In late 2019, the city of Wuhan in China published a report of a new pneumonia caused by the Corona virus (COVID 19). The virus spread rapidly and became a pandemic. The coronavirus pandemic (COVID 19) has placed a heavy burden on governments, organizations, and individuals, especially the medical staff. (1) In the face of this critical situation, front-line medical staff who work directly and closely in the diagnosis, treatment and care of patients with coronavirus (COVID 19) are at high risk for mental illness and other mental health disorders. (2) Although research has shown that people with higher education, especially in the field of health and treatment, have better and more understanding and information, and having this health literacy acts as a protector of their mental health, (3, 4) but an increasing number of confirmed and suspicious cases, high workload, lack of personal protective equipment, extensive media coverage, lack of access to certain drugs and feeling of insufficient support can play a role in exacerbating stress in the medical staff. (5-8)
On the other hand, the necessary preventive measures are taken to prevent the spread of this pandemic, such as quarantine and social distance in all countries. (9, 10) The general public has been asked to observe social distance and experience telecommuting if possible during the pandemic, and at the same time health care workers should continue to work as in the past but with greater care. (11- 14) In this regard, studies have shown that those in the medical staff who are afraid of infecting their family members, friends and colleagues are skeptical of what they are doing because they feel they are labeled by society as being able to carry virus. (5) Also, high level of stress, anxiety, and depressive symptoms are reported, which can have long-term psychological consequences. (6, 15)
These constant challenges and unprecedented anxiety and stress, along with the fear of personal security, are no different from what is seen in Battlefield conditions when caregivers experience high levels of anxiety and stress at the same time as long-term conditions and uncertainty about the duration of the illness, all of which are accompanied by reduced ability to control the situation, therefore they are at risk for stress and burnout. (16)
Also, facing death every day and due to the financial problems of governments and countries, deciding which patient to survive and which one to separate the device causes a challenging situation in the medical staff. This challenging situation causes the treatment staff to feel guilty, helpless and depressed, which eventually leads to common mental disorders such as stress, depression and post-traumatic stress disorder (PTSD). (17)
Stress is the body's response to harmful stimuli, and is a common physical and psychological phenomenon. Stressors are stimuli that cause stress and their types include physical, chemical, biological, social, psychological, cultural and so on. The types of stressors are related to each other, meaning that one type of stressors can combine with another type of stress source to form a compound stressors.(18) The corona virus pandemic (COVID 19) is an important source of stress and can be considered as a compound source of stress because it has disrupted the internal mental balance of more people, which will occur as an external psychological reaction.
Particularly based on previous experience with pandemics or the spread of viruses, it has been observed that treatment staff in hospitals that care for confirmed or suspected patients have been found to be more at risk of negative psychological stress than the general population. (19, 20) For example, the results of a study showed that in the fight against the sudden onset of acute respiratory syndrome in the early stages of the epidemic, psychological distress including fear and anxiety appeared immediately among medical staff, but depression, psychosomatic symptoms and post-traumatic stress disorder symptoms began later, continued and had profound effects. (21, 22) The experience of medical staff in responding to SARS showed that its effects on the mental health of treatment staff were not only short-term, but also long-term. (22, 23) A psychological study has shown the rates of depression, anxiety, insomnia 16 and stress symptoms in medical staff involved in the prevention and control of coronary heart disease were 50.7%, 44.7%, 36.1% and 73.4%, respectively. (24-26) In addition, studies have shown that the psychological stress scores of the treatment staff are generally higher in isolated wards. (27) A study examining the mental health of 230 medical staff at a COVID-19 Infectious Diseases Hospital found that the prevalence of anxiety and stress among medical staff was high, with particular attention to the mental health of female nurses. (26, 28) Another study of 180 medical staff in China found that stress was negatively correlated with sleep quality and self-efficacy (26, 29) and Trauma is more common among nurses who are not in the front line than nurses who are in the front line. (12) Another study found that physicians and dentists around the world experience anxiety and fear at work after the outbreak of the coronavirus. (26, 30)
Based on these findings and many other recent findings, health care providers who are at the forefront of the pandemic in the long run show stronger psychological stress that leads to negative emotional distress, and therefore their mental health should be given special attention by managers and officials with the aim of purposeful intervention to control the psychological crisis in these people. (31, 32) Therefore, the present study aims to Perceived psychological stress and mental health of health advocates were performed in military and civilian hospitals involved in the treatment of patients with COVID in 19 countries.