The coronavirus disease 2019 (COVID-19), a respiratory infection caused by a novel coronavirus (SARS-CoV-2), was first documented in Wuhan, Hubei, China, in December 2019 and has spread globally. As of September 9, 2020, there was a cumulative total of 27.4869 million confirmed cases and 894,900 deaths worldwide1
In 2003, the outbreak of severe acute respiratory syndrome (SARS) had affected 8,096 patients and led to the death of 774 patients worldwide from November 1, 2002, to July 31, 20032 Of these deaths, 346 were of patients in Taiwan, 105 of whom were health professionals. The pandemic had a tremendous impact on people’s daily lives due to stay-at-home policies and school and store closures. Consequently, it provoked mental health problems such as anxiety about infection and depression.
Although COVID-19 has a low mortality rate, several anti-COVID-19 measures have been implemented due to the high infection rate, such as foreign travel bans, shortened restaurant operation hours, prohibition of social gatherings involving five or more people, mandatory use of face masks, social distancing, and two-week mandatory quarantine for people with confirmed infection. Changes in daily life resulting from these prevention measures may impact mental health1 Moreover, physical and mental suffering from sequelae persist even after recovering from COVID-19, and the persistence of the pandemic may lead to serious health problems4.
Post-traumatic stress disorder (PTSD) can also occur among various mental health problems as an aftereffect of large-scale infectious diseases; it is a mental or psychological disorder that manifests following direct or indirect exposure to a shocking traumatic event5. A 2005 study on PTSD in 1,394 SARS survivors in Hong Kong reported that 47.8% of the participants had an onset of PTSD at some point after contracting SARS. Some of these survivors continued to suffer from PTSD 30 months after contracting SARS6. In addition, a study exploring long-term mental disorders among SARS survivors reported that most survivors were diagnosed with PTSD after contracting SARS, and many of them also developed other mental disorders, such as panic disorder. These results show that the mental health problems provoked by PTSD following the SARS infection persisted over a long duration7.
COVID-19 diagnosis which, either confirms the disease or throws suspicion on individuals and socially stigmatizes them8. In particular, a study on PTSD, especially on symptoms such as avoidance and disturbance of sleep among health professionals after an outbreak, Kim and Park (2017)9 reported that the professionals such as doctors, nurses, lab specialists handling virus cases, who work most closely with the infection suffer from more severe forms of PTSD. Similarly, studies also examine the relation of PTSD with job-related variables. There is a study on the effects of occupational hazards among social workers10, and another study examines the physical and mental health and quality of life of firefighters11.
During the beginning of Pandemic in Korea, vaccines were not available and a proper treatment was not found for the globally spreading COVID-19. Healthcare workers are bound to work most closely to the infection, as their work involves making a diagnosis of suspected cases and treating confirmed patients. As their infection risk is also high due to the nature of the virus, health professionals are susceptible to PTSD, including anxiety symptoms.
The majority of health professionals who directly encountered SARS survivors and who suffered from stress12 have sustained a significant impact on their mental health due to the COVID-19 pandemic. A study reported that the incidence of insomnia was markedly higher among health professionals than among the general population13. A previous study that was conducted among health professionals in hospitals that treated Middle East respiratory syndrome (MERS) patients observed that the prevalence of both depression and PTSD symptoms was higher among health professionals than among the general public14. Nevertheless, previous studies on COVID-19 primarily focused on mental and job stress in health professionals, with some of them examining the impact of special COVID-19 circumstances, such as a mass outbreak within a hospital and PTSD among health professionals.
In February 2021, there was a mass outbreak of COVID-19 inpatient wards from the seventh to the ninth floors of the main building of a general hospital in Seoul15, and meticulous frontline tracing was performed on health professionals, patients, family caregivers, and paid caregivers for more than a month to screen close frontline individuals and confirmed patients. A total of 218 patients were diagnosed with the infection.
Thus, the present study aimed to investigate the effects of this incident on the healthcare and non-healthcare staff. In particular, the healthcare staff was divided into frontline health professionals and non-frontline health professionals to compare their levels of anxiety, anger, and depression. We hypothesized that frontline staff would display a higher level of anxiety, depression, and anger than non-frontline staff.