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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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Cites
Clinical characteristics of coronavirus disease 2019 in China
Guan, W.-J., Ni, Z.-Y., Hu, Y., Liang, W.-H., Ou, C.-Q., He, J.-X., Liu, L., Shan, H., Lei, C.-L., Hui, D. S. C., et al. (2020) · New England Journal of Medicine · doi:10.1056/nejmoa2002032 · Cited by 30,246
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“Symptoms of COVID-19 infection are wide-ranging, and may be non-specific and similar to other viral infections (Guan et al., 2019) .”
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Self-citationTimely mental health care for the 2019 novel coronavirus outbreak is urgently needed
Xiang, Y.-T., Yang, Y., Li, W., Zhang, L., Zhang, Q., Cheung, T., & Ng, C. H. (2020) · The Lancet Psychiatry · doi:10.1016/s2215-0366(20)30046-8 · Cited by 3,598
The Impact of Event Scale: Revised
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Self-citationPsychometric properties of the Impact of Event Scale—Revised
Creamer, M., Bell, R., & Failla, S. (2003) · Behaviour Research and Therapy · doi:10.1016/j.brat.2003.07.010 · Cited by 1,947 · cited 1×
“was used to define PTSD of a clinical concern (Creamer et al., 2003; Weiss, 2007).”
Kang, L., Ma, S., Chen, M., Yang, J., Wang, Y., Li, R., Yao, L., Bai, H., Cai, Z., Xiang Yang, B., et al. (2020) · Brain, Behavior, and Immunity · doi:10.1016/j.bbi.2020.03.028 · Cited by 1,516 · cited 1×
“Our findings mirror the trend in recent studies on the psychological impact of the COVID-19 epidemic among the general population in China during its initial stages (Wang et al., 2020a; Li et al., 2020; Kang et al., 2019) .”
Supporting the health care workforce during the COVID-19 global epidemic
Adams, J. G., & Walls, R. M. (2020) · JAMA · doi:10.1001/jama.2020.3972 · Cited by 1,498
Psychological impact of the COVID-19 pandemic on health care workers in Singapore
Tan, B. Y. Q., Chew, N. W. S., Lee, G. K. H., Jing, M., Goh, Y., Yeo, L. L. L., Zhang, K., Chin, H.-K., Ahmad, A., Khan, F. A., et al. (2020) · Annals of Internal Medicine · doi:10.7326/m20-1083 · Cited by 1,279 · cited 3×
“We have previously reported that the psychological impact (specifically anxiety) of COVID-19 was more common among nonmedically trained healthcare workers when compared to the medically trained personnel (Tay et al., 2020) .”
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Research works printed but not linked: 1
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Luo, M., Guo, L., Yu, M., Jiang, W., & Wang, H. (2020) · Psychiatry Research · doi:10.1016/j.psychres.2020.113190 · Cited by 1,615
Epidemiology of mental health problems in COVID-19: a review
Hossain, M. M., Tasnim, S., Sultana, A., Faizah, F., Mazumder, H., Zou, L., McKyer, E. L. J., Ahmed, H. U., & Ma, P. (2020) · F1000Research · doi:10.12688/f1000research.24457.1 · Cited by 1,113
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“Nevertheless, the COVID-19 pandemic has a sudden and massive impact on health care infrastructure, transportation, daily activity, freedom of movement, and distribution of medical resources globally (Gautam and Sharma, 2020; Joob and Wiwanitkit, 2020; Simpson and Katsanis, 2020).”
Self-citationCénat, J. M., Blais-Rochette, C., Kokou-Kpolou, C. K., Noorishad, P.-G., Mukunzi, J. N., McIntee, S.-E., Dalexis, R. D., Goulet, M.-A., & Labelle, P. R. (2021) · Psychiatry Research · doi:10.1016/j.psychres.2020.113599 · Cited by 952
Søvold, L. E., Naslund, J. A., Kousoulis, A. A., Saxena, S., Qoronfleh, M. W., Grobler, C., & Münter, L. (2021) · Frontiers in Public Health · doi:10.3389/fpubh.2021.679397 · Cited by 973
“Based on such working conditions and being deployed on the frontlines in the pandemic response, it is perhaps no surprise that issues related to mental health among healthcare workers have drawn interest since the early days of the COVID-19 pandemic (9, 34, 48).”
Background
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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