There were 2552 Participants in our study. The mean age of participants was 37.94 ± 8.07 years. According to the results the mean years of working experience of participants was 12.66 ± 8.16 and mean of working hours per month was 169.97 ± 179.9. The Characteristics of the participants are shown in Table 1.
Table 1
Demographic Characteristics of medical and Healthcare workers (n = 2552)
Variables | Frequency | % |
Gender | Male | 646 | 25.3 |
Female | 1906 | 74.7 |
Qualification | High school or below | 58 | 2.3 |
Diploma | 345 | 13.5 |
Bachelor | 1661 | 65.1 |
Master | 360 | 14.1 |
PhD/ MD | 87 | 3.4 |
Specialist | 41 | 1.6 |
Work place | Hospital | 1005 | 39.4 |
Medical and health care center | 365 | 14.3 |
Health center | 1182 | 46.3 |
Profession | Doctor | 111 | 4 |
Nurses | 673 | 26.4 |
Medical care giver | 139 | 5.5 |
Technician | 221 | 8.7 |
Midwife | 360 | 14.1 |
Health administrators | 385 | 15.1 |
Social worker and psychologist | 112 | 4.4 |
Others | 556 | 21.8 |
Work in emergency district | No | 2072 | 81.2 |
Yes | 480 | 18.8 |
Shift work | No | 1419 | 55.6 |
Yes | 1133 | 44.4 |
Supported by families and friends | No | 429 | 16.8 |
Yes | 2123 | 83.2 |
Supported by boss and colleagues | No | 1600 | 62.7 |
Yes | 952 | 37.3 |
Job satisfaction | No | 926 | 36.3 |
Yes | 1626 | 63.7 |
Feel the stress of media coverage of Corona | No | 582 | 22.8 |
Yes | 1970 | 77.2 |
Pearson’s correlation analysis was used to identify the correlations between the results from the responses of the Healthcare workers. There was no significant correlation between the Kessler scores and age, work experience and Working hours per month (p > 0.05). Similarly, there was no significant correlation between the PHQ9 scores and age, work experience and working hours per month (P > 0.05). According to Table 2, the independent t-test showed a significant difference between score of PHQ9 and Kessler scales and gender, working place, job satisfaction, supported by family and colleagues and pressure due to mass media. |
Regards to the result, staff who work in shift work or unsatisfied of their job had a depressive, anxiety and stress sign and psychological distress more than others. In addition, pressure due to mass media news the psychological disorder and Depressive, anxiety and stress is higher in medical staff. Also, supported by families and friends and colleagues can helpful to decrease psychological disorders and depressive, anxiety and stress and Psychological Distress.
Regards to Table 3, One-way ANOVA was showed a significant difference in level of education, Place of work, Type of job and the mean score of Kessler and PHQ9 questionnaire.
Table 2
Comparison of depression and anxiety scales between variables categories
Characteristics | Categories | PHQ9 | Kessler |
Mean | SD | P value | Mean | SD | P value |
Gender | Male | 5.09 | 5.61 | 0.001 | 21.39 | 6.19 | 0.001 |
Female | 7.79 | 6.65 | 18.91 | 5.7 |
work in emergency district | Yes | 8.24 | 6.84 | 0.03 | 18.07 | 6.3 | 0.002 |
No | 7.15 | 6.33 | 19.88 | 5.78 |
Shift work | Yes | 8.06 | 6.64 | 0.001 | 18.15 | 5.99 | 0.001 |
No | 6.34 | 6.30 | 20.65 | 5.63 |
Job satisfaction | Yes | 5.26 | 5.29 | 0.001 | 16.24 | 5.32 | 0.001 |
No | 10.33 | 7.17 | 21.42 | 5.40 |
pressure due to mass media | Yes | 7.88 | 6.6 | 0.001 | 22.71 | 5.68 | 0.001 |
No | 4.47 | 5.43 | 18.60 | 5.67 |
Supported by Family and friends | Yes | 6.61 | 6.33 | 0.001 | 20.05 | 5.97 | 0.001 |
No | 6.54 | 6.87 | 17.02 | 4.96 |
Supported by colleagues and boss | Yes | 4.67 | 5.21 | 0.001 | 22.24 | 5.33 | 0.001 |
No | 8.55 | 6.78 | 17.94 | 5.67 |
Table 3
comparison of questionnaire scores means between demographical characteristics
Characteristics | Categories | PHQ9 | Kessler |
Mean ± SD | 95% Confidence Interval | P value | Mean ± SD | 95% Confidence Interval | P value |
Lower bound | Upper bound | Lower bound | Upper bound |
level of education | under diploma | 12.26 ± 16.7 | 7.81 | 16.71 | 0.001 | 16.66 ± 8 | 12.22 | 21.10 | 0.001 |
diploma, | 4.47 ± 5.5 | 3.37 | 5.56 | 22.18 ± 5.8 | 20.93 | 23.43 |
BS | 7.67 ± 8.3 | 7.02 | 8.31 | 18.92 ± 5.9 | 18.35 | 19.50 |
Master | 6.09 ± 7.3 | 4.89 | 7.30 | 20.38 ± 4.7 | 19.38 | 21.38 |
Doctorate | 7.45 ± 10.2 | 4.61 | 10.29 | 19.90 ± 5.1 | 17.60 | 22.21 |
Specialist | 7.10 ± 11 | 3.18 | 11.01 | 18.30 ± 3.9 | 15.45 | 21.14 |
place of work | Hospital | 8.18 ± 6.6 | 7.36 | 9 | 0.003 | 17.79 ± 5.8 | 17.07 | 18.52 | 0.001 |
Medical and health care center | 6.32 ± 5.8 | 5.10 | 7.54 | 20.78 ± 5.3 | 19.67 | 21.88 |
Health center | 6.43 ± 6.4 | 5.69 | 7.17 | 20.65 ± 5.7 | 19.99 | 21.30 |
Type of job | Doctor | 8.46 ± 6.8 | 4.65 | 12.27 | 0.0290 | 19.53 ± 4.56 | 17 | 22.06 | 0.001 |
Nurses | 8.28 ± 6.8 | 7.25 | 9.32 | 17.64 ± 5.6 | 16.78 | 18.5 |
Medical care giver | 2.33 ± 1.5 | -1.46 | 6.12 | 24.33 ± 3.2 | 16.34 | 32.31 |
Technician | 7.81 ± 6.7 | 4.84 | 10.79 | 18.18 ± 5.4 | 15.75 | 20.61 |
Midwife | 7.21 ± 6 | 5.95 | 8.48 | 19.7 ± 5.5 | 18.53 | 20.86 |
Health administrators | 7.86 ± 8.3 | 4.16 | 11.56 | 19.36 ± 6.3 | 16.54 | 22.18 |
Social worker and psychologist | 2.73 ± 3.5 | 1.02 | 4.45 | 22.73 ± 4.8 | 20.37 | 25.09 |
Others | 6.68 ± 6 | 5.6 | 7.76 | 20.61 ± 5.6 | 19.61 | 21.61 |
The level of psychological disorder according to Kessler scale and depression, anxiety and stress according to PHQ9 in gender, qualification, work place, Profession, Work in emergency district, working shift, supported by families and friends, supported by boss and colleagues, Job satisfaction, Feel the stress of media coverage of COVID 19, was shown in Tables 4.
The prevalence of depressive, anxiety, and stress-related symptoms in almost 27% of participants had moderate to severe, regards to PHQ9A majority of the respondents in all job profession categories had moderate to severe mental distress scores in the four weeks preceding the study, according to the Kessler scale (Table 5).
Using Chi-square test, comparison showed significant difference in proportion across the levels of severity of depression in Kessler scale (χ2 = 30.64, P = 0.001) and in PHQ9 scale (χ2 = 20.84, P = 0.001). Table 6 illustrate the result of univariate and multivariate logistic regression. As result of PHQ9 questionnaire, depression was 71% higher in female than male (OR = 1.71, CI 95%: 1.12–2.63, P value: 0.013). Also in Kessler, depression in female was 2.11 time more than male (OR = 2.11, CI 95%: 1.39–2.23, P value: 0.001). The odds of working in hospital compared with working in health centers was 2.04 (CI 95%: 1.18–3.51, P value: 0.011) in PHQ9 and was 1.78 (CI 95%: 2.56–6.60, P value < 0.05) in Kessler. Lack of boss and colleagues support (OR = 2.47, CI 95%: 1.69–3.61, P value < 0.05), Job dissatisfaction (OR = 2.87, CI 95%: 1.92–4.30, P value < 0.05) and feel the stress of media coverage of COVID 19 (OR = 3.37, CI 95%: 2.17–5.22, P value < 0.05) increase the odds of depression in PHQ9 questionnaire. In Kessler questionnaire, lack of families and friends support (OR = 3.3, CI 95%: 1.67–6.54, P value: 0.001), lack of boss and colleagues support (OR = 1.91, CI 95%: 1.28–2.85, P value < 0.002), Job dissatisfaction (OR = 4.11, CI 95%: 2.56–6.60, P value < 0.05) and feel the stress of media coverage of COVID 19 (OR = 3.26, CI 95%: 2.10–5.06, P value < 0.05) increase the odds of depression.
Table 4
The proportion of grade of Kessler scale and PHQ9 Scale among the Healthcare workers baseline status.
| PHQ9 | Kessler |
Group | Without depression | Mild | Moderate | Moderately- Severe | Severe | χ2 | P | Severe | Moderate | Mild | χ2 | P |
Gender | Male | 388 | 139 | 63 | 28 | 28 | 20.84 | 0.001* | 85 | 227 | 334 | 30.64 | 0.001* |
Female | 761 | 563 | 273 | 139 | 170 | 480 | 890 | 536 |
Qualification | High school or below | 12 | 12 | 7 | 12 | 15 | 42.64 | 0.002 * | 22 | 22 | 14 | 37.42 | 0.001* |
Diploma | 230 | 67 | 28 | 12 | 8 | 24 | 126 | 195 |
Bachelor | 678 | 476 | 238 | 115 | 154 | 449 | 712 | 500 |
Master | 178 | 114 | 36 | 16 | 16 | 47 | 190 | 123 |
PhD/ MD | 35 | 24 | 16 | 8 | 4 | 16 | 43 | 28 |
Specialist | 17 | 8 | 12 | 4 | 0 | 8 | 25 | 8 |
Work place | Hospital | 360 | 322 | 158 | 71 | 94 | 21.5 | 0.006 * | 319 | 463 | 223 | 36.86 | 0.001* |
Medical and health care center | 167 | 118 | 36 | 32 | 12 | 44 | 181 | 140 |
Health center | 623 | 261 | 143 | 64 | 91 | 203 | 475 | 504 |
Profession | Doctor | 40 | 28 | 20 | 12 | 4 | 36. 5 | 0.13 | 21 | 56 | 28 | 45.4 | 0.001* |
Nurses | 258 | 258 | 107 | 55 | 67 | 215 | 372 | 156 |
Medical care giver | 214 | 55 | 28 | 28 | 28 | 52 | 100 | 195 |
Technician | 48 | 35 | 8 | 8 | 8 | 32 | 51 | 24 |
Midwife | 143 | 115 | 56 | 28 | 20 | 92 | 143 | 127 |
Health administrators | 134 | 55 | 43 | 15 | 32 | 68 | 120 | 92 |
Social worker and psychologist | 71 | 23 | 8 | 4 | 4 | 57 | 44 | 11 |
Others | 242 | 131 | 67 | 16 | 36 | 76 | 231 | 189 |
Work in emergency district | Yes | 202 | 119 | 59 | 44 | 56 | 5.02 | .284 | 164 | 200 | 116 | 13.81 | 0.001* |
No | 947 | 582 | 278 | 122 | 143 | 404 | 918 | 750 |
Working shift | Yes | 420 | 357 | 154 | 95 | 106 | 14.92 | 0.005 * | 338 | 510 | 285 | 24.63 | 0.001* |
No | 729 | 345 | 182 | 72 | 92 | 230 | 609 | 580 |
Supported by families and friends | Yes | 1025 | 575 | 257 | 115 | 151 | 18.6 | 0.001 * | 412 | 896 | 815 | 31.58 | 0.001* |
No | 124 | 127 | 79 | 51 | 48 | 155 | 223 | 51 |
Supported by boss and colleagues | Yes | 599 | 206 | 83 | 36 | 28 | 53.71 | 0.001 * | 65 | 405 | 482 | 71.54 | 0.001 * |
No | 551 | 495 | 253 | 131 | 170 | 501 | 712 | 387 |
Job satisfaction | Yes | 916 | 422 | 178 | 55 | 55 | 81.56 | 0.001 * | 177 | 703 | 746 | 110.93 | 0.001* |
No | 233 | 281 | 158 | 111 | 143 | 388 | 416 | 122 |
Feel the stress of media coverage of COVID 19 | Yes | 745 | 618 | 286 | 146 | 175 | 46.07 | 0.001 * | 520 | 923 | 527 | 54.03 | 0.001 * |
No | 404 | 83 | 51 | 20 | 24 | 48 | 195 | 339 |
Table 5
Kessler Psychological Distress and PHQ 9 Score in participation
| Frequency | Percent | Mean and SD of Scales |
PHQ-9 cut off point |
Severe depression | 199 | 7.8 | 19.54 ± 5.92 |
Moderately-severe depressive | 166 | 6.5 |
Moderate | 337 | 13.2 |
Mild | 702 | 27.5 |
Without depressive | 1148 | 45.0 |
Kessler cut off point |
Mild | 860 | 33.7 | 7.1 ± 6.51 |
Moderate | 1110 | 43.5 |
Severe | 561 | 22.0 |
Table 6
The crude and adjusted odds ratio of variables by using logistic regression model
Variables | PHQ9 | Kessler |
Crude ORs | Adjusted ORs | Crude ORs | Adjusted ORs |
OR (95%CI) | P- value | OR (95%CI) | P- value | OR (95%CI) | P- value | OR (95%CI) | P- value |
Age | .99 (.97-1.01) | .35 | - | - | .99 (.97-1.01) | .51 | - | - |
Gender | Male | 1 | | 1 | | 1 | | 1 | |
Female | 2.27 ( 1.58–3.26) | .0001 | 1.71 ( 1.12–2.63) | .013 | 2.72 ( 1.9–3.94) | .0001 | 2.11 (1.39–2.23) | .001 |
Level of education | High school or below | 2.67 (.45-15.96) | .28 | 4.90 ( .688- 34.97) | .11 | .83 (.11-6.26) | .86 | - | - |
Diploma | .333 (.09-1.27) | .11 | .34 ( .090- 1.75) | .22 | .19 (0.04–0.96) | .04 | - | - |
Bachelor | .967 (.27-3.48) | .96 | .72 ( .17- 2.98) | .65 | .58 (.12-2.77) | .50 | - | - |
Master | .681 (.18-2.58) | .57 | .53 ( .12- 2.35) | .40 | .48 (.09-2.42) | .38 | - | - |
PhD/ MD | .963 (.21-4.42) | .96 | 1.15 ( .21- 6.28) | .87 | .53 (.09-3.21) | .50 | - | - |
Specialist | 1 | | 1 | | 1 | | - | - |
Work place | Health center | 1 | | 1 | | 1 | | 1 | |
Medical and health care center | 1.326 (.83-2.12) | .24 | 1.88 (1.27–2.80) | .002 | 2.60 (1.80–3.78) | .0001 | 2.67 (1.74–4.10) | .0001 |
Hospital | 1.994 (1.41–2.81) | .0001 | 2.04 (1.18–3.51) | .011 | 1.18 (.73-1.91) | .49 | 1.78 (2.56–6.60) | .0001 |
Work experience, (years) | .999 (.98–1.02) | .95 | - | - | 1 (.98-1.02) | .61 | - | - |
Working hours per month | 1 (.99 − 1) | .75 | - | - | 1 (.99 − 1) | .27 | - | - |
Work in emergency district | No | 1 | | - | - | 1 | | - | - |
Yes | 1.15 (.77-1.72) | .48 | - | - | 1.78 (1.13–2.80) | .01 | - | - |
Working shift | No | 1 | | - | - | 1 | | - | - |
Yes | 1.78 (1.31–2.46) | .0001 | - | - | 2.05 (1.46–2.89) | .0001 | - | - |
Supported by families and friends | No | 2.32 (1.48–3.64) | .0001 | - | - | 4.56 (2.49–8.35) | .0001 | 3.30 (1.67–6.54) | .001 |
Yes | 1 | | - | - | 1 | | 1 | |
Supported by boss and colleagues | No | 3.23 (2.32–4.51) | | 2.47 (1.69–3.61) | .0001 | 3.22 (2.29–4.54) | .0001 | 1.91 (1.28–2.85) | .002 |
Yes | 1 | | 1 | | 1 | | 1 | |
Job satisfaction | No | 3.83 (2.69–5.45) | .0001 | 2.87 (1.92–4.30) | .0001 | 5.56 (3.63–8.51) | .0001 | 4.11 (2.56–6.60) | .0001 |
Yes | 1 | | 1 | | 1 | | 1 | |
Feel the stress of media coverage of COVID 19 | No | 1 | | 1 | | 1 | | 1 | |
Yes | 3.72 (2.51–5.53) | .0001 | 3.37(2.17–5.22) | .0001 | 3.81 (2.59–5.59) | .0001 | 3.26 (2.10–5.06) | .0001 |