Original Article

Mental Health Status among Healthcare Workers during COVID-19 Pandemic


Objective: COVID-19, which is an international concern by far, had fundamental impacts on mental health of medical staff. Healthcare workers are the high-risk group to endure the emotional outcomes brought about by the outbreak. This study assesses the mental consequences of healthcare workers during the acute phase of COVID-19 pandemic in Tehran.

Method: We conducted a cross-sectional study on healthcare workers from two tertiary referral hospitals in Tehran province. A total of 222 of the staff participated in the study. Our questionnaires comprised Impact of Event Scale-Revised (IES-R) and 12-item General Health Questionnaire (GHQ-12), which were handed to participants to obtain data on their general mental problems in addition to the psychological impacts of the evolving virus on this particular group. Epidemiologic and sociodemographic information of participants, level of perceiving exposure to disease, and underlying diseases of each of them were gathered during the recruitment period.

Results: Results showed high probabilities (98.2%) in mental disorders among healthcare workers. Since our study was done during the initial phase of the pandemic, development of mental issues due to the newly emerged infectious virus was expected. However, we recorded mild (41.4%) to moderate (31.5%) impact of this novel virus. The possibility of having mental problems was much higher in females, assistant nurses, individuals with lower education, and those who provided care for COVID-19 patients.

Conclusion: COVID-19 has brought about increased distress among healthcare workers. Noticeably, the forefront group in combating this virus bear the most emotional complications. Thus, efforts should be taken into practice to provide proper psychological support for this vulnerable group.

1. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497-506.
2. Wang C, Horby PW, Hayden FG, Gao GF. A novel coronavirus outbreak of global health concern. Lancet. 2020;395(10223):470-3.
3. Xiang YT, Yu X, Ungvari GS, Correll CU, Chiu HF. Outcomes of SARS survivors in China: not only physical and psychiatric co-morbidities. East Asian Arch Psychiatry. 2014;24(1):37-8.
4. Xiang YT, Yang Y, Li W, Zhang L, Zhang Q, Cheung T, et al. Timely mental healthcare for the 2019 novel coronavirus outbreak is urgently needed. Lancet Psychiatry. 2020;7(3):228-9.
5. Shah K, Kamrai D, Mekala H, Mann B, Desai K, Patel RS. Focus on Mental Health During the Coronavirus (COVID-19) Pandemic: Applying Learnings from the Past Outbreaks. Cureus. 2020;12(3):e7405.
6. Greenberg N, Docherty M, Gnanapragasam S, Wessely S. Managing mental health challenges faced by healthcare workers during covid-19 pandemic. Bmj. 2020;368:m1211.
7. Al-Hanawi MK, Mwale ML, Alshareef N, Qattan AMN, Angawi K, Almubark R, et al. Psychological Distress Amongst Health Workers and the General Public During the COVID-19 Pandemic in Saudi Arabia. Risk Manag Healthc Policy. 2020;13:733-42.
8. Tam CW, Pang EP, Lam LC, Chiu HF. Severe acute respiratory syndrome (SARS) in Hong Kong in 2003: stress and psychological impact among frontline healthcare workers. Psychol Med. 2004;34(7):1197-204.
9. Greenberg N, Docherty M, Gnanapragasam S, Wessely S. Managing mental health challenges faced by healthcare workers during covid-19 pandemic. Bmj. 2020;368:m1211.
10. Zhou C, Shi L, Gao L, Liu W, Chen Z, Tong X, et al. Determinate factors of mental health status in Chinese medical staff: A cross-sectional study. Medicine (Baltimore). 2018;97(10):e0113.
11. Chong MY, Wang WC, Hsieh WC, Lee CY, Chiu NM, Yeh WC, et al. Psychological impact of severe acute respiratory syndrome on health workers in a tertiary hospital. Br J Psychiatry. 2004;185:127-33.
12. World Health Organization. Mental health and psychosocial considerations during the COVID-19 outbreak. 2020; World Health Organization. https://apps.who.int/iris/handle/10665/331490. License: CC BY-NC-SA 3.0 IGO.
13. Weiss DS. The impact of event scale: revised. In. Wilson JP, So-kum Tang C. Cross-cultural assessment of psychological trauma and PTSD. Springer.2007; 219-38.
14. Brewin CR. Systematic review of screening instruments for adults at risk of PTSD. J Trauma Stress. 2005;18(1):53-62.
15. Peters M, Passchier J. Translating instruments for cross-cultural studies in headache research. Headache. 2006;46(1):82-91.
16. Panaghi L, Shooshtari MH, Mogadam JA. Persian version validation in impact of event Scale-Revised. Tehran Univ Med J. 2006;64(3):52-60.
17. Hankins M. The reliability of the twelve-item general health questionnaire (GHQ-12) under realistic assumptions. BMC Public Health. 2008;8:355.
18. Werneke U, Goldberg DP, Yalcin I, Üstün BT. The stability of the factor structure of the General Health Questionnaire. Psychol med. 2000;30(4):823-9.
19. Sánchez-López Mdel P, Dresch V. The 12-Item General Health Questionnaire (GHQ-12): reliability, external validity and factor structure in the Spanish population. Psicothema. 2008;20(4):839-43.
20. Montazeri, A., Harirchi, A.M., Shariati, M. et al. The 12-item General Health Questionnaire (GHQ-12) : translation and validation study of the Iranian version. Health Qual Life Outcomes.2003, 1, 66.
21. Chan AO, Huak CY. Psychological impact of the 2003 severe acute respiratory syndrome outbreak on healthcare workers in a medium size regional general hospital in Singapore. Occup Med (Lond). 2004;54(3):190-6.
22. Lee SM, Kang WS, Cho AR, Kim T, Park JK. Psychological impact of the 2015 MERS outbreak on hospital workers and quarantined hemodialysis patients. Compr Psychiatry. 2018;87:123-7.
23. Chew NWS, Lee GKH, Tan BYQ, Jing M, Goh Y, Ngiam NJH, et al. A multinational, multicentre study on the psychological outcomes and associated physical symptoms amongst healthcare workers during COVID-19 outbreak. Brain Behav Immun. 2020;88:559-65.
24. Wang C, Pan R, Wan X, Tan Y, Xu L, Ho CS, et al. Immediate Psychological Responses and Associated Factors during the Initial Stage of the 2019 Coronavirus Disease (COVID-19) Epidemic among the General Population in China. Int J Environ Res Public Health. 2020;17(5).
25. Lancee WJ, Maunder RG, Goldbloom DS. Prevalence of psychiatric disorders among Toronto hospital workers one to two years after the SARS outbreak. Psychiatr Serv. 2008;59(1):91-5.
26. Ramirez AJ, Graham J, Richards MA, Cull A, Gregory WM, Leaning MS, et al. Burnout and psychiatric disorder among cancer clinicians. Br J Cancer. 1995;71(6):1263-9.
27. Hetherington A. The Extent and Source of Stress in Emergency Care. InReport No. 9110 1993. UK.
28. Zhang WR, Wang K, Yin L, Zhao WF, Xue Q, Peng M, et al. Mental Health and Psychosocial Problems of Medical Health Workers during the COVID-19 Epidemic in China. Psychother Psychosom. 2020;89(4):242-50.
29. Chaib C. Shortage of personal protective equipment endangering health workers worldwide [Internet]. World Health Organization. 2020 [cited 2020 Jun 27].
30. Theorell T, Hammarström A, Aronsson G, Träskman Bendz L, Grape T, Hogstedt C, et al. A systematic review including meta-analysis of work environment and depressive symptoms. BMC Public Health. 2015;15:738.
31. Cai H, Tu B, Ma J, Chen L, Fu L, Jiang Y, et al. Psychological Impact and Coping Strategies of Frontline Medical Staff in Hunan Between January and March 2020 During the Outbreak of Coronavirus Disease 2019 (COVID 19) in Hubei, China. Med Sci Monit. 2020;26:e924171.
32. Lai J, Ma S, Wang Y, Cai Z, Hu J, Wei N, et al. Factors Associated With Mental Health Outcomes Among Healthcare Workers Exposed to Coronavirus Disease 2019. JAMA Netw Open. 2020;3(3):e203976.
33. Koh D, Lim MK, Chia SE, Ko SM, Qian F, Ng V, Tan BH, Wong KS, Chew WM, Tang HK, Ng W. Risk perception and impact of severe acute respiratory syndrome (SARS) on work and personal lives of healthcare Workers in Singapore What can we Learn?. Medical care. 2005 Jul 1:676-82.
34. Hoshino J, Hori Y, Kondo T, Maekawa A, Tamakoshi K, Sakakibara H. [Physical and mental health characteristics of female caregivers]. Nihon Koshu Eisei Zasshi. 2009;56(2):75-86.
35. Eisenbarth CA. Coping with stress: Gender differences among college students. Coll Stud J. 2019;53(2):151-62.
36. Liu N, Zhang F, Wei C, Jia Y, Shang Z, Sun L, et al. Prevalence and predictors of PTSS during COVID-19 outbreak in China hardest-hit areas: Gender differences matter. Psychiatry res. 2020;287:112921.
37. Ho CS, Chee CY, Ho RC. Mental Health Strategies to Combat the Psychological Impact of COVID-19 Beyond Paranoia and Panic. Ann Acad Med Singap. 2020;49(3):155-60.
38. Nemati M, Ebrahimi B, Nemati F. Assessment of Iranian nurses’ knowledge and anxiety toward COVID-19 during the current outbreak in Iran. Arch Clin Infect Dis. 2020;15(COVID-19):e102848.
39. Ning X, Yu F, Huang Q, Li X, Luo Y, Huang Q, et al. The mental health of neurological doctors and nurses in Hunan Province, China during the initial stages of the COVID-19 outbreak. BMC Psychiatry. 2020;20(1):436.
40. Yáñez JA, Afshar Jahanshahi A, Alvarez-Risco A, Li J, Zhang SX. Anxiety, Distress, and Turnover Intention of Healthcare Workers in Peru by Their Distance to the Epicenter during the COVID-19 Crisis. Am J Trop Med Hyg. 2020;103(4):1614-20.
41. Wasim T, Raana Ge, Bushra N, Riaz A. Effect of COVID-19 pandemic on mental wellbeing of healthcare workers in tertiary care hospital. Ann King Edw Med Univ. 2020;26(Special Issue):140-4.
IssueVol 16 No 3 (2021) QRcode
SectionOriginal Article(s)
DOI https://doi.org/10.18502/ijps.v16i3.6250
COVID-19 Coronavirus Healthcare Worker Mental Health Pandemic SARS-CoV-2

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
Kheradmand A, Mahjani M, Pirsalehi A, Fatemizadeh S, Moshari M, Ziaie S, Fatemizadeh S, Khoshgoui B. Mental Health Status among Healthcare Workers during COVID-19 Pandemic. Iran J Psychiatry. 2021;16(3):250-259.