Psychological Impact of the COVID-19 Pandemic on Health Care Workers in Singapore
Authors: Benjamin Y.Q. Tan, Nicholas W.S. Chew, Grace K.H. Lee, Mingxue Jing, Yihui Goh, Leonard L.L. Yeo, Ka Zhang, Howe-Keat Chin, Aftab Ahmad, Faheem Ahmed Khan, Ganesh Napolean Shanmugam, Bernard P.L. Chan, Sibi Sunny, Bharatendu Chandra, Jonathan J.Y. Ong, Prakash R. Paliwal, Lily Y.H. Wong, Renarebecca Sagayanathan, Jin Tao Chen, Alison Ying Ying Ng, Hock Luen Teoh, Cyrus S. Ho, Roger C. Ho, Vijay K. Sharma
Journal: Annals of Internal Medicine (2020)

Letters6 April 2020Psychological Impact of the COVID-19 Pandemic on Health Care Workers in SingaporeFREEBenjamin Y.Q. Tan, MD*, Nicholas W.S. Chew, MD*, Grace K.H. Lee, MD, Mingxue Jing, MD, Yihui Goh, MD, Leonard L.L. Yeo, MD, Ka Zhang, MD, Howe-Keat Chin, MD, Aftab Ahmad, MD, Faheem Ahmed Khan, MD, Ganesh Napolean Shanmugam, MBBCh, Bernard P.L. Chan, MD, Sibi Sunny, MD, Bharatendu Chandra, MD, Jonathan J.Y. Ong, MD, Prakash R. Paliwal, MD, Lily Y.H. Wong, BN, Renarebecca Sagayanathan, BSc, Jin Tao Chen, BN, Alison Ying Ying Ng, Dip, Hock Luen Teoh, MD, Cyrus S. Ho, MD, Roger C. Ho, MD, and Vijay K. Sharma, MDBenjamin Y.Q. Tan, MD*National University Health System and Yong Loo Lin School of Medicine, National University of Singapore, Singapore (B.Y.T., L.L.Y., V.K.S.)Search for more papers by this author, Nicholas W.S. Chew, MD*National University Health System, Singapore (N.W.C., M.J., Y.G., K.Z., H.C., B.P.C., S.S., B.C., J.J.O., P.R.P., L.Y.W., R.S., J.T.C., A.Y.N., H.L.T.)Search for more papers by this author, Grace K.H. Lee, MDYong Loo Lin School of Medicine, National University of Singapore, Singapore (G.K.L.)Search for more papers by this author, Mingxue Jing, MDNational University Health System, Singapore (N.W.C., M.J., Y.G., K.Z., H.C., B.P.C., S.S., B.C., J.J.O., P.R.P., L.Y.W., R.S., J.T.C., A.Y.N., H.L.T.)Search for more papers by this author, Yihui Goh, MDNational University Health System, Singapore (N.W.C., M.J., Y.G., K.Z., H.C., B.P.C., S.S., B.C., J.J.O., P.R.P., L.Y.W., R.S., J.T.C., A.Y.N., H.L.T.)Search for more papers by this author, Leonard L.L. Yeo, MDNational University Health System and Yong Loo Lin School of Medicine, National University of Singapore, Singapore (B.Y.T., L.L.Y., V.K.S.)Search for more papers by this author, Ka Zhang, MDNational University Health System, Singapore (N.W.C., M.J., Y.G., K.Z., H.C., B.P.C., S.S., B.C., J.J.O., P.R.P., L.Y.W., R.S., J.T.C., A.Y.N., H.L.T.)Search for more papers by this author, Howe-Keat Chin, MDNational University Health System, Singapore (N.W.C., M.J., Y.G., K.Z., H.C., B.P.C., S.S., B.C., J.J.O., P.R.P., L.Y.W., R.S., J.T.C., A.Y.N., H.L.T.)Search for more papers by this author, Aftab Ahmad, MDNg Teng Fong General Hospital, Singapore (A.A., F.A.K., G.N.S.)Search for more papers by this author, Faheem Ahmed Khan, MDNg Teng Fong General Hospital, Singapore (A.A., F.A.K., G.N.S.)Search for more papers by this author, Ganesh Napolean Shanmugam, MBBChNg Teng Fong General Hospital, Singapore (A.A., F.A.K., G.N.S.)Search for more papers by this author, Bernard P.L. Chan, MDNational University Health System, Singapore (N.W.C., M.J., Y.G., K.Z., H.C., B.P.C., S.S., B.C., J.J.O., P.R.P., L.Y.W., R.S., J.T.C., A.Y.N., H.L.T.)Search for more papers by this author, Sibi Sunny, MDNational University Health System, Singapore (N.W.C., M.J., Y.G., K.Z., H.C., B.P.C., S.S., B.C., J.J.O., P.R.P., L.Y.W., R.S., J.T.C., A.Y.N., H.L.T.)Search for more papers by this author, Bharatendu Chandra, MDNational University Health System, Singapore (N.W.C., M.J., Y.G., K.Z., H.C., B.P.C., S.S., B.C., J.J.O., P.R.P., L.Y.W., R.S., J.T.C., A.Y.N., H.L.T.)Search for more papers by this author, Jonathan J.Y. Ong, MDNational University Health System, Singapore (N.W.C., M.J., Y.G., K.Z., H.C., B.P.C., S.S., B.C., J.J.O., P.R.P., L.Y.W., R.S., J.T.C., A.Y.N., H.L.T.)Search for more papers by this author, Prakash R. Paliwal, MDNational University Health System, Singapore (N.W.C., M.J., Y.G., K.Z., H.C., B.P.C., S.S., B.C., J.J.O., P.R.P., L.Y.W., R.S., J.T.C., A.Y.N., H.L.T.)Search for more papers by this author, Lily Y.H. Wong, BNNational University Health System, Singapore (N.W.C., M.J., Y.G., K.Z., H.C., B.P.C., S.S., B.C., J.J.O., P.R.P., L.Y.W., R.S., J.T.C., A.Y.N., H.L.T.)Search for more papers by this author, Renarebecca Sagayanathan, BScNational University Health System, Singapore (N.W.C., M.J., Y.G., K.Z., H.C., B.P.C., S.S., B.C., J.J.O., P.R.P., L.Y.W., R.S., J.T.C., A.Y.N., H.L.T.)Search for more papers by this author, Jin Tao Chen, BNNational University Health System, Singapore (N.W.C., M.J., Y.G., K.Z., H.C., B.P.C., S.S., B.C., J.J.O., P.R.P., L.Y.W., R.S., J.T.C., A.Y.N., H.L.T.)Search for more papers by this author, Alison Ying Ying Ng, DipNational University Health System, Singapore (N.W.C., M.J., Y.G., K.Z., H.C., B.P.C., S.S., B.C., J.J.O., P.R.P., L.Y.W., R.S., J.T.C., A.Y.N., H.L.T.)Search for more papers by this author, Hock Luen Teoh, MDNational University Health System, Singapore (N.W.C., M.J., Y.G., K.Z., H.C., B.P.C., S.S., B.C., J.J.O., P.R.P., L.Y.W., R.S., J.T.C., A.Y.N., H.L.T.)Search for more papers by this author, Cyrus S. Ho, MDNational University of Singapore, Singapore (C.S.H.)Search for more papers by this author, Roger C. Ho, MDInstitute of Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore (R.C.H.)Search for more papers by this author, and Vijay K. Sharma, MDNational University Health System and Yong Loo Lin School of Medicine, National University of Singapore, Singapore (B.Y.T., L.L.Y., V.K.S.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M20-1083 SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Background: In response to the coronavirus disease 2019 (COVID-19) pandemic, Singapore raised its Disease Outbreak Response System Condition alert to “orange,” the second highest level. Between 19 February and 13 March 2020, confirmed cases rose from 84 to 200 (34.2 per 1 000 000 population), with an increase in patients in critical condition from 4 to 11 (5.5%) and no reported deaths in Singapore (1). Understanding the psychological impact of the COVID-19 outbreak among health care workers is crucial in guiding policies and interventions to maintain their psychological well-being.Objective: To examine the psychological distress, depression, anxiety, and stress experienced by health care workers in Singapore in the midst of the outbreak, and to compare these between medically and non–medically trained hospital personnel.Methods and Findings: From 19 February to 13 March 2020, health care workers from 2 major tertiary institutions in Singapore who were caring for patients with COVID-19 were invited to participate with a self-administered questionnaire. In addition to information on demographic characteristics and medical history (Table 1), the questionnaire included the validated Depression, Anxiety, and Stress Scales (DASS-21) and the Impact of Events Scale–Revised (IES-R) instrument (2, 3). Health care workers included “medical” (physicians, nurses) and “nonmedical” personnel (allied health professionals, pharmacists, technicians, administrators, clerical staff, and maintenance workers). The primary outcome was the prevalence of depression, stress, anxiety, and posttraumatic stress disorder (PTSD) among all health care workers (Table 2). Secondary outcomes were comparison of the prevalence of depression, anxiety, stress, and PTSD, and mean DASS-21 and IES-R scores between medical and nonmedical health care workers. The Pearson χ2 test and student t test were used to compare categorical and continuous outcomes, respectively, between the 2 groups. Multivariable regression was used to adjust for the a priori defined confounders of age, sex, ethnicity, marital status, presence of comorbid conditions, and survey completion date.Table 1. Participant Characteristics at BaselineTable 2. Prevalence of Depression, Anxiety, Stress, and PTSD and Mean DASS-21 and IES-R Scores in Medical and Nonmedical Health Care Personnel (n = 470)Of 500 invited health care workers, 470 (94%) participated in the study; baseline characteristics are shown in Table 1. Sixty-eight (14.5%) participants screened positive for anxiety, 42 (8.9%) for depression, 31 (6.6%) for stress, and 36 (7.7%) for clinical concern of PTSD. The prevalence of anxiety was higher among nonmedical health care workers than medical personnel (20.7% versus 10.8%; adjusted prevalence ratio, 1.85 [95% CI, 1.15 to 2.99]; P = 0.011), after adjustment for age, sex, ethnicity, marital status, survey completion date, and presence of comorbid conditions. Similarly, higher mean DASS-21 anxiety and stress subscale scores and higher IES-R total and subscale scores were observed in nonmedical health care workers (Table 2).Discussion: Overall mean DASS-21 and IES-R scores among health care workers were lower than those in the published literature from previous disease outbreaks, such as severe acute respiratory syndrome (SARS). A previous study in Singapore found higher IES scores among physicians and nurses during the SARS outbreak, and an almost 3 times higher prevalence of PTSD, than those in our study (4). This could be attributed to increased mental preparedness and stringent infection control measures after Singapore's SARS experience.Of note, nonmedical health care workers had higher prevalence of anxiety even after adjustment for possible confounders. Our findings are consistent with those of a recent COVID-19 study demonstrating that frontline nurses had significantly lower vicarious traumatization scores than non–frontline nurses and the general public (5). Reasons for this may include reduced accessibility to formal psychological support, less first-hand medical information on the outbreak, and less intensive training on personal protective equipment and infection control measures.As the pandemic continues, important clinical and policy strategies are needed to support health care workers. Our study identified a vulnerable group susceptible to psychological distress. Educational interventions should target nonmedical health care workers to ensure understanding and use of infection control measures. Psychological support could include counseling services and development of support systems among colleagues.Our study has limitations. First, data obtained from self-reported questionnaires were not verified with medical records. Second, the study did not assess socioeconomic status, which may be helpful in evaluating associations of outcomes and tailoring specific interventions. Finally, the study was performed early in the outbreak and only in Singapore, which may limit the generalizability of the findings. Follow-up studies could help assess for progression or even a potential rebound effect of psychological manifestations once the imminent threat of COVID-19 subsides.In conclusion, our study highlights that nonmedical health care personnel are at highest risk for psychological distress during the COVID-19 outbreak. Early psychological interventions targeting this vulnerable group may be beneficial.References1. Ministry of Health Singapore. Updates on COVID-19 (coronavirus disease 2019) local situation. Ministry of Health, Singapore. Accessed at www.moh.gov.sg/covid-19 on 13 March 2020. Google Scholar2. Lovibond SH, Lovibond PF. Manual for the Depression Anxiety Stress Scales. 2nd ed. Psychology Foundation of Australia; 1995. Google Scholar3. Creamer M, Bell R, Failla S. Psychometric properties of the Impact of Event Scale - Revised. Behav Res Ther. 2003;41:1489-96. [PMID: 14705607] CrossrefMedlineGoogle Scholar4. Chan AO, Huak CY. Psychological impact of the 2003 severe acute respiratory syndrome outbreak on health care workers in a medium size regional general hospital in Singapore. Occup Med (Lond). 2004;54:190-6. [PMID: 15133143] CrossrefMedlineGoogle Scholar5. Li Z, Ge J, Yang M, et al. Vicarious traumatization in the general public, members, and non-members of medical teams aiding in COVID-19 control. Brain Behav Immun. 2020. [PMID: 32169498] doi:10.1016/j.bbi.2020.03.007 CrossrefMedlineGoogle Scholar Comments 0 Comments Sign In to Submit A Comment Majorie Ann MahusayPasig City General Hospital Metro Manila Philippines9 June 2020 Questionnaire Greetings, I have read the study and it is quite interesting for me. I am currently in my 2nd year of Residency Training in Pediatrics at Pasig City General Hospital. And I would like to have a copy of your questionnaire. This is to help me formulate a questionnaire suited for our demographics for our country. Hoping for your positive response. EmaS.m.c15 June 2020 Questionnaire Greetings, I have read the study and i found it interesting . And I would like to have a copy of your questionnaire. Thank you Janvil MerialesAdventist University of the Philippines17 June 2020 Nursing Student Hello, I found this research very relevant to a study I'm interested in doing a thesis on. Would it be possible for me to receive a copy of the full document? ..20 June 2020 questionnaire have read the study and i found it interesting . And I would like to have a copy of your questionnaire. Thank you Elitsa GyokovaMedical University Pleven24 June 2020 Request Thank you for the interesting study! Can I receive a copy of the questionnaire? Benjamin Y.Q. Tan, MD, Nicholas W.S. Chew, MD, et.alBrokenshire Hospital, Davao City, Philippines24 June 2020 Greetings Hello Sir, I have read the journal and I am very much interested of having a same study here in my training institution. I am currently a 2nd year resident of Internal Medicine and one of the requirements to be promoted to 3rd year is to have a research. Is it possible if I could have a copy of your formulated questionnaire so I could somehow use and modify it according to our current system here in my institution. Hoping for a positive feedback. Thank You and Godspeed. Vijay K Sharma, Nicholas WS Chew, Benjamin YQ TanYLL School of Medicine, National University of Singapore27 June 2020 Psychological Impact of the COVID-19 Pandemic on Health Care Workers in Singapore We are happy to see the interest generated by our manuscript. We used Depression, Anxiety, and Stress Scales (DASS-21) and the Impact of Events Scale–Revised (IES-R) instrument (1,2). In addition, we collected data about deographics, work role and symptoms, if any during the preceding one month. The primary outcome was the prevalence of depression, stress, anxiety, and posttraumatic stress disorder (PTSD) among all health care workers. Secondary outcomes were comparison of the prevalence of depression, anxiety, stress, and PTSD, and mean DASS-21 and IES-R scores between medical and non-medical health care workers. The corresponding author would be happy to share the questionnaire upon request. References- 1. Lovibond SH. Lovibond PF. Manual for the Depression Anxiety Stress Scales. 2d ed. Sydney: Psychology Foundation of Australia; 1995. 2. Creamer M, Bell R, Failla S. Psychometric properties of the impact of event scale - revised. Behav Res Ther. 2003;41:1489-96. Vijay K SharmaIEDCR, Bangladesh29 June 2020 Questionnaire Dear sir, Greetings. I have read the journal and I am very much interested to know about your questionnaire. Is it possible if I could have a copy of your formulated questionnaire. Hoping for a positive feedback. Thank you for the interesting study, Can I receive a copy of the questionnaire? Disclosures: I am currently working in epidemiology department of Bangladesh and also involved in covid case investigation in covid hospital. I am interested to read the questionnaire used in this study . Johnson OlaniyiFederal Medical Centre, Owo, Nigeria26 June 2020 Questionnaire This is a wonderful work. I will appreciate if I can get the questionnaire to see the possibility of adopting it for a similar work I am doing NilLasuth23 June 2020 Request for questionnaire Read through your study and was found to be very helpful, can I have access to the questionnaire, many thanks in anticipation of your quick response LOMA R WAGHMARENurse Educator- Ruby Hall Clinic- Pune26 June 2020 Share questionnaire The study looks interesting. Would like to conduct similar study in my setup Disclosures: would like to use your questionnaire Author, Article, and Disclosure InformationAuthors: Benjamin Y.Q. Tan, MD; Nicholas W.S. Chew, MD; Grace K.H. Lee, MD; Mingxue Jing, MD; Yihui Goh, MD; Leonard L.L. Yeo, MD; Ka Zhang, MD; Howe-Keat Chin, MD; Aftab Ahmad, MD; Faheem Ahmed Khan, MD; Ganesh Napolean Shanmugam, MBBCh; Bernard P.L. Chan, MD; Sibi Sunny, MD; Bharatendu Chandra, MD; Jonathan J.Y. Ong, MD; Prakash R. Paliwal, MD; Lily Y.H. Wong, BN; Renarebecca Sagayanathan, BSc; Jin Tao Chen, BN; Alison Ying Ying Ng, Dip; Hock Luen Teoh, MD; Cyrus S. Ho, MD; Roger C. Ho, MD; Vijay K. Sharma, MDAffiliations: National University Health System and Yong Loo Lin School of Medicine, National University of Singapore, Singapore (B.Y.T., L.L.Y., V.K.S.)National University Health System, Singapore (N.W.C., M.J., Y.G., K.Z., H.C., B.P.C., S.S., B.C., J.J.O., P.R.P., L.Y.W., R.S., J.T.C., A.Y.N., H.L.T.)Yong Loo Lin School of Medicine, National University of Singapore, Singapore (G.K.L.)Ng Teng Fong General Hospital, Singapore (A.A., F.A.K., G.N.S.)National University of Singapore, Singapore (C.S.H.)Institute of Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore (R.C.H.)Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M20-1083.Reproducible Research Statement: Study protocol and statistical code: Available from Dr. Sharma (e-mail, vijay_kumar_sharma@nuhs.edu.sg). Data set: Not available.Corresponding Author: Vijay K. Sharma, MD, Division of Neurology, National University Health System, NUHS Tower Block, Level 10, 1 East Kent Ridge Road, Singapore 119228; e-mail, vijay_kumar_sharma@nuhs.edu.sg.This article was published at Annals.org on 6 April 2020.* Drs. Tan and Chew contributed equally to this work. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byEMDR for symptoms of depression, stress and burnout in health care workers exposed to COVID-19 (HARD): A study protocol for a trial within a cohort studyAnxiety, depression, and uncertainty appraisal and factors affecting uncertainty risk and opportunity appraisal of health care workers in Korea during the COVID-19 outbreakCovid-19 Hastalarına Bakım Veren Sağlık Personellerinin İkincil Travmatik Stres Düzeyinin Tükenmişlik ve İşten Ayrılma Niyetine EtkisiEffects of human capital, natural resource, urbanization, energy consumption on carbon emissions in the top ten emitter countriesQuality of Life in Adolescents and Young Adults with Cleft Lip and Palate with and Without Speech Therapy During COVID-19Burnout, moral injury, and suicidal/self-harm ideation among healthcare professionals in Mainland China: Insights from an online survey during the COVID-19 pandemicBetrayal-Based Moral Injury and Mental Health Problems Among Healthcare and Hospital Workers Serving COVID-19 PatientsEin moderiertes Mediationsmodell zur Erklärung der Beziehung zwischen Risikogruppenzugehörigkeit, Wahrnehmung der Bedrohung, Wissen und Einhaltung der COVID-19-VerhaltensmaßnahmenDas wahrgenommene Risiko einer COVID-19-Exposition und eines schweren COVID-19-Verlaufs beeinträchtigt den Schlaf. Die mediierenden und moderierenden Rollen von Ängstlichkeit und Wissen in Bezug auf COVID-19Association between Moral Distress and Burnout Syndrome in university-hospital nursesAssociação do Sofrimento Moral e Síndrome de Burnout em enfermeiros de hospital universitárioAsociación del Sufrimiento Moral y Síndrome de Burnout en enfermeros de un hospital universitarioThe reliability and validity of the training elements scale for clinicians in the new era——based on the perspective of Chinese doctors’ job demandsPsychological disturbances encountered by the healthcare professionals, military professionals and general public in Sri Lanka during COVID-19 pandemic: a cross-sectional studyPsychological distress among primary health care workers during COVID-19 pandemic: a cross-sectional study in Mansoura, EgyptThe longitudinal study of subjective wellbeing and absenteeism of healthcare workers considering post-COVID condition and the COVID-19 pandemic tollPsychological stressors and needs among essential workers at a Singapore hospital during the COVID-19 pandemicA Resilience Program for Hospital Security Officers During the COVID-19 Pandemic Using a Community Engagement ModelThe experiences of Red Crescent relief workers during the COVID-19 pandemic in Iran: a qualitative phenomenological studyMental health and resilience after the covid-19 pandemic: a multi-ethnic longitudinal surveyRisk perception, mental health distress, and flourishing during the COVID-19 pandemic in China: The role of positive and negative affectSymptoms of post traumatic stress disorder and their relationship with the fear of COVID−19 and COVID−19 burden among health care workers after the full liberalization of COVID−19 prevention and control policy in China: a cross-sectional studyPsychopathological Burden among Healthcare Workers during the COVID-19 Pandemic Compared to the Pre-Pandemic PeriodMental health of healthcare workers during the first year of the COVID-19 pandemic in the Netherlands: a longitudinal studyPsychological Trauma, Anxiety, and Depression Among University Students During First Phase of COVID-19 Movement Control Order in MalaysiaGeography of patients in the federal ENT hospital before and after the COVID-19 pandemic: changing spatial patterns and characteristicsCOVID-19 infodemic and health-related quality of life in patients with chronic respiratory diseases: A multicentre, observational studyAnalysis of the mental health status of hospital staff during the COVID-19 pandemicWhat are effective strategies to respond to the psychological impacts of working on the frontlines of a public health emergency?Evaluation of Mental Health Status of the Pregnant Women Working in Hospitals During Covid-19 Era: A Cross-Sectional StudyMental health during the omicron pandemic: A comparison between medical staff and non-medical staffPrevalence of Post COVID-19 Condition among Healthcare Workers: Self-Reported Online Survey in Four African Countries, December 2021–January 2022Safety attitudes, burnout and well-being among healthcare workers during the COVID-19 pandemic: an Indo-Pacific regional cross-sectional studyGender Aspects of Cognitive Functioning in Former COVID-19 PatientsPsychosocial impact of COVID-19 pandemic: experience of healthcare workers in QatarConflict occurrence and preferred management styles among ICU nurses during the first wave of COVID ‐19 pandemic: A cross‐sectional study in Saudi ArabiaExploring protective psychological factors of healthcare professionals during COVID-19 in Singapore: A qualitative studyFacing the pandemic with a smile: the case of Memedical and its impact on cardiovascular professionalsPhysicians’ Turnover Intention During the “Post–COVID-19” EraAssociation of face mask use with self-reported cardiovascular symptoms during the COVID-19 pandemicFatores de risco à saúde mental dos profissionais da saúde durante a pandemia de COVID-19: revisão sistemáticaRisk factors for healthcare professionals’ mental health during the COVID-19 pandemic: a systematic reviewPath of fear: Experiences of health professionals in the fight against COVID‐19Best-worst scaling in studying the impact of the coronavirus pandemic on health professionals in GhanaPSYCHOLOGICAL EFFECTS AND PSYCHOLOGICAL RESILIENCE OF THE COVID-19 OUTBREAK IN TURKEYExploring Psychological and Socio-Economic Impact of Covid 2019 on Healthcare Workers in India: Evidence from Delhi-NCR HospitalsParenting stress and associated factors in healthcare workers after the second wave of COVID-19 in India: a two-center cross-sectional studyWill we ever be the same again? The mental health impact of the COVID ‐19 pandemic on health care staff and institutionsStress, anxiety, and depression levels among family members of patients admitted to intensive care and general units of an educational hospital during the COVID-19 pandemicPerspectives on training in obstetrics and gynaecology during the COVID-19 pandemic: Thematic analysis of trainee responses from a pan-European surveyThe prevalence of effort-reward imbalance and its associations with working conditions, psychosocial resources and burden among health care workers during the COVID-19 pandemic: Results of the egePan-Voice studyLongitudinal investigation of factors influencing mental health during centralized quarantine for COVID-19Effect of the COVID-19 Pandemic and Subsequent Social Distancing on Individual's Mental HealthThe role of Covid-19 outbreak on well-being of healthcare employees of Turkey by considering gender differencesPsychological consequences of the COVID-19 pandemic: A qualitative studyExperiences of Operating Room Nurses During the COVID-19 Pandemic: A Qualitative StudyAssociation of the time spent on social media news with depression and suicidal ideation among a sample of Lebanese adults during the COVID-19 pandemic and the Lebanese economic crisisIncreased preanalytical errors during Covid-19 PandemicCovid-19 Hastalarına Bakım Veren Hemşirelerde Öz YeterlilikBurnout and quality of life among healthcare professionals during the COVID-19 pandemic in Saudi ArabiaGender as a determinant of physical activity levels and mental health of medical students from Poland and Belarus in the context of the COVID-19 pandemicMental health complaints among healthcare workers engaged in the care of COVID‐19 patients: A prospective cohort study from JapanAnxiety and Stress due to COVID-19 Pandemic and Associated Factors Among Healthcare Workers in West Guji Zone Southern EthiopiaAnxiety during the COVID-19 pandemic in hospital staff: systematic review plus meta-analysisScale Development for COVID-19 Vaccine Hesitancy by Integration of Socio-Demographic and Psychological FactorsPsychological impact of the COVID-19 pandemic on anaesthetists in an academic institution in South AfricaMeasuring mental well-being among frontline nurses during the COVID-19 crisis: Evidence from Saudi ArabiaTraumatic Stress and Health Anxiety in Intensive Care Workers During the Covid-19 PandemicPsychological Distress and Fear of COVID-19 in Primary Health Care WorkersHemşirelerin ve Son Sınıf Hemşirelik Bölümü Öğrencilerinin COVID-19 Pandemi Sürecinde Mesleklerine Olan Bakış Açılarının DeğerlendirilmesiAssessment of working conditions and risks caused by the COVID-19 pandemic: results of an online survey of personnel of medical organizationsPsychological Distress and Consequences of COVID-19 Pandemic on Different GroupsThe experiences of nurses during the COVID‐19 crisis in India and the role of the state: A qualitative analysisPsychological impact of COVID-19 containment on CADASIL patientsA Cross-Sequential Study of the Effect of the Coronavirus Disease 2019 Pandemic on the Risk of Anxiety and Depression of Royal Flying Doctors Staff, an Australian Air Medical OrganizationNephrologists’ perspectives on the impact of COVID-19 on caring for patients undergoing dialysis in Latin America: a qualitative studyAnxiety and psychological needs of high school students: COVID‐19 periodAumento del síndrome de burnout en los adjuntos de Medicina Interna durante la pandemia de COVID-19Burnout syndrome increase during COVID-19 pandemic in attending Internal Medicine physiciansPhysicians’ mental health and coping during the COVID-19 pandemic: One year explorationPrevalence and determinants of Italian physicians’ burnout in the “post-COVID-19” eraPredictors of Feeling of Threat Caused by COVID-19 Pandemic, the Distinctive Effects of Automatic vs. Reflective EmotionsImpact of COVID-19 in mental health trustsFeasibility and effect of a self-help online acceptance and commitment therapy program focused on repetitive negative thinking for Colombian young womenCOVID-19 Döneminde Çalışan Hemşirelerin Depresyon, Anksiyete ve Stres Düzeyleri ile Psikolojik Bakım Algılarının İncelenmesiSustainable Development Method in Healthcare Systems After the COVID-19 PandemicPrevalence and risk factors of depression and anxiety among Chinese adults who received SARS-CoV-2 vaccine — A cross-sectional surveyDentists' lived experience of providing dental care during the COVID-19 pandemic: A qualitative study in Mashhad, IranPsychological first aid intervention: rescue from psychological distress and improving the pre-licensure nursing students’ resilience amidst COVID-19 crisis and beyondImpact of long working hours on depressive symptoms among COVID-19 frontline medical staff: The mediation of job burnout and the moderation of family and organizational supportThe effect of the COVID-19 pandemic on weight gain, physical activity and mental health among Turkish university students“Cuidar do outro é cuidar de mim”Changes in Working Women’s Self-Reported Subjective Wellbeing and Quality of Interpersonal Relationships During COVID-19: A Quantitative Comparison of Essential and Non-essential Workers in SingaporeDigitization of Mental Health Therapy in the Era and Post-Pandemic COVID-19Traumatic stress in Egyptian doctors during COVID-19 pandemicCOVID-19 Relates to Both PTSD and PTG in a Non-clinical Population, Why?Psychological Distress of Healthcare Workers in 4 Hospitals Compared to General Population During the First Italian Wave of COVID-19 PandemicComparing the Psychological Problems Among the Health Care Workers Across Two Waves of SARS-CoV-2 (COVID-19) Pandemic: An Observational Study from IndiaPrevalence of Anxiety Symptoms Among Health Care Workers in Colombia During the COVID-19 PandemicWorsening general health and psychosocial wellbeing of Australian hospital allied health practitioners during the COVID-19 pandemicPsychological Resilience, Anxiety, and Well-Being of Health Care Providers During the COVID-19 PandemicInternatio