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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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Psychological consequences of the COVID-19 pandemic: A qualitative study
Vancappel, A., Aubouin-Bonnaventure, J., El‐Hage, W., Fouquereau, E., & Réveillère, C. (2022) · L Encéphale · doi:10.1016/j.encep.2022.03.002 · Cited by 4
Becerra‐García, J. A., Sánchez‐Gutiérrez, T., Barbeito, S., Pascual, L. A., Martínez, A. V., Pardo, M. E. L., Garrido, A. V., Aguilar, A. B. O., Márquez, N. P., & Calvo, A. (2022) · Behavioral Psychology/Psicología Conductual · doi:10.51668/bp.8322307n · Cited by 4
Rahmani, N., Nabavian, M., Roshan, F. S., & Firouzbakht, M. (2022) · Nursing and Midwifery Journal · doi:10.52547/unmf.20.7.538 · Cited by 4
Khobragade, A. W., & Agrawal, N. (2023) · Indian Journal of Community Medicine · doi:10.4103/ijcm.ijcm_482_22 · Cited by 4
Akanko, I., Abor, P. A., & Tetteh, C. K. (2023) · SAGE Open Medicine · doi:10.1177/20503121231197398 · Cited by 5
Silistraru, I., Ciubară, A., Olariu, O., Ciureanu, I.-A., Checheriță, L. E., Druguș, D., Dănilă, R., & Roşca, Ș. (2023) · Healthcare · doi:10.3390/healthcare11192667 · Cited by 4
Serrano‐Ibáñez, E. R., Castelo, A. M. D. L. V., Varela, C., Montero-Matellanes, M. M., & Pulido, A. G. (2023) · SAGE Open · doi:10.1177/21582440231207269 · Cited by 5
“%) in this population, a result that was consistent with other studies (e.g., Muller et al., 2020; Tan et al., 2023), founding that this symptomatology had significantly associated with the manifestation of physical symptoms as headache (Chew et al., 2020).”
ResultManjareeka, M., Kanungo, P., Yadav, S., & Das, R. C. (2024) · The Open Public Health Journal · doi:10.2174/0118749445280047240108070649 · Cited by 4
Pei, Y., Li, Y., Wu, L., Xi, J., & Zhou, N. (2024) · International Journal of Disaster Risk Reduction · doi:10.1016/j.ijdrr.2024.104567 · Cited by 4
Jahan, Y., Khair, Z., Moriyama, M., Amin, M. R., Hawlader, M. D. H., Ananta, T. T., Aziz, A. B., Sharif, M., Hasan, M., Chowdhury, M. F. I., et al. (2024) · Journal of Family Medicine and Primary Care · doi:10.4103/jfmpc.jfmpc_1608_23 · Cited by 4
Anxiety, Depression and Sleep Disorders during Coronavirus Disease: A Systematic Review
Sine, H. (2020) · European Journal of Basic Medical Sciences · doi:10.21601/ejbms/9251 · Cited by 4
“Also, The fear of transmitting the disease to their own families is particularly high due to reports of asymptomatic transmission of COVID-19 [28].”
BackgroundMethodResultInfluentialGüre, M. D. P., Karataş, M., & Duyan, V. (2021) · Asia Pacific Journal of Social Work and Development · doi:10.1080/02185385.2021.1935310 · Cited by 4
Coronavirus disease 2019 pandemic and anxiety: a longitudinal study in 287 Brazilians
de Souza, A. C. M., Manoel, A. Z., Manoel, P. Z., Weiler, R. A., Kimura, R. N. Y., & Skare, T. L. (2021) · Revista da Associação Médica Brasileira · doi:10.1590/1806-9282.20200881 · Cited by 4
Engagement in Meaningful Activities and Psychological Distress During the COVID-19 Pandemic
Tigershtrom, A., & Boyraz, G. (2022) · Journal of Loss and Trauma · doi:10.1080/15325024.2021.2016140 · Cited by 4
“2021 Taylor & Francis Group, LLC reported in many countries, including China (Sun et al., 2020), Italy (Casagrande et al., 2020), Spain (Gonz alez-Sanguino et al., 2020), Singapore and India (Chew et al., 2020), and Ireland (Hyland et al., 2020).”
BackgroundJoy, K., Mahmud, R., Rabbani, M. G., Islam, M. K., Saha, R., Fazal, S. M. A., Khalil, M. I., & Kundu, N. C. (2021) · Headache Medicine Connections · doi:10.52828/hmc.v1i2.8 · Cited by 4
Platonova, T. A., Golubkova, A. A., Смирнова, С. С., Dyachenko, E. V., Владимировна, Ш. К., & Nikitskaya, A. D. (2021) · Health Risk Analysis · doi:10.21668/health.risk/2021.4.18 · Cited by 4
Choudhary, A., Ranjan, J. K., Sharma, P., & Asthana, H. S. (2022) · Contributions to economics · doi:10.1007/978-3-030-89996-7_15 · Cited by 4
The global ‘hot shop’: COVID‐19 as a union organising catalyst
Maffie, M. D. (2022) · Industrial Relations Journal · doi:10.1111/irj.12367 · Cited by 4
“Second, this scale has been used extensively to measure the impact of the COVID-19 pandemic on individuals, including their work experiences (Alexander & Grow, 2020; Chew et al., 2020; Torun & Torun, 2020).”
MethodJunaid, K. (2021) · Psychology & Psychological Research International Journal · doi:10.23880/pprij-16000292 · Cited by 3
Tang, N., Sun, F., Zhang, D., Leung, C. T.-L., & Gao, X. (2022) · The British Journal of Social Work · doi:10.1093/bjsw/bcac170 · Cited by 4
Is This All COVID-19′s Fault? A Study on Trainees in One of the Most Affected Italian Cities
Manfredi, P. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph192013136 · Cited by 3
“4% of them lamented more than four physical symptoms [4].”
BackgroundKim, K. D., & Yi, Y. H. (2022) · Journal of Korean Critical Care Nursing · doi:10.34250/jkccn.2022.15.3.101 · Cited by 5
“5%[35]보다 낮은 수준이었고, Chew 등[33]의 연구에서 나타난 7.”
InfluentialAli, M., Mohamed, A., & Saber, E. H. (2022) · Minia Scientific Nursing Journal · doi:10.21608/msnj.2023.184207.1046 · Cited by 5
Harbi, M. K. A., Alsabani, M. H., Olayan, L. H., Rifai, D. A., Alobaid, S. A., Althanyyan, A. F., Alsahli, N. M., Alsubaie, W. S., Alotaibi, W. S. M., & Alosaimi, S. D. (2023) · Journal of Multidisciplinary Healthcare · doi:10.2147/jmdh.s399546 · Cited by 4
“Symptomatic anxiety due to COVID-19 was reported in a multinational survey-based study, with approximately 30% of the HCWs reported that they experienced physical symptoms due to anxiety.(8) High rates of psychological disturbances among HCWs and general population due to COVID-19 have been also reported in France,(9)…”
BackgroundRisk perception in the era of COVID‐19 and related factors among nurses: A cross‐sectional study
Zhao, L., Huang, H., Liu, P., Xu, L., Deng, W., Tian, F., & Tan, L.-P. (2023) · Nursing Open · doi:10.1002/nop2.1811 · Cited by 4
“Several studies have focussed on doctors, nurses and other staff who have shown moderate- to- severe psychological disorders after the epidemic (Chew et al., 2020; Zhu This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits…”
BackgroundSilva, N. M., Pinho, R. D. N. L., Costa, T. F., Areal, A. F. B., Salles, A. D. M., Oliveira, A. P. R. A., Rassi, C. H. R. E., Valero, C. E. B., Gomes, C. M., da Silva, D. L. M., et al. (2023) · BMC Medical Education · doi:10.1186/s12909-023-04202-7 · Cited by 5
“The prevalence of these symptoms observed in our study was higher than that in other studies conducted with health professionals [10, 16, 27] and in the general population [28, 29] in the context of the pandemic.”
BackgroundResultShahzadi, M., Hafeez, S., Abbas, Q., Ehsaan, S., & Khan, M. U. (2023) · Journal of the Pakistan Medical Association · doi:10.47391/jpma.7136 · Cited by 3
The psychological impact of COVID-19 on frontline doctors in Tshwane public hospitals
Duffton, J. D., Heystek, M., Engelbrecht, A., Rajan, S., & Toit, R. D. (2023) · South African Family Practice · doi:10.4102/safp.v65i1.5807 · Cited by 4
“1,2,3,4,19 The literature suggests that burnout is exacerbated during a pandemic.”
BackgroundResultMakhado, G., Ntuli, B., Zungu, L. I., Thovhogi, N., Mphekgwana, P. M., Lebelo, S. L., Madiba, S., & Modjadji, P. (2024) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph21030372 · Cited by 6
MENTAL HEALTH BURDEN AMONG HEALTHCARE WORKERS DURING THE COVID-19 TIME IN ALBANIA
Ramasaco, L., Abazaj, E., & Brati, B. (2023) · ASEAN Journal of Psychiatry · doi:10.54615/2231-7805.47289 · Cited by 5
Susanti, E., & Zainiyah, Z. (2020) · Media Kesehatan Masyarakat Indonesia · doi:10.30597/mkmi.v16i3.9953 · Cited by 4
HEALTH PROFESSIONALS LIVED EXPERIENCED DURING THE FIRST WAVE OF COVID-19
Ferreira, R. J. O., Marques, A., Marques, M., Meneses, S., Pimentel, G., Gonçalves, R. F. L., Loureiro, L. M. D. J., & Marques, A. (2021) · Psicologia Saúde & Doenças · doi:10.15309/20psd210302 · Cited by 4
Thakar, S., Singh, S., Dalton, A. E., & Kumar, K. (2021) · International Journal of Community Medicine and Public Health · doi:10.18203/2394-6040.ijcmph20211982 · Cited by 3
“Some psychological symptoms have even been reported to be significant enough to present with concurrent physical symptoms.(21)”
BackgroundThe impact of COVID-19 on mental health of frontline health workers in Ghana and Uganda
Katongole, S., Yaro, P., & Bukuluki, P. (2021) · Mental Health Effects of COVID-19 · doi:10.1016/b978-0-12-824289-6.00014-3 · Cited by 4
Starkowska, A., Tyburski, E. M., Skałacka, K., & Gąsiorowska, A. (2021) · Frontiers in Psychology · doi:10.3389/fpsyg.2021.635973 · Cited by 5
Skamnia, E., Εconomou, P., Bersimis, S., Frouda, M., Politis, A., & Alexopoulos, P. (2022) · Journal of Applied Statistics · doi:10.1080/02664763.2021.2022607 · Cited by 4
Lee, Y., Wang, L., Chou, W., Chiang, M.-C., Huang, S., Lin, Y., Lin, J., Chiu, N., Chen, C., Lee, I., et al. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19020833 · Cited by 4
El-Tallawy, S. N., Titi, M. A., Ahmad, A. E., Abdulmomen, A., Elmorshedy, H., Aldammas, F., Baaj, J., Alharbi, M., & Ahmad, A. (2022) · International Journal of Mental Health · doi:10.1080/00207411.2022.2035905 · Cited by 4
“Moreover, moderate to very severe levels of depression, anxiety, stress, and distress were reported by HCWs in Singapore and India during the COVID-19 outbreaks (Chew et al., 2020).”
BackgroundSelf-citationKantaş, F., & Karakuş, S. (2022) · Pakistan Journal of Medical and Health Sciences · doi:10.53350/pjmhs22165887 · Cited by 4
Jamalidoust, M., Ashkan, Z., Pouladfar, G., Asaei, S., Aliabadi, N., Abbasi, P., Namayandeh, M., & Ziyaeyan, M. (2022) · Archives of Pediatric Infectious Diseases · doi:10.5812/pedinfect-121753 · Cited by 4
“As a result of factors such as high workload, stress, and confronting the risks of infection for themselves and their families, there has been an increased psychological burden that may exacerbate the disease symptoms (12, 13).”
BackgroundAta, E. E., Sarıtaş, M., & Özer, D. (2022) · Turkish Journal of Science and Health · doi:10.51972/tfsd.1176353 · Cited by 4
PANORAMA DAS PUBLICAÇÕES EM SAÚDE MENTAL NO CONTEXTO DA PANDEMIA POR COVID-19: SCOPING REVIEW
de Freitas, R. J. M., de Moura, N. A., Teixeira, L. A., Fernandes, A. P. N. D. L., & Monteiro, A. R. M. (2021) · Global Academic Nursing Journal · doi:10.5935/2675-5602.20200084 · Cited by 5
COVID-19 Pandemi Sürecinde Sağlık Çalışanlarının Yaşadıkları Mental Sorunlar
Özaydın, Ö., & Güdük, Ö. (2021) · Yüksek İhtisas Üniversitesi Sağlık Bilimleri Dergisi · doi:10.51261/yiu.2021.00035 · Cited by 4
“çalışanlarını da psikolojik olarak etkilemektedir (4,5).”
InfluentialCOVID-19 et trouble de stress post-traumatique (TSPT) chez les professionnels de santé
Underner, M., Perriot, J., Peiffer, G., & Jaafari, N. (2021) · Revue des Maladies Respiratoires · doi:10.1016/j.rmr.2020.11.014 · Cited by 4
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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