Stress and Anxiety Among Healthcare Workers Associated with COVID-19 Pandemic in Russia

Background: The first COVID-19 cases were diagnosed in Russia on 31 January 2020. By the end of March, many hospitals cancelled all scheduled procedures and started receiving patients with COVID-19. Large group of healthcare workers were involved in the treatment of patients with the novel virus. The mental health of medical workers treating patients with COVID-19 is now becoming an issue of increasing concern worldwide. However, the available data on stress and anxiety symptoms among healthcare workers during the COVID-19 are relatively limited and have not been evaluated in Russia yet. This study had two objectives: first, we aimed to evaluate stress and anxiety symptoms among healthcare workers directly involved in the diagnosis and treatment of patients with COVID-19 during the outbreak in Russia. A second objective was to validate the Russian version of new Stress and Anxiety to Viral Epidemics – 9 (SAVE-9) scale. Methods: The study was a cross-sectional hospital-based anonymous on-line survey between May 12th and May 26th, 2020 of 1,090 healthcare workers - 548 physicians [50.2%] and 542 nurses [49.8%] directly involved in the diagnosis and treatment of patients with COVID-19 . All the participants were directly involved in the treatment of such patients. Stress and anxiety symptoms were assessed using the Russian versions of SAVE-9 and GAD-7 scales. Logistic regression, Kaiser-Meyer-Olkin two component factor model, Cronbach's alpha and ROC-analysis were performed to determine the influence of different variables, internal structure and consistency, sensitivity and specificity of SAVE-9 compared with Generalized Anxiety Disorder – 7 (GAD-7). Findings: The median scores on the GAD-7 and SAVE-9 were 5 and 14, respectively. 535 [49.1%] respondents had moderate and 239 [21.9%] had severe anxiety according to selected SAVE-9 total score interpretation by percentiles. 134 participants [12.3%] had severe anxiety, 144 [13.2%] had moderate according to GAD-7. 707 [64.9%] participants often or always have been worried about their family or friends getting infected because of them, 387 [35.5%] – have been more sensitive towards minor physical symptoms. The component model (Kaiser-Meyer-Olkin adequacy criterion = 0.847, Barletts' sphericity criterion, p<0.0001) revealed two-factor structure of SAVE-9: 1) “anxiety and somatic concern” included items 2,3,4,8 (EV = 3.497), 2) “social stress” - 1,5,6,7,9 (EV = 1.096). The factor loading of each individual SAVE-9 scale item was greater than 0.5. The regression SAVE-9 model was reliable (-2Log likelihood ratio = 1935.2; p=0.05). Female gender (OR - 0.98, p=0.035) and younger age (OR – 0.65, p=0.035) were associated with higher level of anxiety. The Cronbach's alpha was 0.787 that means good internal consistency. The total score of SAVE-9 with a high degree of confidence predicted the GAD-7 value in comparative ROC analysis. The appropriate cut-off score for SAVE-9 was determined as 18 with good sensitivity and specificity (AUC=0.808, sensitivity = 0.68~0.73, specificity = 0.76~0.8). Interpretation: Healthcare workers in Russia fighting with COVID-19 reported high rates of stress and anxiety similar to other countries and are in need in urgent supportive programs. The Russian version of the SAVE-9 displayed a good ratio of sensitivity to specificity compared with GAD-7 and can be recommended as a screening instrument for detection of stress and anxiety symptoms in healthcare workers during viral outbreak. Funding Statement: The authors received no funding for this work.Declaration of Interests: This research had no specific funding, and all authors declare no competing interests.Ethics Approval Statement: The study and the form of the survey were approved by Local Ethical Committee of Moscow Research Institute of Psychiatry, and written informed consent for participation was waived