The prevalence of anxiety, depression, insomnia, and post-traumatic stress disorders symptoms among healthcare workers after the COVID-19 vaccinations

Abstract

Objective: The purpose of this study was to determine the frequencies of depression, anxiety, insomnia, and post-traumatic stress disorder (PTSD) symtoms among HCWs in Turkey after the COVID-19 vaccinations and to evaluate the associated factors. Method: A cross-sectional online survey was conducted in Turkey between November and December 2021. We used a demographic data form, COVID-19 vaccination status, the Patient Health Questionnaire-9, General Anxiety Disorder-7, the Insomnia Severity Index, and the National Stressful Events Survey post-traumatic stress disorder (PTSD) Short Scale. Results: A total of 1013 HCWs participated in the study. Women constituted 68.5% of the participants, 65.4% were physicians, 32.5% had histories of COVID-19, and 98.0% had received at least one dose of the COVID-19 vaccine. Depressive symptoms were exhibited by 50.3% of the HCWs, while 35.7% exhibited anxiety, 44.6% insomnia, and 12.0% PTSD symptoms. Nurses reported significantly greater depression (p<0.001), anxiety (p<0.001), insomnia (p<0.001), and PTSD (p<0.001) symptoms than physicians did. No statistically significant association was determined in terms of the reporting of depression, anxiety, insomnia, and PTSD symptoms and receipt of COVID-19 vaccination. Conclusion: The prevalence of depression, anxiety, insomnia, and PTSD symptoms among health workers decreased from the beginning of the pandemic, although the prevalence of these symptoms was still high. Nurses exhibited greater depressive, anxiety, insomnia, and PTSD symptoms than physicians. Receipt or non-receipt of vaccination, or the number of doses involved, caused no difference in terms of mental health.

Keywords

• COVID-19
• Physicians
• Nurses
• Anxiety
• Depression
• Insomnia
• PTSD

COVID-19 Aşılamaları Sonrasında Sağlık Çalışanları Arasında Anksiyete, Depresyon, Uykusuzluk ve Travma Sonrası Stres Bozukluğu Semptomlarının Sıklığı

Abstract

Amaç: Bu çalışmanın amacı, COVID-19 aşılamaları sonrasında Türkiye'deki sağlık çalışanları arasında depresyon, anksiyete, uykusuzluk ve travma sonrası stres bozukluğu (TSSB) semptomlarının sıklığını belirlemek ve ilişkili faktörleri değerlendirmektir. Yöntem: Kasım ve Aralık 2021 tarihleri arasında Türkiye'de kesitsel bir çevrimiçi anket gerçekleştirilmiştir. Demografik veri formu, COVID-19 aşılama durumu, Hasta Sağlığı Anketi-9, Genel Anksiyete Bozukluğu-7, Uykusuzluk Şiddet İndeksi ve Ulusal Stresli Olaylar Anketi Travma Sonrası Stres Bozukluğu (TSSB) Kısa Ölçeği kullanılmıştır. Bulgular: Çalışmaya toplam 1013 sağlık çalışanı katılmıştır. Katılımcıların %68,5'ini kadınlar, %65,4'ünü doktorlar, %32,5'ini COVID-19 geçmişi olanlar ve %98,0'ını en az bir doz COVID-19 aşısı olanlar oluşturmuştur. Sağlık çalışanlarının %50,3'ü depresif semptomlar gösterirken, %35,7'si anksiyete, %44,6'sı uykusuzluk ve %12,0'si TSSB semptomları sergilemiştir. Hemşireler doktorlara göre anlamlı derecede daha fazla depresyon (p<0.001), anksiyete (p<0.001), uykusuzluk (p<0.001) ve TSSB (p<0.001) semptomları bildirmiştir. Depresyon, anksiyete, uykusuzluk ve TSSB semptomlarının bildirilmesi ile COVID-19 aşısının alınması arasında istatistiksel olarak anlamlı bir ilişki tespit edilmemiştir. Sonuç: Sağlık çalışanları arasında depresyon, anksiyete, uykusuzluk ve TSSB semptomlarının yaygınlığı pandeminin başlangıcından itibaren azalmakla birlikte, bu semptomların yaygınlığı hala yüksektir. Hemşirelerde depresyon, anksiyete, uykusuzluk ve TSSB semptomları hekimlere göre daha yüksekti. Aşı olup olmama ya da aşı dozu sayısı ruh sağlığı açısından bir fark yaratmamıştır.

Keywords

• COVID-19
• Doktorlar
• Hemşireler
• Anksiyete
• Depresyon
• Uykusuzluk
• PTSD

References

1. 1. Borges LM, Holliday R, Barnes SM, Bahraini NH, Kinney A, Forster JE, et al. A longitudinal analysis of the role of potentially morally injurious events on COVID-19-related psychosocial functioning among healthcare providers. PLoS One. 2021;16(11):e0260033.
2. 2. Nafilyan V, Pawelek P, Ayoubkhani D, Rhodes S, Pembrey L, Matz M, et al. Occupation and COVID-19 mortality in England: a national linked data study of 14.3 million adults. Occup Environ Med. 2022;79(7):433-41.
3. 3. Ferland L, Carvalho C, Gomes Dias J, Lamb F, Adlhoch C, Suetens C, et al. Risk of hospitalization and death for healthcare workers with COVID-19 in nine European countries, January 2020-January 2021. J Hosp Infect. 2022;119:170-4.
4. 4. Bandyopadhyay S, Baticulon RE, Kadhum M, Alser M, Ojuka DK, Badereddin Y, et al. Infection and mortality of healthcare workers worldwide from COVID-19: a systematic review. BMJ Glob Health. 2020;5(12).
5. 5. Kaplan AK, Sahin MK, Parildar H, Adadan Guvenc I. The willingness to accept the COVID-19 vaccine and affecting factors among healthcare professionals: A cross-sectional study in Turkey. Int J Clin Pract. 2021;75(7):e14226.
6. 6. Zhang R, Liu D, Leung KY, Fan Y, Lu L, Chan PC, et al. Immunogenicity of a Heterologous Prime-Boost COVID-19 Vaccination with mRNA and Inactivated Virus Vaccines Compared with Homologous Vaccination Strategy against SARS-CoV-2 Variants. Vaccines (Basel). 2022;10(1).
7. 7. Kittikraisak W, Hunsawong T, Punjasamanvong S, Wongrapee T, Suttha P, Piyaraj P, et al. Anti-SARS-CoV-2 IgG antibody levels among Thai healthcare providers receiving homologous and heterologous COVID-19 vaccination regimens. Influenza Other Respir Viruses. 2022;16(4):662-72.
8. 8. Costa Clemens SA, Weckx L, Clemens R, Almeida Mendes AV, Ramos Souza A, Silveira MBV, et al. Heterologous versus homologous COVID-19 booster vaccination in previous recipients of two doses of CoronaVac COVID-19 vaccine in Brazil (RHH-001): a phase 4, non-inferiority, single blind, randomised study. Lancet. 2022;399(10324):521-9.

9. 9. Demirhindi H, Mete B, Tanir F, Kara E, Kibar F, Cetiner S, et al. Effect of Heterologous Vaccination Strategy on Humoral Response against COVID-19 with CoronaVac plus BNT162b2: A Prospective Cohort Study. Vaccines (Basel). 2022;10(5).
10. 10. Thomas SJ, Moreira ED, Jr., Kitchin N, Absalon J, Gurtman A, Lockhart S, et al. Safety and Efficacy of the BNT162b2 mRNA Covid-19 Vaccine through 6 Months. N Engl J Med. 2021;385(19):1761-73.
11. 11. Polack FP, Thomas SJ, Kitchin N, Absalon J, Gurtman A, Lockhart S, et al. Safety and Efficacy of the BNT162b2 mRNA Covid-19 Vaccine. N Engl J Med. 2020;383(27):2603-15.
12. 12. McMenamin ME, Nealon J, Lin Y, Wong JY, Cheung JK, Lau EHY, et al. Vaccine effectiveness of one, two, and three doses of BNT162b2 and CoronaVac against COVID-19 in Hong Kong: a population-based observational study. Lancet Infect Dis. 2022.
13. 13. Hall VJ, Foulkes S, Saei A, Andrews N, Oguti B, Charlett A, et al. COVID-19 vaccine coverage in health-care workers in England and effectiveness of BNT162b2 mRNA vaccine against infection (SIREN): a prospective, multicentre, cohort study. Lancet. 2021;397(10286):1725-35.
14. 14. Andrews N, Tessier E, Stowe J, Gower C, Kirsebom F, Simmons R, et al. Duration of Protection against Mild and Severe Disease by Covid-19 Vaccines. N Engl J Med. 2022;386(4):340-50.
15. 15. Kim SC, Rankin L, Ferguson J. Nurses' mental health from early COVID-19 pandemic to vaccination. J Nurs Scholarsh. 2022;54(4):485-92.
16. 16. Mojtabai R. COVID-19 Vaccination and Mental Health Distress. J Gen Intern Med. 2022;37(4):1020-1.
17. 17. Mahmud S, Hossain S, Muyeed A, Islam MM, Mohsin M. The global prevalence of depression, anxiety, stress, and, insomnia and its changes among health professionals during COVID-19 pandemic: A rapid systematic review and meta-analysis. Heliyon. 2021;7(7):e07393.
18. 18. Sahin MK, Aker S, Sahin G, Karabekiroglu A. Prevalence of Depression, Anxiety, Distress and Insomnia and Related Factors in Healthcare Workers During COVID-19 Pandemic in Turkey. J Community Health. 2020;45(6):1168-77.
19. 19. Al Maqbali M, Al Sinani M, Al-Lenjawi B. Prevalence of stress, depression, anxiety and sleep disturbance among nurses during the COVID-19 pandemic: A systematic review and meta-analysis. J Psychosom Res. 2021;141:110343.
20. 20. Sahebi A, Nejati-Zarnaqi B, Moayedi S, Yousefi K, Torres M, Golitaleb M. The prevalence of anxiety and depression among healthcare workers during the COVID-19 pandemic: An umbrella review of meta-analyses. Prog Neuropsychopharmacol Biol Psychiatry. 2021;107:110247.
21. 21. Santabarbara J, Bueno-Notivol J, Lipnicki DM, Olaya B, Perez-Moreno M, Gracia-Garcia P, et al. Prevalence of anxiety in health care professionals during the COVID-19 pandemic: A rapid systematic review (on published articles in Medline) with meta-analysis. Prog Neuropsychopharmacol Biol Psychiatry. 2021;107:110244.
22. 22. Zhang H, Li W, Li H, Zhang C, Luo J, Zhu Y, et al. Prevalence and dynamic features of psychological issues among Chinese healthcare workers during the COVID-19 pandemic: a systematic review and cumulative meta-analysis. Gen Psychiatr. 2021;34(3):e100344.
23. 23. Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606-13.
24. 24. Sari YE, Kokoglu B, Balcioglu H, Bilge U, Colak E, Unluoglu I. Turkish reliability of the patient health questionnaire-9. Biomedical Research-India. 2016;27:S460-S2.
25. 25. Spitzer RL, Kroenke K, Williams JB, Lowe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006;166(10):1092-7.
26. 26. Konkan R, Şenormanci Ö, Güçlü O, Aydin E, Sungur MZ. [Yaygın Anksiyete Bozukluğu-7 (YAB-7) Testi Türkçe Uyarlaması, Geçerlik ve Güvenirliği]. Archives of Neuropsychiatry. 2013;50(1):53-8.
27. 27. Morin CM, Belleville G, Belanger L, Ivers H. The Insomnia Severity Index: psychometric indicators to detect insomnia cases and evaluate treatment response. Sleep. 2011;34(5):601-8.
28. 28. Boysan M, Gulec M, Besiroglu L, Kalafat T. Psychometric properties of the Insomnia Severity Index in Turkish sample. Anadolu Psikiyatri Dergisi-Anatolian Journal of Psychiatry. 2010;11(3):248-52.
29. 29. Bastien CH, Vallieres A, Morin CM. Validation of the Insomnia Severity Index as an outcome measure for insomnia research. Sleep Med. 2001;2(4):297-307.
30. 30. Asçibasi K, Çökmüs FP, Aydemir Ö. [DSM-5 Akut Stres Belirti Siddeti Ölçegi Türkçe Formunun geçerliligi ve güvenilirligi]. Anadolu Psikiyatri Dergisi. 2017;18:38.
31. 31. Kilpatrick DG, Resnick HS, Friedman MJ. National Stressful Events Survey PTSD Short Scale (NSESSS‐PTSD) 2013 [Available from: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Severity-of-Posttraumatic-Stress-Symptoms-Adult.pdf.
32. 32. Nwachukwu I, Nkire N, Shalaby R, Hrabok M, Vuong W, Gusnowski A, et al. COVID-19 Pandemic: Age-Related Differences in Measures of Stress, Anxiety and Depression in Canada. Int J Environ Res Public Health. 2020;17(17).
33. 33. Lai J, Ma S, Wang Y, Cai Z, Hu J, Wei N, et al. Factors Associated With Mental Health Outcomes Among Health Care Workers Exposed to Coronavirus Disease 2019. JAMA Netw Open. 2020;3(3):e203976.
34. 34. Aymerich C, Pedruzo B, Perez JL, Laborda M, Herrero J, Blanco J, et al. COVID-19 pandemic effects on health worker's mental health: Systematic review and meta-analysis. Eur Psychiatry. 2022;65(1):e10.
35. 35. Collaborators C-MD. 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.
36. 36. El Gindi H, Shalaby R, Gusnowski A, Vuong W, Surood S, Hrabok M, et al. The Mental Health Impact of the COVID-19 Pandemic Among Physicians, Nurses, and Other Health Care Providers in Alberta: Cross-sectional Survey. JMIR Form Res. 2022;6(3):e27469.
37. 37. Li Y, Chen B, Hong Z, Sun Q, Dai Y, Basta M, et al. Insomnia symptoms during the early and late stages of the COVID-19 pandemic in China: a systematic review and meta-analysis. Sleep Med. 2022;91:262-72.
38. 38. Alimoradi Z, Gozal D, Tsang HWH, Lin CY, Brostrom A, Ohayon MM, et al. Gender-specific estimates of sleep problems during the COVID-19 pandemic: Systematic review and meta-analysis. J Sleep Res. 2022;31(1):e13432.
39. 39. Pappa S, Sakkas N, Sakka E. A year in review: sleep dysfunction and psychological distress in healthcare workers during the COVID-19 pandemic. Sleep Med. 2022;91:237-45.
40. 40. Robinson E, Sutin AR, Daly M, Jones A. A systematic review and meta-analysis of longitudinal cohort studies comparing mental health before versus during the COVID-19 pandemic in 2020. J Affect Disord. 2022;296:567-76.
41. 41. Sasaki N, Asaoka H, Kuroda R, Tsuno K, Imamura K, Kawakami N. Sustained poor mental health among healthcare workers in COVID-19 pandemic: A longitudinal analysis of the four-wave panel survey over 8 months in Japan. J Occup Health. 2021;63(1):e12227.
42. 42. Goss CW, Duncan JG, Lou SS, Holzer KJ, Evanoff BA, Kannampallil T. Effects of Persistent Exposure to COVID-19 on Mental Health Outcomes Among Trainees: a Longitudinal Survey Study. J Gen Intern Med. 2022;37(5):1204-10.
43. 43. Daly M, MacLachlan M, Maguire R, Power JM, Nolan A, Shevlin M, et al. Changes in PTSD, depression, and generalized anxiety before and during the COVID-19 pandemic in Ireland. J Affect Disord Rep. 2021;5:100184.
44. 44. Kok AAL, Pan KY, Rius-Ottenheim N, Jorg F, Eikelenboom M, Horsfall M, et al. Mental health and perceived impact during the first Covid-19 pandemic year: A longitudinal study in Dutch case-control cohorts of persons with and without depressive, anxiety, and obsessive-compulsive disorders. J Affect Disord. 2022;305:85-93.
45. 45. Pan KY, Kok AAL, Eikelenboom M, Horsfall M, Jorg F, Luteijn RA, et al. The mental health impact of the COVID-19 pandemic on people with and without depressive, anxiety, or obsessive-compulsive disorders: a longitudinal study of three Dutch case-control cohorts. Lancet Psychiatry. 2021;8(2):121-9.
46. 46. Koltai J, Raifman J, Bor J, McKee M, Stuckler D. COVID-19 Vaccination and Mental Health: A Difference-In-Difference Analysis of the Understanding America Study. Am J Prev Med. 2022;62(5):679-87.
47. 47. Alam MD, Paul SK, Momi M, Ni L, Xu Y. Factors Associated With Psychological Outcomes Among Vaccinated and Unvaccinated Health Care Workers Against COVID-19 Infection in Bangladesh. Front Med (Lausanne). 2022;9:852922.
48. 48. Sasaki N, Kuroda R, Tsuno K, Imamura K, Kawakami N. COVID-19 vaccination did not improve employee mental health: A prospective study in an early phase of vaccination in Japan. Neuropsychopharmacol Rep. 2022;42(2):230-2.
49. 49. Pierce M, McManus S, Jessop C, John A, Hotopf M, Ford T, et al. Says who? The significance of sampling in mental health surveys during COVID-19. Lancet Psychiatry. 2020;7(7):567-8. 50. Johnson TP. Snowball Sampling: Introdu