INTRODUCTION

The COVID-19 pandemic associated with the SARS-CoV-2 virus was one of the events of the greatest psychological impact in recent decades. The speed with which the disease propagated is relevant: the first cases in Wuhan (China) were reported in December 2019, and by March 2020, a worldwide pandemic had been declared ⁽¹⁾.

In this regard, there was an early warning about the effect this scenario could have on people's mental health, considering there were risk factors related to economic and social vulnerability before the pandemic. It was foreseeable that these would be exacerbated by such measures as border closures, quarantine, and social distancing, thus triggering increases in the rates of violence, depression, suicides, and substance abuse ⁽²⁾. This was evidenced in one of the first exploratory studies published on the psychosocial impact of social isolation in Santiago, Chile, which reported rates of worry and anxiety that reached 67% and 60%, respectively ⁽³⁾.

In this light, health professionals are particularly vulnerable to developing adverse indicators of poor mental health. Several factors can explain this; however, the leading causes include job demands, a higher risk of contagion for themselves and their families, and in those settings where resources were scarce, they constantly faced ethical dilemmas ⁽⁴⁾. In this sense, among the available scientific evidence, three systematic literature reviews stand out for their methodological quality^(5,6,7). The common points of these works are, first, considering the variables of depression, anxiety, and insomnia as mental health indicators; second, they emphasize the existence of sociodemographic variables (e.g., sex) and the working environment (e.g., profession) that end up as predispositions for a greater manifestation of symptoms.

Previous studies have emphasized that working conditions, such as being on the front line, i.e., being in direct contact with infected patients, can cause major psychological distress ⁽⁸⁾. In the Latin American context, transcultural studies compared the depression and anxiety levels of health professionals in different countries. The report by Abeldaño et al. ⁽⁹⁾ was particularly relevant to this study, which revealed that health professionals in Chile presented higher anxiety scores than in Argentina, Colombia, and Mexico. Additionally, the studies conducted solely in Chile show a high prevalence of depression, anxiety, and insomnia symptoms in health personnel ^(10,11,12).

The available literature to date has focused predominantly on the differences by profession and being on the front line; however, the interaction among these factors has been less explored. At the same time, there is little evidence of the impact of workload and changes in the routine of health personnel compared to their pre-pandemic dynamics, which is particularly relevant for those with a sedentary routine ⁽⁵⁾.

Given the theoretical and empirical background and considering the lack of evidence in the Latin American context concerning the interaction of sociodemographic elements in health personnel, this study sought to determine the relationship between mental health indicators and socio-professional factors in a sample of medical and nursing professionals in southern Chile.

MATERIALS AND METHODS

Participants

The sample was initially comprised of 112 professionals. The inclusion criteria were: working in health, specifically doctors and nurses, who could answer the survey digitally way and who participated voluntarily. Also, as an exclusion criterion for this study, participants could not have been off sick or on medical leave since the beginning of the pandemic; therefore, a total of 22 participants were excluded from the study. Consequently, the final sample contained 90 health professionals, 71% women, and 53% doctors with an average age of 39 years (see Table 1). The sample size was considered adequate when the statistical power required to detect a moderate effect size in the most robust analysis (2 x 2 factorial ANOVA) was taken into account, with a type I error probability of 5%, obtaining a total size of at least 84 individuals for a power of 95% and a critical F of 3.96; this estimation was done using the G Power software.

Table 1. Descriptive statistics of the sample. 

^Note:M= Mean; SD = Standard deviation.

RESULTS

First, the descriptive statistics were calculated for the sociodemographic variables of the sample, and the working conditions were analyzed. Women were in the majority (71.11%), with an average age of 39.87 years. Most participants were medical personnel (46.67%), did not work on the front line (72.22%), and had a daytime work schedule (62.92%). Regarding the change in workday, half of the sample reported working on a different shift from before the pandemic. In addition, 24.44% of the sample reported having presented mental health disorders before.

When analyzing the interaction between profession and being in the front line of care for depressive symptomatology scores, no significant interaction was obtained (F (1,86) = 0.34, p= 0.56). The main effects reveal a significant effect was found only for the variable profession (F (1,86) = 19.36, p= 0.001, η² partial= 0.18), which in terms of the marginal means, indicates that nurses have higher scores (M= 12.55 ± 0.86) than doctors (M= 7.48 ± 0.77). The results of the analysis of variance, which include the inter-subject factors profession and change in workday, pointed to a significant interaction effect between the two variables (F (1,86) = 3.83, p= 0.05, η² partial= 0.04). In this sense, an analysis of the marginal means (see Table 2) reveals that being nursing staff and having had a change in workday leads to significantly higher scores in the depression measurement. Finally, when analyzing the profession and the type of workday, a significant interaction (F (1,86) = 6.80, p= 0.01, η was obtained ² partial = 0.07); when analyzing the marginal means, being a nurse and working a shift other than daytime leads to higher scores on the depression measurement.

Table 2. Averages of PHQ-7 test scores when combining socio-professional factors. 

^Note:Standard deviation in parentheses.

Regarding the GAD-7 anxiety scale scores, no significant interaction was obtained between the profession and being on the front line (F (1,86) = 0,20, p =0.66). When the main effects were analyzed, a significant effect was found only for the variable profession (F (1,86) = 30.05, p= 0.001, η² partial= 0.26), which in light of the marginal means, indicates that nurses have higher scores (M= 10,47 ± 5,01) than doctors (M= 5.02 ± 3.40). When profession and change in a workday are included as inter-subject factors, there is a significant interaction effect between the two variables (F(1,86) = 5.83, p= 0.02, η² partial= 0.06). When analyzing the marginal means, it is observed that being nursing staff and having a change in workday leads to higher anxiety scores. Moreover, a significant interaction was obtained between profession and type of workday, (F (1,86) = 9.26, p= 0.003, η² partial = 0.10) from the analysis of the marginal means (see Table 3). It is concluded that being part of the nursing staff and working a schedule other than the day shift leads to higher scores in the anxiety measurement.

Table 3. Averages of GDA-7 test scores when combining socio-professional factors. 

^Note:Standard deviation in parentheses.

The analysis of variable insomnia, including profession and being on the front line as factors, obtained a significant interaction between the two variables (F (1,86) = 4.40, p = 0.04, η² partial= 0.05). The marginal means (Table 4) show that being a nurse combined with being on the front line of care of patients with COVID-19 results in greater insomnia-related symptomatology. A significant effect of interaction between profession and change in workday was identified (F (1,86) = 3.88, p = 0.052, η² partial= 0.04), which, when visualizing the marginal means, reflects that being part of the nursing staff and having had changes in workday leads to more significant insomnia issues. There was no interaction effect when profession and work schedule were included as fixed factors (F (1,86) = 2.21, p = 0.14). Only one main effect was found for the variable profession, with sleep disturbances being greater for the nursing staff (M = 12.90 ± 6.95) than for the medical staff (M = 7.08 ± 5.17).

Table 4. Averages of ISI-3 test scores when combining socio-professional factors. 

^Note:Standard deviation in parentheses.

DISCUSSION

This study aimed to determine the relationship between mental health indicators and socio-occupational factors in medical and nursing personnel in Chile. The results obtained show that nursing staff consistently reported more depressive symptoms, anxiety, and sleep disturbances than medical staff. It is known that the presence of these symptoms not only affects mental health and work performance but is also a risk factor for the development of psychiatric morbidity in the future⁽¹⁸⁾. This higher prevalence may be due at least in part to gender-related factors, as previous studies have reported that a considerable percentage of nursing staff are women, who also report higher levels of discrimination ⁽¹¹⁾.

This creates a complex scenario for nursing staff, given the nature of their work, where there is greater exposure to biological risk factors as well as elements that threaten psychosocial stability^(19,20). In this respect, several studies have concluded that the COVID-19 pandemic has caused greater vulnerability among health personnel, being affected by different stressors in their place of work, primarily the responsibility of providing care and treatment ⁽²¹⁾.

The change in workday in the context of the COVID-19 pandemic and having a different shift from the daytime schedule also affected the nursing staff more. The convergence of these elements resulted specifically in the report of greater anxiety symptomatology. This result is consistent with several previous studies that describe high levels of anxiety in nursing personnel, even higher than depressive symptomatology ^{(22,23,24,25,26)}. The global pandemic context has generated circumstances of uncertainty, work overload, and a greater perception of risk associated with contagion in the general population and particular health personnel ⁽²⁷⁾. This scenario could be the cause of the symptoms reported by those who participated in this study.

This study has some limitations. Therefore, the results must be interpreted with caution, considering the specific features of this sample. It is also important to note that the instruments used in this study do not constitute a diagnosis since they evaluate the presence of a group of symptoms and cannot replace an assessment by mental health professionals. Moreover, according to the DSM-5 diagnostic criteria, temporality is a component to determine the intensity of symptomatology. Given that the minimal temporality for the intensity threshold in the conditions reported is over three months, it is suggested that the time between measurements be increased in future studies.

Nevertheless, the present study is a valuable contribution to understanding how work-related aspects can influence the mental well-being of health workers. It also opens the possibility that future research may identify protective factors against the development of mental health disorders in health workers, mainly because there is evidence that variables such as social support ⁽²⁸⁾ and dispositional optimism can help people reduce the impact of negative feelings and make possible the development of healthier coping strategies or increase the willingness to seek psychological help where depressive or anxiety symptoms are present ⁽²⁹⁾. Finally, it is recommended that health institutions guarantee working conditions consistent with the prevention of mental health disorders and increase the supply of psychosocial support services to promote the well-being of health personnel ⁽³⁰⁾.

CONCLUSIONS

The results obtained make it possible to conclude that during the COVID-19 pandemic, the nursing staff presented a greater negative affective response than the rest of the health personnel, which was also intensified by the changes in working conditions, such as shift changes and the extension of working hours. This poses a challenge for institutions and management and well-being teams to follow up with these employees, given the consequences of excessive exposure to stressful events like those that occurred during the pandemic.