood of experiencing stress, anxiety and depression in comparison to married HCWs, specifically those in anesthesiology, working ≤ 27 h per week, and those without history of mental illness, respectively. However, higher age (OR: 0.663, 95% CI: 0.144–0.883, P = 0.001) and higher work experience of more than 6 years (OR: 0.562, 95% CI: 0.088–0.899, P = 0.008) were found to be negatively associated with the total score of DASS-21.

Adjusted binary logistic regression analysis for the prognostic value MBI (Fig. 3) revealed that older HCWs (OR: 0.569, 95% CI: 0.052–0.887, P = 0.001) and those with higher work experience of more than 6 years (OR: 0.585, 95% CI: 0.052–0.802, P = 0.007) had a lower likelihood of experiencing burnout compared to younger HCWs and those with less work experience. While, working longer than 27 h per week (OR: 1.467, 95% CI: 1.107–2.082, P = 0.012), working more than 29 h per week during the COVID-19 outbreak (OR: 1.358, 95% CI: 1.125–2.035, P = 0.046), working in COVID-19 area within the hospital (OR:1.782, 95% CI: 1.128–2.225, P = 0.004), directly interacting with COVID-19 patients (OR: 1.841, 95% CI: 1.124–3.309, P = 0.041), currently taking medication for mental illness (OR: 2.387, 95% CI: 1.192–3.743, P = 0.001) and having a family history of mental illness (OR: 1.969, 95% CI: 1.226–3.161, P = 0.005) were positively associated with burnout among HCWs.

Adjusted binary logistic regression was applied to the prognostic CWEQ-II (Fig. 4), indicating that age (OR: 1.422, 95% CI: 1.131–1.039, P = 0.041), female gender (OR: 1.534, 95% CI: 1.138–2.081, P = 0.029), physicians (OR: 1.933, 95% CI: 1.371–3.489, P = 0.029), higher work experience (OR: 1.428, 95% CI: 1.172–2.538, P = 0.022), working in the COVID-19 area (OR: 2.371, 95% CI: 1.168–4.809, P = 0.017) and receiving specific training (OR: 1.546, 95% CI: 1.133–2.109, P = 0.006) were positively correlated with work effectiveness.

Fig. 4
figure 4

Unadjusted and adjusted binary logistic regression analysis of CWEQ-II prognostic total scores. Forest plot showed results, after adjusting for the factors: age, gender, having children, job position, working in COVID-19 area and history of mental health issues. In addition, a comparison of respondents’ demographic variables based on high versus low-moderate CWEQ-II scores is reported. Abbreviations; F/M: female/male; D/M: divorced/widowed/married; S/M: single/married, Y/N: yes/no; P/N: physician/nurse; T/N: therapist/nurse; O/N: others/nurse; I/A: internal medicine/anesthesiology; C/A: critical care/anesthesiology; S/A: surgery/anesthesiology; E/A emergency/anesthesiology; O/A others/anesthesiology; B/MD: bachelors-masters/ doctor of medicine; PhD/MD: doctor of philosophy/ doctor of medicine and OR: odds ratio

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