Depression, Anxiety and Coping Responses among Iranian Healthcare Professionals during the Coronavirus Disease (COVID-19) Outbreak
-
Farnaz Etesam
,
Melika Arab Bafrani
,
Samaneh Akbarpour
,
Helia Tarighatnia
,
Gilda Rajabi
,
Mahsa Dolatshahi
,
Zahra Vahabi
Abstract
Objective: This cross-sectional study aimed to assess the effects of different coping strategies on the mood states (anxiety and depression) of healthcare providers in the novel coronavirus disease (COVID-19) pandemic.
Method: From February to April 2020, we asked medical staff in 4 referral hospitals in Iran to voluntarily complete online questionnaires including: Generalized Anxiety Disorder (GAD-2) questionnaire, Patient Health Questionnaire (PHQ-2) and the Coping Strategies Questionnaire-28. Univariate and multiple logistic regressions were applied to identify the associations of coping strategies and mood states.
Results: 258 people filled out the online questionnaire. Of them, 39.9% and 39.1% reported anxiety and depression, respectively, with age as a risk factor. Overall, participants used more emotion-based coping strategies. Anxiety and depression were associated with applying more of emotion-based and less of problem-based coping mechanisms. The findings remained stable even after adjustment for confounding variables including age, gender and direct contact with COVID-19 patients.
Conclusion: Providing social support to health workers, planning to reduce their perceived stigma, and educating them about how to use more effective coping mechanisms can be beneficial in reducing the psychological impact on this segment of the population in the event of COVID-19.
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4. Li W, Yang Y, Liu ZH, Zhao YJ, Zhang Q, Zhang L, et al. Progression of Mental Health Services during the COVID-19 Outbreak in China. Int J Biol Sci. 2020;16(10):1732-8.
5. Stuijfzand S, Deforges C, Sandoz V, Sajin CT, Jaques C, Elmers J, et al. Psychological impact of an epidemic/pandemic on the mental health of healthcare professionals: a rapid review. BMC Public Health. 2020;20(1):1230.
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7. Huang L, Lei W, Xu F, Liu H, Yu L. Emotional responses and coping strategies in nurses and nursing students during Covid-19 outbreak: A comparative study. PLoS One. 2020;15(8):e0237303.
8. Shih FJ, Turale S, Lin YS, Gau ML, Kao CC, Yang CY, et al. Surviving a life-threatening crisis: Taiwan's nurse leaders' reflections and difficulties fighting the SARS epidemic. J Clin Nurs. 2009;18(24):3391-400.
9. Main A, Zhou Q, Ma Y, Luecken LJ, Liu X. Relations of SARS-related stressors and coping to Chinese college students' psychological adjustment during the 2003 Beijing SARS epidemic. J Couns Psychol. 2011;58(3):410-23.
10. Kasi PM, Naqvi HA, Afghan AK, Khawar T, Khan FH, Khan UZ, et al. Coping styles in patients with anxiety and depression. ISRN Psychiatry. 2012;2012:128672.
11. Sungchul B, Do-Youn L, Il Kon K. Rendering Problem-Oriented CCD for chronic diseases. Annu Int Conf IEEE Eng Med Biol Soc. 2017;2017:4277-80.
12. Popa-Velea O, Diaconescu L, Jidveian Popescu M, Truţescu C. Resilience and active coping style: effects on the self-reported quality of life in cancer patients. The international journal of psychiatry in medicine. 2017;52(2):124-36.
13. Keramati M, Ebrahimi H, Basirinezhad M, Shamsizadeh M, Mohammadpourhodki R. The prevalence of anxiety, stress, and depression with respect to coping strategies in caregivers of patients with head injuries. Archives of Trauma Research. 2019;8:165.
14. Folkman S, Lazarus RS. An analysis of coping in a middle-aged community sample. J Health Soc Behav. 1980;21(3):219-39.
15. Frijda NH. Emotions are functional, most of the time. 1994.
16. Gok Metin Z, Karadas C, Izgu N, Ozdemir L, Demirci U. Effects of progressive muscle relaxation and mindfulness meditation on fatigue, coping styles, and quality of life in early breast cancer patients: An assessor blinded, three-arm, randomized controlled trial. Eur J Oncol Nurs. 2019;42:116-25.
17. Tuncay T, Musabak I, Gok DE, Kutlu M. The relationship between anxiety, coping strategies and characteristics of patients with diabetes. Health Qual Life Outcomes. 2008;6:79.
18. Dadfar M, Lester D. Psychometric characteristics of Patient Health Questionnaire-2 (PHQ-2) in Iranian psychiatric outpatients. Austin Journal of Psychiatry and Behavioral Sciences. 2017;4:2-6.
19. Ahmadi SM, Masjedi Arani A, Bakhtiari M, Davazdah Emamy MH. Psychometric Properties of Persian Version of Patient Health Questionnaires-4 (PHQ-4) in Coronary Heart Disease Patients. Iran J Psychiatry Behav Sci. 2019;13(4):e85820.
20. Wild B, Eckl A, Herzog W, Niehoff D, Lechner S, Maatouk I, et al. Assessing generalized anxiety disorder in elderly people using the GAD-7 and GAD-2 scales: results of a validation study. Am J Geriatr Psychiatry. 2014;22(10):1029-38.
21. Hughes AJ, Dunn KM, Chaffee T, Bhattarai JJ, Beier M. Diagnostic and Clinical Utility of the GAD-2 for Screening Anxiety Symptoms in Individuals with Multiple Sclerosis. Arch Phys Med Rehabil. 2018;99(10):2045-9.
22. Carver CS. You want to measure coping but your protocol's too long: consider the brief COPE. Int J Behav Med. 1997;4(1):92-100.
23. Yeung DY, Fung HH. Age differences in coping and emotional responses toward SARS: a longitudinal study of Hong Kong Chinese. Aging Ment Health. 2007;11(5):579-87.
24. Ashktorab T, Baghcheghi N, Seyedfatemi N, Baghestani A. Psychometric parameters of the Persian version of the BriefCOPE among wives of patients under hemodialysis. Med J Islam Repub Iran. 2017;31:20.
25. Groothuis-Oudshoorn K, Van Buuren S. Mice: multivariate imputation by chained equations in R. J Stat Softw. 2011;45(3):1-67.
26. Saeedi Shahri SS, Ghashghaee A, Behzadifar M, Bragazzi NL, Behzadifar M, Mousavinejad N, et al. Depression among Iranian nurses: A systematic review and meta-analysis. Med J Islam Repub Iran. 2017;31:130.
27. Yazdanshenas Ghazwin M, Kavian M, Ahmadloo M, Jarchi A, Golchin Javadi S, Latifi S, et al. The Association between Life Satisfaction and the Extent of Depression, Anxiety and Stress among Iranian Nurses: A Multicenter Survey. Iran J Psychiatry. 2016;11(2):120-7.
28. Hajebi A, Motevalian SA, Rahimi-Movaghar A, Sharifi V, Amin-Esmaeili M, Radgoodarzi R, et al. Major anxiety disorders in Iran: prevalence, sociodemographic correlates and service utilization. BMC Psychiatry. 2018;18(1):261.
29. Ahmadvand AF, Sepehrmanesh ZA, Ghoreyshi FS, Assarian FA, Moosavi GA, Etesam FA. Prevalence of mental disorders in general population of Kashan City. Iranian Journal of Epidemiology. 2010;6(2):16-24.
30. Taghizadeh F, Hassannia L, Moosazadeh M, Zarghami M, Taghizadeh H, Fathi Dooki A, et al. Anxiety and Depression in Health Workers and General Population During COVID-19 Epidemic in IRAN: A Web-Based Cross-Sectional Study. medRxiv. 2020:2020.05.05.20089292.
31. Tahara M, Mashizume Y, Takahashi K. Coping Mechanisms: Exploring Strategies Utilized by Japanese Healthcare Workers to Reduce Stress and Improve Mental Health during the COVID-19 Pandemic. Int J Environ Res Public Health. 2020;18(1):131.
32. Tracy JL, Robins RW. TARGET ARTICLE: "Putting the Self Into Self-Conscious Emotions: A Theoretical Model". Psychological Inquiry. 2004;15(2):103-25.
33. Gee S, Skovdal M. Public Discourses of Ebola Contagion and Courtesy Stigma: The Real Risk to International Health Care Workers Returning Home From the West Africa Ebola Outbreak? Qual Health Res. 2018;28(9):1499-508.
34. Spoorthy MS, Pratapa SK, Mahant S. Mental health problems faced by healthcare workers due to the COVID-19 pandemic-A review. Asian J Psychiatr. 2020;51:102119.
35. Siyu C, Xia M, Wen W, Cui L, Yang W, Liu S, et al. Mental health status and coping strategy of medical workers in China during The COVID-19 outbreak. medRxiv. 2020:2020.02.23.20026872.
36. Salman M, Raza MH, Mustafa ZU, Khan TM, Asif N, Tahir H, et al. The psychological effects of COVID-19 on frontline healthcare workers and how they are coping: a web-based, cross-sectional study from Pakistan. medRxiv. 2020.
37. Tan BYQ, Chew NWS, Lee GKH, Jing M, Goh Y, Yeo LLL, et al. Psychological Impact of the COVID-19 Pandemic on Health Care Workers in Singapore. Ann Intern Med. 2020;173(4):317-20.
38. Salk RH, Hyde JS, Abramson LY. Gender differences in depression in representative national samples: Meta-analyses of diagnoses and symptoms. Psychol Bull. 2017;143(8):783-822.
39. Pappa S, Ntella V, Giannakas T, Giannakoulis VG, Papoutsi E, Katsaounou P. Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis. Brain Behav Immun. 2020;88:901-7.
40. Mohammadzadeh F, Delshad Noghabi A, Khosravan S, Bazeli J, Armanmehr V, Paykani T. Anxiety Severity Levels and Coping Strategies during the COVID-19 Pandemic among People Aged 15 Years and Above in Gonabad, Iran. Arch Iran Med. 2020;23(9):633-8.
41. Taha S, Matheson K, Cronin T, Anisman H. Intolerance of uncertainty, appraisals, coping, and anxiety: the case of the 2009 H1N1 pandemic. Br J Health Psychol. 2014;19(3):592-605.
42. Hu D, Kong Y, Li W, Han Q, Zhang X, Zhu LX, et al. Frontline nurses' burnout, anxiety, depression, and fear statuses and their associated factors during the COVID-19 outbreak in Wuhan, China: A large-scale cross-sectional study. EClinicalMedicine. 2020;24:100424.
43. Chew QH, Chia FL, Ng WK, Lee WCI, Tan PLL, Wong CS, et al. Psychological and coping responses to COVID-19 amongst residents in training across ACGME-I accredited specialties in Singapore. Psychiatry Res. 2020;290:113146.
2. Organization WH. Coronavirus disease 2019 (COVID-19): situation report, 72. 2020.
3. Rothan HA, Byrareddy SN. The epidemiology and pathogenesis of coronavirus disease (COVID-19) outbreak. J Autoimmun. 2020;109:102433.
4. Li W, Yang Y, Liu ZH, Zhao YJ, Zhang Q, Zhang L, et al. Progression of Mental Health Services during the COVID-19 Outbreak in China. Int J Biol Sci. 2020;16(10):1732-8.
5. Stuijfzand S, Deforges C, Sandoz V, Sajin CT, Jaques C, Elmers J, et al. Psychological impact of an epidemic/pandemic on the mental health of healthcare professionals: a rapid review. BMC Public Health. 2020;20(1):1230.
6. Liu CY, Yang YZ, Zhang XM, Xu X, Dou QL, Zhang WW, et al. The prevalence and influencing factors in anxiety in medical workers fighting COVID-19 in China: a cross-sectional survey. Epidemiol Infect. 2020;148:e98.
7. Huang L, Lei W, Xu F, Liu H, Yu L. Emotional responses and coping strategies in nurses and nursing students during Covid-19 outbreak: A comparative study. PLoS One. 2020;15(8):e0237303.
8. Shih FJ, Turale S, Lin YS, Gau ML, Kao CC, Yang CY, et al. Surviving a life-threatening crisis: Taiwan's nurse leaders' reflections and difficulties fighting the SARS epidemic. J Clin Nurs. 2009;18(24):3391-400.
9. Main A, Zhou Q, Ma Y, Luecken LJ, Liu X. Relations of SARS-related stressors and coping to Chinese college students' psychological adjustment during the 2003 Beijing SARS epidemic. J Couns Psychol. 2011;58(3):410-23.
10. Kasi PM, Naqvi HA, Afghan AK, Khawar T, Khan FH, Khan UZ, et al. Coping styles in patients with anxiety and depression. ISRN Psychiatry. 2012;2012:128672.
11. Sungchul B, Do-Youn L, Il Kon K. Rendering Problem-Oriented CCD for chronic diseases. Annu Int Conf IEEE Eng Med Biol Soc. 2017;2017:4277-80.
12. Popa-Velea O, Diaconescu L, Jidveian Popescu M, Truţescu C. Resilience and active coping style: effects on the self-reported quality of life in cancer patients. The international journal of psychiatry in medicine. 2017;52(2):124-36.
13. Keramati M, Ebrahimi H, Basirinezhad M, Shamsizadeh M, Mohammadpourhodki R. The prevalence of anxiety, stress, and depression with respect to coping strategies in caregivers of patients with head injuries. Archives of Trauma Research. 2019;8:165.
14. Folkman S, Lazarus RS. An analysis of coping in a middle-aged community sample. J Health Soc Behav. 1980;21(3):219-39.
15. Frijda NH. Emotions are functional, most of the time. 1994.
16. Gok Metin Z, Karadas C, Izgu N, Ozdemir L, Demirci U. Effects of progressive muscle relaxation and mindfulness meditation on fatigue, coping styles, and quality of life in early breast cancer patients: An assessor blinded, three-arm, randomized controlled trial. Eur J Oncol Nurs. 2019;42:116-25.
17. Tuncay T, Musabak I, Gok DE, Kutlu M. The relationship between anxiety, coping strategies and characteristics of patients with diabetes. Health Qual Life Outcomes. 2008;6:79.
18. Dadfar M, Lester D. Psychometric characteristics of Patient Health Questionnaire-2 (PHQ-2) in Iranian psychiatric outpatients. Austin Journal of Psychiatry and Behavioral Sciences. 2017;4:2-6.
19. Ahmadi SM, Masjedi Arani A, Bakhtiari M, Davazdah Emamy MH. Psychometric Properties of Persian Version of Patient Health Questionnaires-4 (PHQ-4) in Coronary Heart Disease Patients. Iran J Psychiatry Behav Sci. 2019;13(4):e85820.
20. Wild B, Eckl A, Herzog W, Niehoff D, Lechner S, Maatouk I, et al. Assessing generalized anxiety disorder in elderly people using the GAD-7 and GAD-2 scales: results of a validation study. Am J Geriatr Psychiatry. 2014;22(10):1029-38.
21. Hughes AJ, Dunn KM, Chaffee T, Bhattarai JJ, Beier M. Diagnostic and Clinical Utility of the GAD-2 for Screening Anxiety Symptoms in Individuals with Multiple Sclerosis. Arch Phys Med Rehabil. 2018;99(10):2045-9.
22. Carver CS. You want to measure coping but your protocol's too long: consider the brief COPE. Int J Behav Med. 1997;4(1):92-100.
23. Yeung DY, Fung HH. Age differences in coping and emotional responses toward SARS: a longitudinal study of Hong Kong Chinese. Aging Ment Health. 2007;11(5):579-87.
24. Ashktorab T, Baghcheghi N, Seyedfatemi N, Baghestani A. Psychometric parameters of the Persian version of the BriefCOPE among wives of patients under hemodialysis. Med J Islam Repub Iran. 2017;31:20.
25. Groothuis-Oudshoorn K, Van Buuren S. Mice: multivariate imputation by chained equations in R. J Stat Softw. 2011;45(3):1-67.
26. Saeedi Shahri SS, Ghashghaee A, Behzadifar M, Bragazzi NL, Behzadifar M, Mousavinejad N, et al. Depression among Iranian nurses: A systematic review and meta-analysis. Med J Islam Repub Iran. 2017;31:130.
27. Yazdanshenas Ghazwin M, Kavian M, Ahmadloo M, Jarchi A, Golchin Javadi S, Latifi S, et al. The Association between Life Satisfaction and the Extent of Depression, Anxiety and Stress among Iranian Nurses: A Multicenter Survey. Iran J Psychiatry. 2016;11(2):120-7.
28. Hajebi A, Motevalian SA, Rahimi-Movaghar A, Sharifi V, Amin-Esmaeili M, Radgoodarzi R, et al. Major anxiety disorders in Iran: prevalence, sociodemographic correlates and service utilization. BMC Psychiatry. 2018;18(1):261.
29. Ahmadvand AF, Sepehrmanesh ZA, Ghoreyshi FS, Assarian FA, Moosavi GA, Etesam FA. Prevalence of mental disorders in general population of Kashan City. Iranian Journal of Epidemiology. 2010;6(2):16-24.
30. Taghizadeh F, Hassannia L, Moosazadeh M, Zarghami M, Taghizadeh H, Fathi Dooki A, et al. Anxiety and Depression in Health Workers and General Population During COVID-19 Epidemic in IRAN: A Web-Based Cross-Sectional Study. medRxiv. 2020:2020.05.05.20089292.
31. Tahara M, Mashizume Y, Takahashi K. Coping Mechanisms: Exploring Strategies Utilized by Japanese Healthcare Workers to Reduce Stress and Improve Mental Health during the COVID-19 Pandemic. Int J Environ Res Public Health. 2020;18(1):131.
32. Tracy JL, Robins RW. TARGET ARTICLE: "Putting the Self Into Self-Conscious Emotions: A Theoretical Model". Psychological Inquiry. 2004;15(2):103-25.
33. Gee S, Skovdal M. Public Discourses of Ebola Contagion and Courtesy Stigma: The Real Risk to International Health Care Workers Returning Home From the West Africa Ebola Outbreak? Qual Health Res. 2018;28(9):1499-508.
34. Spoorthy MS, Pratapa SK, Mahant S. Mental health problems faced by healthcare workers due to the COVID-19 pandemic-A review. Asian J Psychiatr. 2020;51:102119.
35. Siyu C, Xia M, Wen W, Cui L, Yang W, Liu S, et al. Mental health status and coping strategy of medical workers in China during The COVID-19 outbreak. medRxiv. 2020:2020.02.23.20026872.
36. Salman M, Raza MH, Mustafa ZU, Khan TM, Asif N, Tahir H, et al. The psychological effects of COVID-19 on frontline healthcare workers and how they are coping: a web-based, cross-sectional study from Pakistan. medRxiv. 2020.
37. Tan BYQ, Chew NWS, Lee GKH, Jing M, Goh Y, Yeo LLL, et al. Psychological Impact of the COVID-19 Pandemic on Health Care Workers in Singapore. Ann Intern Med. 2020;173(4):317-20.
38. Salk RH, Hyde JS, Abramson LY. Gender differences in depression in representative national samples: Meta-analyses of diagnoses and symptoms. Psychol Bull. 2017;143(8):783-822.
39. Pappa S, Ntella V, Giannakas T, Giannakoulis VG, Papoutsi E, Katsaounou P. Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis. Brain Behav Immun. 2020;88:901-7.
40. Mohammadzadeh F, Delshad Noghabi A, Khosravan S, Bazeli J, Armanmehr V, Paykani T. Anxiety Severity Levels and Coping Strategies during the COVID-19 Pandemic among People Aged 15 Years and Above in Gonabad, Iran. Arch Iran Med. 2020;23(9):633-8.
41. Taha S, Matheson K, Cronin T, Anisman H. Intolerance of uncertainty, appraisals, coping, and anxiety: the case of the 2009 H1N1 pandemic. Br J Health Psychol. 2014;19(3):592-605.
42. Hu D, Kong Y, Li W, Han Q, Zhang X, Zhu LX, et al. Frontline nurses' burnout, anxiety, depression, and fear statuses and their associated factors during the COVID-19 outbreak in Wuhan, China: A large-scale cross-sectional study. EClinicalMedicine. 2020;24:100424.
43. Chew QH, Chia FL, Ng WK, Lee WCI, Tan PLL, Wong CS, et al. Psychological and coping responses to COVID-19 amongst residents in training across ACGME-I accredited specialties in Singapore. Psychiatry Res. 2020;290:113146.
| Files | ||
| Issue | Vol 17 No 4 (2022) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/ijps.v17i4.10694 | |
| Keywords | ||
| Anxiety COVID-19 Pandemic Depression Mental Health | ||
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How to Cite
1.
Etesam F, Arab Bafrani M, Akbarpour S, Tarighatnia H, Rajabi G, Dolatshahi M, Vahabi Z. Depression, Anxiety and Coping Responses among Iranian Healthcare Professionals during the Coronavirus Disease (COVID-19) Outbreak. Iran J Psychiatry. 2022;17(4):446-454.
