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A multinational, multicentre study on the psychological outcomes and associated physical symptoms amongst healthcare workers during COVID-19 outbreak
Open accessAbstract
Objective Since the declaration of the coronavirus 2019 (COVID-19) outbreak as pandemic, there are reports on the increased prevalence of physical symptoms observed in the general population. We investigated the association between psychological outcomes and physical symptoms among healthcare workers.Methods Healthcare workers from 5 major hospitals, involved in the care for COVID-19 patients, in Singapore and India were invited to participate in a study by performing a self-administered questionnaire within the period of February 19 to April 17, 2020. Healthcare workers included doctors, nurses, allied healthcare workers, administrators, clerical staff and maintenance workers. This questionnaire collected information on demographics, medical history, symptom prevalence in the past month, Depression Anxiety Stress Scales (DASS-21) and the Impact of Events Scale-Revised (IES-R) instrument. The prevalence of physical symptoms displayed by healthcare workers and the associations between physical symptoms and psychological outcomes of depression, anxiety, stress, and post-traumatic stress disorder (PTSD) were evaluated.Results Out of the 906 healthcare workers who participated in the survey, 48 (5.3%) screened positive for moderate to very-severe depression, 79 (8.7%) for moderate to extremely-severe anxiety, 20 (2.2%) for moderate to extremely-severe stress, and 34 (3.8%) for moderate to severe levels of psychological distress. The commonest reported symptom was headache (32.3%), with a large number of participants (33.4%) reporting more than four symptoms. Participants who had experienced symptoms in the preceding month were more likely to be older, have pre-existing comorbidities and a positive screen for depression, anxiety, stress, and PTSD. After adjusting for age, gender and comorbidities, it was found that depression (OR 2.79, 95% CI 1.54-5.07, p = 0.001), anxiety (OR 2.18, 95% CI 1.36-3.48, p = 0.001), stress (OR 3.06, 95% CI 1.27-7.41, p = 0.13), and PTSD (OR 2.20, 95% CI 1.12-4.35, p = 0.023) remained significantly associated with the presence of physical symptoms experienced in the preceding month. Linear regression revealed that the presence of physical symptoms was associated with higher mean scores in the IES-R, DASS Anxiety, Stress and Depression subscales.Conclusions Our study demonstrates a significant association between the prevalence of physical symptoms and psychological outcomes among healthcare workers during the COVID-19 outbreak. We postulate that this association may be bi-directional, and that timely psychological interventions for healthcare workers with physical symptoms should be considered once an infection has been excluded.
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“Overall, the available findings highlight the presence of trauma-related stress, with a prevalence ranging from 7.4 to 35%, particularly among women, nurses, frontline workers, and in workers who experienced physical symptoms.”
From Traumatic Stress in Healthcare Workers during COVID-19 Pandemic: A Review of the Immediate Impact (2020) · cites this paper as Chew et al., 2020
In the citing paper
“The results of the study by Chew et al. (2020) were similar; 7.4% of the total sample of HCWs exceeded the IES-R cut-off (Singapore, 7.5%; India, 7.3).”
From Traumatic Stress in Healthcare Workers during COVID-19 Pandemic: A Review of the Immediate Impact (2020) · cites this paper as Chew et al., 2020
In the citing paper
“Like to the finding of Chew et al. (2020) and Kang et al. (2020) associated having physical symptoms with an increased probability of high scores for trauma-related stress.”
From Traumatic Stress in Healthcare Workers during COVID-19 Pandemic: A Review of the Immediate Impact (2020) · cites this paper as Chew et al., 2020
In the citing paper
“All studies found higher percentages of females (64.3–82.7%) and nurses (up to 82.7%), with average ages ranging from 26 to 40 years (Chew et al., 2020; Kang et al., 2020; Lai et al., 2020; Li et al., 2020; Tan et al., 2020; Xiao et al., 2020; Zhang et al., 2020).”
From Traumatic Stress in Healthcare Workers during COVID-19 Pandemic: A Review of the Immediate Impact (2020) · cites this paper as Chew et al., 2020
In the citing paper
“Overall, the available findings highlight the presence of trauma-related stress, with a prevalence ranging from 7.4 to 35%, particularly among women, nurses, frontline workers, and in workers who experienced physical symptoms.”
From Traumatic Stress in Healthcare Workers during COVID-19 Pandemic: A Review of the Immediate Impact (2020) · cites this paper as Chew et al., 2020
In the citing paper
“The COVID-19 pandemic has revealed that healthcare workers (HW) are at risk of developing psychological and psychiatric disorders due to the extreme working conditions [3], with a high rate of anxiety, depression, and insomnia among them [4,5,6,7].”
From Anxiety, depression and risk of post-traumatic stress disorder in health workers: the relationship with burnout during COVID-19 pandemic in Italy (2021) · cites this paper as [7]
In the citing paper
“which were significantly associated with psychological outcomes (Chew et al., 2020).”
From The psychological impact of COVID-19 and other viral epidemics on frontline healthcare workers and ways to address it: A rapid systematic review (2020) · cites this paper as Chew et al., 2020
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BackgroundSirois, F. M., & Owens, J. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2020.589545 · Cited by 202
“HCW who reported elevated levels of psychological distress during the COVID-19 outbreak also experienced sleep disturbances (10), poorer physical health (11), and a greater number of physical symptoms, including headaches (12).”
BackgroundPsychological effects of the COVID 19 pandemic on healthcare workers globally: A systematic review
Sheraton, M., Deo, N., Dutt, T., Surani, S., Hall‐Flavin, D. K., & Kashyap, R. (2020) · Psychiatry Research · doi:10.1016/j.psychres.2020.113360 · Cited by 208
Yamamoto, T., Uchiumi, C., Suzuki, N., Yoshimoto, J., & Murillo‐Rodríguez, E. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17249382 · Cited by 203
“Healthcare workers experienced increased psychological distress, especially MMPD, consistent with previous studies reporting a higher risk to healthcare workers [10,44].”
ResultDe los Santos, J. A. A., & Labrague, L. J. (2021) · Traumatology · doi:10.1037/trm0000294 · Cited by 188
Hao, F., Tam, W., Hu, X., Tan, W., Jiang, L., Jiang, X., Zhang, L., Zhao, X., Zou, Y., Hu, Y., et al. (2020) · Translational Psychiatry · doi:10.1038/s41398-020-01039-2 · Cited by 193
Self-citationThe psychological impact of COVID-19 and restrictive measures in the world
Passavanti, M., Argentieri, A., Barbieri, D. M., Lou, B., Wijayaratna, K. P., Mirhosseini, A. F., Wang, F., Naseri, S., Qamhia, I. I. A., Tangerås, M., et al. (2021) · Journal of Affective Disorders · doi:10.1016/j.jad.2021.01.020 · Cited by 211
Self-citationYörük, S., & Güler, D. S. (2020) · Perspectives In Psychiatric Care · doi:10.1111/ppc.12659 · Cited by 192
Studies of Novel Coronavirus Disease 19 (COVID-19) Pandemic: A Global Analysis of Literature
Tran, B., Ha, G. H., Nguyen, L., Vu, G., Hoang, M. T., Le, H., Latkin, C., Ho, C. S. H., & Ho, R. C. M. (2020) · medRxiv · doi:10.3390/ijerph17114095 · Cited by 172
“Moreover, continued medical training for healthcare workers [47] and preventive measures for the workforce [48], along with frequent transparent communication and educational interventions for the public, is essential to strengthen the preventive capacity of each individual and thus, contribute to the global fight aga…”
BackgroundSelf-citationChigwedere, O. C., Sadath, A., Kabir, Z., & Arensman, E. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18136695 · Cited by 181
“Amerio et al. (2020) 8 Y Y Y Y Y Y Y Y Cai et al. (2020) 5 Y Y Y Y N N N Y Chew et al. (2020) 8 Y Y Y Y Y Y Y Y Du et al. (2020) 5 N Y Y Y N N Y Y Hacimusalar et al. (2020) 8 Y Y Y Y Y Y Y Y Hu et al. (2020) 6 Y Y Y Y N N Y Y Kang et al. (2020) 7 N Y Y Y Y Y Y Y Lai et al. (2020) 8 Y Y Y Y Y Y Y…”
BackgroundInfluentialBareeqa, S. B., Ahmed, S. I., Samar, S. S., Yasin, W., Zehra, S., Monese, G. M., & Gouthro, R. V. (2020) · The International Journal of Psychiatry in Medicine · doi:10.1177/0091217420978005 · Cited by 197
“5% are stressed due to COVID-19 contagion.(38) Considering the mental health issues due to COVID-19, when compared to these other countries, the levels seen in China were significantly higher.”
BackgroundDinçer, B., & İnangil, D. (2020) · EXPLORE · doi:10.1016/j.explore.2020.11.012 · Cited by 215
“Numerous studies have recently appeared which suggest that special interventions should be applied to promote the mental wellbeing of healthcare professionals exposed to COVID-19 and to prevent burnout.(3,4,7-10) Failure to take these steps may not only create”
BackgroundImpacto psicológico de la COVID-19 en una muestra de profesionales sanitarios españoles
Santamaría, M. D., Ozamiz-Etxebarria, N., Rodríguez, I. R., Jaureguizar, J., & Gorrotxategi, M. P. (2020) · Revista de Psiquiatría y Salud Mental · doi:10.1016/j.rpsm.2020.05.004 · Cited by 240
Chew, N., Cheong, C., Kong, G., Phua, K., Ngiam, J. N., Tan, B. Y., Wang, B., Hao, F., Tan, W., Han, X., et al. (2021) · International Journal of Infectious Diseases · doi:10.1016/j.ijid.2021.03.069 · Cited by 177
Self-citationGan, Y., Ma, J., Wu, J., Chen, Y., Zhu, H., & Hall, B. J. (2020) · Psychological Medicine · doi:10.1017/s0033291720003116 · Cited by 182
Salehi, M., Amanat, M., Mohammadi, M.-R., Salmanian, M., Rezaei, N., Saghazadeh, A., & Garakani, A. (2021) · Journal of Affective Disorders · doi:10.1016/j.jad.2020.12.188 · Cited by 172
Industry 4.0 Disruption and Its Neologisms in Major Industrial Sectors: A State of the Art
Bongomin, O., Yemane, A., Kembabazi, B., Malanda, C., Mwape, M. C., Mpofu, N. S., & Tigalana, D. (2020) · Journal of Engineering · doi:10.1155/2020/8090521 · Cited by 125
“0 adoption have been witnessed in the fight of the novel coronavirus 2019 (COVID-19) pandemic [426].”
BackgroundRodriguez, R. M., Medak, A. J., Baumann, B. M., Lim, S. C., Chinnock, B. F., Frazier, R., & Cooper, R. J. (2020) · Academic Emergency Medicine · doi:10.1111/acem.14065 · Cited by 172
Greene, T., Harju‐Seppänen, J., Adeniji, M., Steel, C., Grey, N., Brewin, C. R., Bloomfield, M., & Billings, J. (2021) · European Journal of Psychotraumatology · doi:10.1080/20008198.2021.1882781 · Cited by 198
“…on the COVID19 pandemic indicates high rates of mental disorders among HSCWs in many countries, including China, USA, India, and Italy (Braquehais et al., 2020; Carmassi et al., 2020; Chew et al., 2020; Krishnamoorthy, Nagarajan, Saya, & Menon, 2020; Pappa et al., 2020; Shechter et al., 2020).”
BackgroundThe effect of the COVID-19 pandemic on healthcare workers' mental health
Hall, H. (2020) · JAAPA · doi:10.1097/01.jaa.0000669772.78848.8c · Cited by 162
Chen, X., Zhang, S. X., Jahanshahi, A. A., Álvarez-Risco, A., Dai, H., Li, J., & Ibarra, V. J. G. (2020) · JMIR Public Health and Surveillance · doi:10.2196/20737 · Cited by 180
“In particular, we focus on the mental health and well-being of health care workers, which is a prevalent and emergent issue during the COVID-19 pandemic [9].”
BackgroundThe Mental Health Impact of the COVID-19 Pandemic: Implications for Sub-Saharan Africa
Semo, B., & Frissa, S. (2020) · Psychology Research and Behavior Management · doi:10.2147/prbm.s264286 · Cited by 182
Civantos, A. M., Byrnes, Y. M., Chang, C., Prasad, A., Chorath, K. T., Poonia, S. K., Jenks, C. M., Bur, A. M., Thakkar, P., Graboyes, E. M., et al. (2020) · Head & Neck · doi:10.1002/hed.26292 · Cited by 162
Nurses’ Mental Health During the Covid-19 Outbreak
Sampaio, F., Sequeira, C., & Teixeira, L. (2020) · Journal of Occupational and Environmental Medicine · doi:10.1097/jom.0000000000001987 · Cited by 160
“5).(29) The findings of our study indicate tendentially higher levels of anxiety, stress and depression, which can be explained by the fact that our sample is composed only by nurses, that is, by personnel who had contact with patients with Covid-19.”
BackgroundCOVID-19: anxiety among hospital staff and associated factors
Mattila, E., Peltokoski, J., Neva, M. H., Kaunonen, M., Helminen, M., & Parkkila, A. (2020) · Annals of Medicine · doi:10.1080/07853890.2020.1862905 · Cited by 160
“This association is most probably bi-directional, which may result in the exacerbation of insignificant symptoms [16].”
BackgroundChew, N. W. S., Ngiam, J. N., Tan, B. Y.-Q., Tham, S.-M., Tan, C. Y.-S., Jing, M., Sagayanathan, R., Chen, J. T., Wong, L. Y. H., Ahmad, A., et al. (2020) · BJPsych Open · doi:10.1192/bjo.2020.98 · Cited by 159
Self-citationRosyanti, L., & Hadi, I. (2020) · Health Information Jurnal Penelitian · doi:10.36990/hijp.vi.191 · Cited by 192
Social Stigma: The Hidden Threat of COVID-19
Abdelhafiz, A. S., & Alorabi, M. (2020) · Frontiers in Public Health · doi:10.3389/fpubh.2020.00429 · Cited by 164
“Healthcare workers also suffered from burnout and faced tremendous stress (8, 9) and potential stigma.”
BackgroundXiong, H., Yi, S., & Lin, Y. (2020) · INQUIRY The Journal of Health Care Organization Provision and Financing · doi:10.1177/0046958020957114 · Cited by 186
Rieckert, A., Schuit, E., Bleijenberg, N., ten Cate, D., de Lange, W., Ginkel, J. M. D. M., Mathijssen, E. G. E., Smit, L. C., Stalpers, D., Schoonhoven, L., et al. (2021) · BMJ Open · doi:10.1136/bmjopen-2020-043718 · Cited by 169
Anxiety and Resilience of Healthcare Workers During COVID-19 Pandemic in Indonesia
Setiawati, Y., Wahyuhadi, J., Joestandari, F., Maramis, M. M., & Atika, A. (2021) · Journal of Multidisciplinary Healthcare · doi:10.2147/jmdh.s276655 · Cited by 174
Ken, C. S., Francis, B., Ng, Y. H., Naim, N., Beh, H. C., Ariffin, M. A. A., Yusuf, M. H. M., Lee, J. W., & Sulaiman, A. H. (2021) · Healthcare · doi:10.3390/healthcare9010079 · Cited by 162
“Chan, A.O.; Huak, C.Y. Psychological impact of the 2003 severe acute respiratory syndrome outbreak on health care workers in a medium size regional general hospital in Singapore.”
ResultLenzo, V., Quattropani, M. C. A., Sardella, A., Martino, G., & Bonanno, G. A. (2021) · Frontiers in Psychology · doi:10.3389/fpsyg.2021.623033 · Cited by 172
“One study involving a large sample of healthcare workers reported prevalence rates of moderate to very severe symptoms of 5 percent for depression, 9 percent for anxiety, and 2 percent for stress (Chew et al., 2020).”
BackgroundPsychological well-being of Australian hospital clinical staff during the COVID-19 pandemic
Holton, S., Wynter, K. H., Trueman, M., Bruce, S., Sweeney, S., Crowe, S., Dabscheck, A., Eleftheriou, P., Booth, S., Hitch, D., et al. (2020) · Australian Health Review · doi:10.1071/ah20203 · Cited by 152
Danet, A. (2021) · Medicina Clínica · doi:10.1016/j.medcli.2020.11.009 · Cited by 202
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Santabárbara, J., Bueno‐Notivol, J., Lipnicki, D. M., Olaya, B., Pérez-Moreno, M. A., Gracia‐García, P., Mondragón, N. I., & Ozamiz-Etxebarria, N. (2021) · Progress in Neuro-Psychopharmacology and Biological Psychiatry · doi:10.1016/j.pnpbp.2021.110244 · Cited by 158
Predictors of UK healthcare worker burnout during the COVID-19 pandemic
Ferry, A. V., Wereski, R., Strachan, F. E., & Mills, N. L. (2020) · QJM · doi:10.1093/qjmed/hcab065 · Cited by 147
Mental Health Challenges of United States Healthcare Professionals During COVID-19
Pearman, A. M., Hughes, M., Smith, E. L., & Neupert, S. D. (2020) · Frontiers in Psychology · doi:10.3389/fpsyg.2020.02065 · Cited by 140
“Those who have higher levels of proactive coping compared to those with lower levels of proactive coping have more meaning in life (Miao et al., 2017), fewer symptoms of PTSD (Vernon et al., 2009), and higher levels of quality of life (Cruz et al., 2018).”
BackgroundSriharan, A., Ratnapalan, S., Tricco, A. C., Lupea, D., Ayala, A. P., Pang, H. Y. M., & Lee, D. D. (2020) · Frontiers in Global Women s Health · doi:10.3389/fgwh.2020.596690 · Cited by 149
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Weiner, L., Berna, F. S., Nourry, N., Séverac, F., Vidailhet, P., & Mengin, A. C. (2020) · Trials · doi:10.1186/s13063-020-04772-7 · Cited by 143
Health care workers' mental health in the face of COVID-19: a systematic review and meta-analysis
Ghahramani, S., Kasraei, H., Hayati, R., Tabrizi, R., & Marzaleh, M. A. (2022) · International Journal of Psychiatry in Clinical Practice · doi:10.1080/13651501.2022.2101927 · Cited by 155
“Finally for stress, studies in which used DASS (Alnazly et al., 2021; Chew et al., 2020; Sandesh et al., 2020; Tan et al., 2020; Zakeri et al., 2021) questionnaire were meta-analysed.”
MethodInfluentialHassannia, L., Taghizadeh, F., Moosazadeh, M., Zarghami, M., Taghizadeh, H., Dooki, A. F., Fathi, M., Alizadeh‐Navaei, R., Hedayatizadeh‐Omran, A., & Dehghan, N. (2020) · Neuropsychopharmacology Reports · doi:10.1002/npr2.12153 · Cited by 137
Depression and Anxiety During the COVID-19 Pandemic: Epidemiology, Mechanism, and Treatment
Zhu, C., Zhang, T., Li, Q., Chen, X., & Wang, K. (2022) · Neuroscience Bulletin · doi:10.1007/s12264-022-00970-2 · Cited by 166
“reported that healthcare workers with comorbid chronic diseases, such as hypertension, hyperlipidemia, and diabetes mellitus, had greater susceptibility to psychological problems than those without comorbidities [41].”
BackgroundClinical update on COVID ‐19 in pregnancy: A review article
Ryan, G. A., Purandare, N. C., McAuliffe, F. M., Hod, M., & Purandare, C. N. (2020) · Journal of obstetrics and gynaecology research · doi:10.1111/jog.14321 · Cited by 131
Metadata
- Authors
- Chew, N. W. S., Lee, G. K. H., Tan, B. Y. Q., Jing, M., Goh, Y., Ngiam, N. J. H., Yeo, L. L. L., Ahmad, A., Ahmed Khan, F., Napolean Shanmugam, G., Sharma, A. K., Komalkumar, R. N., Meenakshi, P. V., Shah, K., Patel, B., Chan, B. P. L., Sunny, S., Chandra, B., Ong, J. J. Y., Paliwal, P. R., Wong, L. Y. H., Sagayanathan, R., Chen, J. T., Ying Ng, A. Y., Teoh, H. L., Tsivgoulis, G., Ho, C. S., Ho, R. C., & Sharma, V. K.
- Affiliations
- National University Health System (SG)
- National University of Singapore (SG)
- Ng Teng Fong General Hospital (SG)
- Zydus Lifesciences Limited (India) (IN)
- University of Tennessee Health Science Center (US)
- Corresponding author
- Sharma, Vijay K.
- ORCID
- Venue
- Brain, Behavior, and Immunity
- Publisher
- Elsevier BV
- Published
- 2020-08
- Volume
- 88
- Pages
- 559-565
- ISSN
- 0889-1591 (ISSN-L)
- PMC
- PMC7172854
- OpenAlex
- W3016592702
- Cited by
- 1,650
- References
- 29
- Citations by year
- 2026: 24 · 2025: 60 · 2024: 140 · 2023: 250 · 2022: 364 · 2021: 532 · 2020: 277
- FWCI
- 142.14
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Licence
- Locations
- Brain Behavior and Immunity (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- National University of Singapore (submittedVersion)
- Rare & Special e-Zone (The Hong Kong University of Science and Technology) (submittedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › COVID-19 and Mental Health
- Health Sciences › Health Professions › General Health Professions › Healthcare professionals’ stress and burnout
- Health Sciences › Medicine › Clinical Neurology › Long-Term Effects of COVID-19
- Keywords
- COVID-19 pandemic, healthcare workers, psychological distress, depression, anxiety, stress, post-traumatic stress disorder, somatic symptoms, headache, workplace mental health, Singapore, India, comorbidities, DASS-21, Impact of Event Scale-Revised, doctors and nurses
- MeSH terms
- Betacoronavirus, COVID-19, SARS-CoV-2, Adult, Allied Health Personnel, Anxiety, Depression, Female, Headache, Health Personnel, Humans, India, Sleep Initiation and Maintenance Disorders, Male, Nurses, Pharyngitis, Physicians, Pneumonia, Viral, Surveys and Questionnaires, Singapore, Stress Disorders, Post-Traumatic, Stress, Psychological, Prevalence, Coronavirus Infections, Internationality, Lethargy, Pandemics
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