Post-Pandemic Anxiety Among Nurses and Midwives: The Role of Intolerance of Uncertainty, Chronic Conditions, and Professional Experience

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Persistent exposure to uncertainty and individual health-related vulnerabilities may contribute to sustained anxiety beyond the acute crisis phase. Aim This study aimed to assess levels of state anxiety, trait anxiety, and intolerance of uncertainty among nurses and midwives in the post-pandemic period, and to examine whether intolerance of uncertainty, chronic health conditions, and professional experience are associated with elevated trait anxiety. Methods A cross-sectional analytical study was conducted among 1,201 nurses and midwives working in hospital and primary care settings. Data were collected using structured questionnaires, including measures based on the State–Trait Anxiety Inventory (STAI) and the 12-item Intolerance of Uncertainty Scale (IUS-12). Descriptive and inferential statistical analyses, including multiple linear regression, were performed using SPSS. Statistical significance was set at p < 0.05. Results Participants reported moderate levels of state anxiety (M = 2.15, SD = 0.90), trait anxiety (M = 2.40, SD = 0.86), and intolerance of uncertainty (M = 2.64, SD = 1.01). Higher intolerance of uncertainty and the presence of chronic health conditions were significantly associated with increased trait anxiety (p < 0.01), while lower professional experience also emerged as a contributing factor. Conclusion Nurses and midwives continue to experience moderate levels of anxiety and intolerance of uncertainty in the post-pandemic period, suggesting that psychological adaptation may involve stabilization rather than full recovery. The findings highlight the role of both individual vulnerability and professional context in shaping long-term emotional outcomes and underscore the need for sustained, targeted interventions to support healthcare workforce wellbeing. post-pandemic nurses midwives trait anxiety intolerance of uncertainty chronic conditions Figures Figure 1 Introduction The COVID-19 pandemic imposed unprecedented psychological demands on healthcare workers worldwide, particularly nurses and midwives who were continuously exposed to high workloads, uncertainty, and rapidly changing clinical environments ( 1 , 2 ). While healthcare systems have transitioned into a more stable post-pandemic phase, the longer-term psychological adaptation of frontline staff remains insufficiently understood ( 3 ). Emerging evidence suggests that the psychological impact of large-scale health crises extends beyond immediate stress reactions, contributing to more persistent patterns of emotional vulnerability ( 4 ). In this context, anxiety is increasingly conceptualized not only as a situational response but also as a more stable psychological tendency shaped by prolonged exposure to uncertainty and individual-level factors ( 5 ). A key construct in this regard is intolerance of uncertainty, defined as a dispositional tendency to perceive uncertain situations as stressful or threatening. This construct has been consistently associated with elevated anxiety across clinical and non-clinical populations ( 6 , 7 ). In healthcare environments characterized by unpredictability, evolving protocols, and systemic pressures, intolerance of uncertainty may remain a critical factor influencing mental health even after the acute crisis phase ( 8 , 15 ). In addition, individual health status may play an important role in psychological adaptation. Healthcare professionals with chronic conditions may perceive increased personal risk, contributing to sustained anxiety responses ( 9 , 20 ). Furthermore, professional experience may influence coping capacity, with less experienced staff potentially more vulnerable to prolonged stress ( 10 ). Despite extensive research on the immediate psychological impact of COVID-19, fewer studies have examined how these factors interact in the post-pandemic context ( 3 , 15 ). Understanding these relationships is essential for informing long-term mental health strategies in healthcare settings. Therefore, this study aimed to assess levels of state anxiety, trait anxiety, and intolerance of uncertainty among nurses and midwives in the post-pandemic period, and to examine whether intolerance of uncertainty, chronic health conditions, and professional experience predict elevated trait anxiety. Methods Study Design and Setting A cross-sectional analytical study was conducted among nurses and midwives employed in public healthcare institutions, including both hospital-based services and primary healthcare settings, during the post-pandemic period. Data collection took place at a time when healthcare systems had largely transitioned back to routine operational functioning following the acute phases of the COVID-19 pandemic. However, services continued to operate under conditions characterized by residual systemic uncertainty, evolving organizational demands, and ongoing structural pressures within the healthcare system. Participants and Sampling Eligible participants included registered nurses and midwives who were actively employed in clinical practice and had a minimum of six months of professional experience in their current role. This criterion was applied to ensure that participants had sufficient exposure to the healthcare environment during or following the pandemic period. Individuals who were on long-term medical leave, maternity leave, or not directly involved in patient care during the pandemic were excluded from the study to maintain consistency in exposure to the clinical context. Participants were recruited using a convenience sampling strategy across multiple healthcare institutions. Recruitment was facilitated through collaboration with institutional administrators and healthcare units. Participation was voluntary, and all respondents were informed about the purpose of the study prior to participation. Written informed consent was obtained from all participants before completing the survey. A total of 1,201 nurses and midwives were included in the final sample. Measures Sociodemographic and Professional Characteristics - Participants provided information on key sociodemographic and professional variables, including age, gender, marital status, years of professional experience, and workplace setting (hospital or primary care). Additionally, participants reported the presence of self-identified chronic health conditions. These variables were examined as potential predictors of anxiety outcomes. Trait Anxiety - Trait anxiety was assessed using the State–Trait Anxiety Inventory (STAI), a widely used and validated instrument for measuring anxiety ( 11 ). Responses were recorded using Likert-type scales, with higher scores indicating greater dispositional anxiety. State Anxiety - State anxiety was assessed using items derived from the State–Trait Anxiety Inventory (STAI), a validated instrument designed to measure transient emotional states ( 11 ). These items captured transient emotional experiences, including feelings of nervousness, worry, tension, calmness, and overall mood. Intolerance of Uncertainty - Intolerance of uncertainty was measured using the 12-item Intolerance of Uncertainty Scale (IUS-12), a validated instrument previously developed and widely used in psychological research ( 7 ). The scale captures both cognitive and behavioral responses to uncertainty. The questionnaire used in this study was adapted from a previously published study conducted among nurses and midwives during the COVID-19 outbreak (Aksoy & Koçak, 2020), with permission obtained from the original authors. The instrument included the State–Trait Anxiety Inventory (STAI) and the Intolerance of Uncertainty Scale (IUS-12), both of which are standardized and validated measures. Reliability and Validity Considerations - Both instruments have been previously published and validated in multiple populations. Previous studies have consistently demonstrated satisfactory reliability and validity of these measures across diverse populations, including healthcare professionals. For the purposes of this study, the instruments were carefully adapted into the Albanian language. Particular attention was given to preserving the original conceptual meaning of each item while ensuring cultural and linguistic appropriateness. This process aimed to maintain conceptual equivalence with the original versions. Given their extensive validation in prior research and their relevance to the constructs under investigation, these instruments were considered appropriate for assessing anxiety and intolerance of uncertainty in the present sample. Data Collection Procedure - Data were collected using structured, self-administered questionnaires distributed in clinical settings by trained research personnel. Participants completed the questionnaires independently to minimize response bias and ensure authenticity of responses. Completed questionnaires were returned in sealed envelopes, ensuring anonymity and confidentiality of the collected data. No identifying personal information was recorded. Statistical Analysis - Data were analyzed using the Statistical Package for the Social Sciences (SPSS). Descriptive statistics were calculated to summarize participant characteristics and levels of state anxiety, trait anxiety, and intolerance of uncertainty. Group comparisons were conducted using independent samples t-tests and one-way analysis of variance (ANOVA), as appropriate. Pearson correlation analysis was performed to examine associations between continuous variables. To identify predictors of trait anxiety, multiple linear regression analysis was conducted. Intolerance of uncertainty, presence of chronic health conditions, and professional experience were included as independent variables. Sociodemographic variables, including age and gender, were entered as control variables to account for potential confounding effects. Statistical significance was set at p < 0.05. Ethical Considerations - The study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki. Ethical approval was obtained from the relevant institutional ethics committee prior to data collection. Participation was voluntary, and all participants provided informed consent. Confidentiality and anonymity were strictly maintained throughout the study, and data were used solely for research purposes. Results Participant characteristics. A total of 1,201 nurses and midwives participated in the study, with a mean age of 39.5 ± 10.9 years. The majority of participants were female (85.2%) and worked primarily in urban healthcare settings (89.8%). Most respondents were nurses (80%), while midwives accounted for 19.8% of the sample. In terms of professional experience, 37.9% had between 6 and 15 years of work experience, and 26% had less than five years of experience. Additionally, 22.7% of participants reported the presence of at least one chronic health condition, including hypertension, thyroid disorders, or diabetes. State anxiety. Participants reported a combination of positive affect and worry-related indicators. Higher endorsements for positive mood and happiness were observed, with 63.9% reporting being in a good mood and 61.4% feeling happy at the time of assessment. Concurrently, 44.3% reported feeling worried and 42.7% expressed concern about future outcomes. Key state anxiety indicators are summarized in Table 5 , while detailed item responses are presented in Table 1 . Table 1 Distribution of Responses to State Anxiety Items Item Not at all n (%) Somewhat n (%) Moderately n (%) Very much n (%) I currently feel calm 363 (30.8) 478 (40.5) 195 (16.5) 143 (12.1) I feel secure 303 (26.0) 508 (43.6) 238 (20.4) 117 (10.0) I feel nervous 202 (17.3) 533 (45.6) 363 (31.1) 70 (6.0) I feel self-pity 478 (40.8) 383 (32.7) 236 (20.1) 76 (6.5) I feel at ease 389 (33.7) 371 (32.1) 232 (20.1) 163 (14.1) I am not enjoying things 437 (37.8) 350 (30.3) 178 (15.4) 192 (16.6) I worry about what will happen to me 218 (18.7) 451 (38.7) 318 (27.3) 179 (15.4) I feel rested 512 (43.8) 393 (33.6) 196 (16.8) 68 (5.8) I feel worried 202 (17.3) 447 (38.4) 361 (31.0) 155 (13.3) I feel comfortable 548 (47.2) 354 (30.5) 178 (15.3) 81 (7.0) I feel confident 131 (11.4) 378 (32.8) 376 (32.6) 268 (23.2) I am in a bad mood 246 (21.3) 533 (46.1) 279 (24.2) 97 (8.4) I feel angry 358 (31.2) 477 (41.6) 206 (17.9) 107 (9.3) I feel tense 310 (27.0) 469 (40.9) 278 (24.2) 90 (7.8) I feel relieved 499 (44.6) 348 (31.1) 179 (16.0) 92 (8.2) I am satisfied with my situation during COVID-19 681 (59.0) 247 (21.4) 143 (12.4) 84 (7.3) I feel worried now 496 (42.5) 466 (39.9) 148 (12.7) 58 (5.0) I feel emotionally overwhelmed 488 (42.7) 403 (35.3) 183 (16.0) 69 (6.0) I feel happy now 162 (13.9) 287 (24.7) 430 (37.0) 284 (24.4) I am in a good mood now 117 (9.9) 310 (26.2) 404 (34.2) 351 (29.7) Table 5 Key State Anxiety Indicators (Top Items by “Moderately/Very much”) State anxiety item Moderately n (%) Very much n (%) Moderately/Very much n (%) I feel confident 376 (32.6) 268 (23.2) 644 (55.8) I am in a good mood now 404 (34.2) 351 (29.7) 755 (63.9) I feel happy now 430 (37.0) 284 (24.4) 714 (61.4) I worry about what will happen to me 318 (27.3) 179 (15.4) 497 (42.7) I feel worried 361 (31.0) 155 (13.3) 516 (44.3) I feel nervous 363 (31.1) 70 (6.0) 433 (37.1) I feel tense 278 (24.2) 90 (7.8) 368 (32.0) I am not enjoying things 178 (15.4) 192 (16.6) 370 (32.0) Trait anxiety. A substantial proportion of participants reported recurrent worry and emotional sensitivity. For example, 66.7% indicated that they worry about minor matters, and 72.2% reported taking disappointments seriously. Additionally, 66.8% reported frequent sadness. Key trait anxiety indicators are summarized in Table 6 , with full distributions provided in Table 2 . Table 2 Distribution of Responses to Trait Anxiety Items Item Almost never n (%) Sometimes n (%) Often n (%) Almost always n (%) I am usually in a good mood 137 (11.6) 669 (56.8) 295 (25.0) 77 (6.5) I usually get tired easily 269 (23.0) 562 (48.1) 250 (21.4) 87 (7.4) I cry easily 55 (4.8) 238 (21.0) 357 (31.4) 484 (42.6) I want to be as happy as others 236 (20.3) 604 (52.1) 234 (20.2) 86 (7.4) I miss opportunities because I cannot decide quickly 164 (14.3) 543 (47.3) 352 (30.7) 89 (7.8) I feel fatigued 72 (6.1) 367 (31.3) 464 (39.6) 268 (22.9) I am usually calm and composed 265 (22.7) 623 (53.5) 229 (19.7) 48 (4.1) Difficulties accumulate beyond my control 293 (25.0) 530 (45.2) 286 (24.4) 63 (5.4) I worry about minor matters 55 (4.8) 323 (28.5) 510 (44.9) 247 (21.8) I am usually happy 154 (13.4) 514 (44.7) 335 (29.1) 147 (12.8) I take everything seriously and worry 325 (27.8) 575 (49.1) 196 (16.8) 74 (6.3) I usually feel insecure 99 (8.5) 367 (31.4) 508 (43.5) 194 (16.6) I usually feel secure 264 (22.6) 440 (37.7) 316 (27.1) 144 (12.3) I avoid confronting difficult situations 335 (28.8) 582 (50.0) 182 (15.6) 65 (5.6) I usually feel sad 78 (6.7) 307 (26.5) 462 (39.9) 312 (26.9) I am generally satisfied with my life 341 (29.5) 476 (41.2) 232 (20.1) 105 (9.1) Minor thoughts bother me 380 (32.6) 438 (37.5) 227 (19.5) 122 (10.5) I take disappointments seriously 98 (8.4) 228 (19.5) 437 (37.4) 407 (34.8) I am a determined person 340 (29.1) 488 (41.7) 234 (20.0) 107 (9.2) Table 6 Key Trait Anxiety Indicators (Top Items by “Often/Almost always”) Trait anxiety item Often n (%) Almost always n (%) Often/Almost always n (%) I cry easily 357 (31.4) 484 (42.6) 841 (74.0) I take disappointments seriously 437 (37.4) 407 (34.8) 844 (72.2) I usually feel sad 462 (39.9) 312 (26.9) 774 (66.8) I worry about minor matters 510 (44.9) 247 (21.8) 757 (66.7) I usually feel insecure 508 (43.5) 194 (16.6) 702 (60.1) I feel fatigued 464 (39.6) 268 (22.9) 732 (62.5) I miss opportunities because I cannot decide quickly 352 (30.7) 89 (7.8) 441 (38.5) Intolerance of uncertainty. Participants reported moderate levels of intolerance of uncertainty. The highest mean score was observed for the item reflecting the need to organize situations in detail in advance (M = 3.22, SD = 1.25), followed by the need to anticipate future events (M = 2.91, SD = 1.33). Lower mean scores were observed for items reflecting direct functional impairment, such as difficulty acting under uncertainty (M = 2.26, SD = 1.24) and perceived restriction in daily functioning (M = 2.36, SD = 1.27). Standard deviations ranging from 1.20 to 1.35 indicated variability in responses across participants. Mean responses for the Intolerance of Uncertainty Scale (IUS-12) are presented in Table 3 . Table 3 Mean Scores for Intolerance of Uncertainty Items Item Mean (M) Standard Deviation (SD) Unexpected events upset me greatly 2.59 1.20 I get frustrated if I do not have all the information I need 2.75 1.20 I always need to look ahead to avoid surprises 2.98 1.23 Even small unexpected events can disrupt everything 2.50 1.22 I want to know what the future holds for me 2.91 1.33 I cannot tolerate being caught off guard 2.66 1.28 I need to organize everything in detail in advance 3.22 1.25 Uncertainty prevents me from living life fully 2.36 1.27 Uncertainty makes it difficult to act 2.26 1.24 I cannot function well when things are uncertain 2.58 1.29 Even small doubts interfere with my actions 2.26 1.31 I avoid uncertain situations 2.64 1.35 Overall pattern. State anxiety demonstrated a moderate level (M = 2.15, SD = 0.90), while trait anxiety showed a slightly higher mean score (M = 2.40, SD = 0.86). Intolerance of uncertainty also remained within the moderate range (M = 2.64, SD = 1.01). Mean scores across constructs are summarized in Table 4 and illustrated in Fig. 1 . Table 4 Summary of Mean Scores Across Study Constructs Construct Mean (M) Standard Deviation (SD) State anxiety 2.15 0.90 Trait anxiety 2.40 0.86 Intolerance of uncertainty (IUS-12) 2.64 1.01 Discussion This study examined levels of state anxiety, trait anxiety, and intolerance of uncertainty among nurses and midwives in the post-pandemic period. The findings revealed moderate levels across all three constructs, suggesting that psychological burden persists even after the stabilization of healthcare systems. These findings are consistent with previous research examining long-term mental health outcomes among healthcare workers following major health crises ( 12 ). These results indicate that the impact of the COVID-19 pandemic on healthcare professionals extends beyond the acute crisis phase and continues to influence emotional wellbeing. A key finding of this study is the distinction between state anxiety and trait anxiety. While state anxiety remained at moderate levels, trait anxiety was slightly higher, reflecting a more stable and enduring tendency toward emotional distress. This pattern supports existing literature suggesting that prolonged exposure to large-scale health crises may lead to longer-term changes in emotional regulation and psychological functioning ( 4 , 8 ). Rather than representing a temporary response, anxiety in this context appears to reflect a more persistent dispositional pattern. The observed moderate levels of intolerance of uncertainty further reinforce this interpretation. Participants demonstrated an increased need for predictability, structure, and anticipatory control, without exhibiting severe functional impairment. Previous research has consistently identified intolerance of uncertainty as a central factor associated with anxiety across both clinical and occupational contexts ( 5 , 7 ). In healthcare environments characterized by ongoing uncertainty, evolving protocols, and systemic pressures, this tendency may contribute to the maintenance of emotional distress even after the acute phase of the pandemic has passed ( 8 ). Recent studies have further confirmed the role of intolerance of uncertainty and resilience mechanisms in shaping post-pandemic mental health outcomes among healthcare professionals ( 17 , 18 ). Importantly, the study identified significant associations between trait anxiety, chronic health conditions, and professional experience. Participants with chronic conditions reported higher levels of anxiety, which may reflect increased perceived vulnerability and heightened health-related concerns. Similarly, lower professional experience was associated with higher anxiety levels, suggesting that less experienced healthcare professionals may have fewer coping resources or reduced resilience when facing prolonged uncertainty. These findings are consistent with previous studies highlighting the role of individual health status and professional experience in shaping psychological responses in high-demand healthcare environments ( 9 , 10 ). When compared with studies conducted during the acute phases of the COVID-19 pandemic, which reported elevated levels of state anxiety and acute psychological distress ( 1 , 2 ), the present findings suggest a shift toward more stable and enduring patterns of anxiety in the post-pandemic context. This transition indicates that psychological responses may evolve over time, moving from acute stress reactions to more persistent emotional tendencies influenced by both individual and contextual factors. Systematic reviews continue to highlight the persistent psychological burden among healthcare workers beyond the acute phase of the pandemic ( 13 , 14 ). From a professional and organizational perspective, these findings highlight the importance of conceptualizing psychological adaptation as a long-term process rather than a simple return to pre-crisis baseline functioning. Even in the absence of emergency conditions, underlying emotional vulnerability may persist and continue to affect performance, decision-making, and overall wellbeing among healthcare staff. Overall, this study contributes to the existing literature by focusing on the post-pandemic period and by examining the combined role of intolerance of uncertainty and individual vulnerability factors in shaping sustained anxiety among healthcare professionals. It provides further evidence that the psychological consequences of global health crises may extend well beyond their immediate impact. Strengths and Limitations This study benefits from a large and diverse sample of nurses and midwives across multiple healthcare settings, enhancing the robustness and ecological validity of the findings. The inclusion of both hospital and primary care professionals allows for a broader understanding of psychological responses across different clinical environments. However, several limitations should be acknowledged. The cross-sectional design limits the ability to draw causal inferences regarding the relationships between variables. The use of a convenience sampling strategy may introduce selection bias and limit generalizability. Additionally, reliance on self-reported measures may be subject to response bias, including social desirability and recall bias. Finally, cultural and organizational factors specific to the study context may influence perceptions of uncertainty and anxiety, and should be considered when interpreting the findings. Implications for Practice The findings of this study suggest that psychological support strategies in the post-pandemic period should extend beyond addressing acute stress and instead focus on long-term adaptation processes. Interventions aimed at improving tolerance of uncertainty, strengthening coping mechanisms, and enhancing resilience may be particularly beneficial. Special attention should be directed toward early-career healthcare professionals and those with chronic health conditions, as these groups appear to be more vulnerable to sustained anxiety. Organizational policies that promote supportive work environments, ongoing mental health monitoring, and targeted interventions may play a critical role in maintaining workforce wellbeing in the post-pandemic era. Conclusion The findings of this study indicate that nurses and midwives in the post-pandemic period continue to experience moderate levels of anxiety and intolerance of uncertainty, suggesting that psychological adaptation following prolonged systemic stress may involve stabilization rather than full recovery. Importantly, anxiety in this context appears to reflect a more enduring dispositional tendency rather than a transient situational response. The observed associations between intolerance of uncertainty, chronic health conditions, and professional experience highlight the combined role of individual vulnerability and professional context in shaping long-term emotional outcomes. These results emphasize that the psychological impact of large-scale health crises may extend beyond the acute phase and become embedded in everyday professional functioning. Future research should adopt longitudinal approaches to better understand the evolution of anxiety over time and to identify mechanisms that support long-term psychological adaptation in healthcare settings. Declarations CONFLICT OF INTEREST The authors declare that they have no conflict of interest related to this study. CONSENT FOR PUBLICATION Not applicable. ETHICS APPROVAL STATEMENT The study received ethical approval from the Ethics Council of the University of Medicine, Tirana, Albania (Protocol No. 825/2, Decision No. 10, March 18, 2024), and authorizations from 17 university, regional, and municipal hospitals across Albania. All participants provided informed consent, and confidentiality and anonymity were strictly maintained. FUNDING This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Author Contribution A.C. conceptualized and designed the study, drafted the initial manuscript, and coordinated the overall project. E.R. supervised the study, contributed to questionnaire development, data management, and manuscript revision. A.S. provided statistical support, contributed to data interpretation, and critically revised the manuscript. A.B. contributed to manuscript writing, performed the statistical analysis, and interpreted the results. F.Z. contributed to data collection, conducted the literature review, and revised the manuscript. All authors read and approved the final manuscript. ACKNOWLEDGEMENTS The authors would like to thank all nurses and midwives who participated in this study for their time and for sharing their experiences during the post-pandemic period. 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Arch Psychiatr Nurs. 2020;34(5):427–33. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 17 May, 2026 Reviewers agreed at journal 07 May, 2026 Reviewers agreed at journal 07 May, 2026 Reviewers invited by journal 28 Apr, 2026 Editor assigned by journal 27 Apr, 2026 Editor invited by journal 24 Apr, 2026 Submission checks completed at journal 22 Apr, 2026 First submitted to journal 22 Apr, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9394982","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":635000962,"identity":"21bbfe8d-35c5-402b-b1b2-87db440bd537","order_by":0,"name":"Anila Cake","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+klEQVRIiWNgGAWjYFACxsYDIEqCgRlEMwNxAhAX4NXSANXCloCkxQC/PVAtPAbEaeGf3dxw4AeDnbxke883qRsV1gz87DkGDD/waJG4c7DhYA9DsuFsnrPbpHPOpDNI9rwxYOzB57AbiQ0HeBgOMM6TyN0mndt2mMHgBtAWHjxa5IFaDv5hOGA/T/7NM+ncf4cZ7IFaGP/g0WIA1HIYaEvibAkeNuncBqAtEjkGzPhsMQRpkTFITp7Zk2ZsnXMsnUfizLMCoAhuLXI30h8+fFNhZzvj+OGHt3NqrOX425M3AkXweB/iPASTB0QcIKRhFIyCUTAKRgF+AACUr1EbtYUSuwAAAABJRU5ErkJggg==","orcid":"","institution":"Faculty of Technical Medical Sciences","correspondingAuthor":true,"prefix":"","firstName":"Anila","middleName":"","lastName":"Cake","suffix":""},{"id":635000963,"identity":"ed1a5c6f-64f8-4d8a-91b9-bac3dbb6f603","order_by":1,"name":"Ergys Ramosacaj","email":"","orcid":"","institution":"Faculty of Technical Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Ergys","middleName":"","lastName":"Ramosacaj","suffix":""},{"id":635000964,"identity":"99874e4b-108c-4951-89a9-d14503bdb5da","order_by":2,"name":"Artan Simaku","email":"","orcid":"","institution":"Faculty of Technical Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Artan","middleName":"","lastName":"Simaku","suffix":""},{"id":635000965,"identity":"041c6f8d-4d95-46e4-ada9-e6f88c30350d","order_by":3,"name":"Agron Bytyqi","email":"","orcid":"","institution":"Faculty of Technical Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Agron","middleName":"","lastName":"Bytyqi","suffix":""},{"id":635000966,"identity":"0f272b23-078d-44a2-aa0d-d24fb832fd8e","order_by":4,"name":"Flora Zyberaj","email":"","orcid":"","institution":"Faculty of Technical Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Flora","middleName":"","lastName":"Zyberaj","suffix":""}],"badges":[],"createdAt":"2026-04-12 14:38:10","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9394982/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9394982/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":108950629,"identity":"e695f9e3-3b27-4bd6-9fe5-c7fd14faec69","added_by":"auto","created_at":"2026-05-11 07:06:48","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":61553,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003e\u003cstrong\u003eMean scores and standard deviations for state anxiety, trait anxiety, and intolerance of uncertainty\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-9394982/v1/e07a68ae9cf6db3c03aa7224.png"},{"id":108978274,"identity":"781fbdb3-4f49-4d21-8154-9bc0e54ee2c6","added_by":"auto","created_at":"2026-05-11 11:35:40","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":447262,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9394982/v1/19aab0f2-68d1-498c-a061-11d8b98d2c69.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Post-Pandemic Anxiety Among Nurses and Midwives: The Role of Intolerance of Uncertainty, Chronic Conditions, and Professional Experience","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe COVID-19 pandemic imposed unprecedented psychological demands on healthcare workers worldwide, particularly nurses and midwives who were continuously exposed to high workloads, uncertainty, and rapidly changing clinical environments (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). While healthcare systems have transitioned into a more stable post-pandemic phase, the longer-term psychological adaptation of frontline staff remains insufficiently understood (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eEmerging evidence suggests that the psychological impact of large-scale health crises extends beyond immediate stress reactions, contributing to more persistent patterns of emotional vulnerability (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). In this context, anxiety is increasingly conceptualized not only as a situational response but also as a more stable psychological tendency shaped by prolonged exposure to uncertainty and individual-level factors (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eA key construct in this regard is intolerance of uncertainty, defined as a dispositional tendency to perceive uncertain situations as stressful or threatening. This construct has been consistently associated with elevated anxiety across clinical and non-clinical populations (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). In healthcare environments characterized by unpredictability, evolving protocols, and systemic pressures, intolerance of uncertainty may remain a critical factor influencing mental health even after the acute crisis phase (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn addition, individual health status may play an important role in psychological adaptation. Healthcare professionals with chronic conditions may perceive increased personal risk, contributing to sustained anxiety responses (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). Furthermore, professional experience may influence coping capacity, with less experienced staff potentially more vulnerable to prolonged stress (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eDespite extensive research on the immediate psychological impact of COVID-19, fewer studies have examined how these factors interact in the post-pandemic context (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Understanding these relationships is essential for informing long-term mental health strategies in healthcare settings.\u003c/p\u003e \u003cp\u003eTherefore, this study aimed to assess levels of state anxiety, trait anxiety, and intolerance of uncertainty among nurses and midwives in the post-pandemic period, and to examine whether intolerance of uncertainty, chronic health conditions, and professional experience predict elevated trait anxiety.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design and Setting\u003c/h2\u003e \u003cp\u003eA cross-sectional analytical study was conducted among nurses and midwives employed in public healthcare institutions, including both hospital-based services and primary healthcare settings, during the post-pandemic period. Data collection took place at a time when healthcare systems had largely transitioned back to routine operational functioning following the acute phases of the COVID-19 pandemic. However, services continued to operate under conditions characterized by residual systemic uncertainty, evolving organizational demands, and ongoing structural pressures within the healthcare system.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eParticipants and Sampling\u003c/h3\u003e\n\u003cp\u003eEligible participants included registered nurses and midwives who were actively employed in clinical practice and had a minimum of six months of professional experience in their current role. This criterion was applied to ensure that participants had sufficient exposure to the healthcare environment during or following the pandemic period.\u003c/p\u003e \u003cp\u003eIndividuals who were on long-term medical leave, maternity leave, or not directly involved in patient care during the pandemic were excluded from the study to maintain consistency in exposure to the clinical context.\u003c/p\u003e \u003cp\u003eParticipants were recruited using a convenience sampling strategy across multiple healthcare institutions. Recruitment was facilitated through collaboration with institutional administrators and healthcare units. Participation was voluntary, and all respondents were informed about the purpose of the study prior to participation. Written informed consent was obtained from all participants before completing the survey.\u003c/p\u003e \u003cp\u003eA total of 1,201 nurses and midwives were included in the final sample.\u003c/p\u003e\n\u003ch3\u003eMeasures\u003c/h3\u003e\n\u003cp\u003e \u003cb\u003eSociodemographic and Professional Characteristics -\u003c/b\u003e Participants provided information on key sociodemographic and professional variables, including age, gender, marital status, years of professional experience, and workplace setting (hospital or primary care). Additionally, participants reported the presence of self-identified chronic health conditions. These variables were examined as potential predictors of anxiety outcomes.\u003c/p\u003e \u003cp\u003e \u003cb\u003eTrait Anxiety -\u003c/b\u003e Trait anxiety was assessed using the State\u0026ndash;Trait Anxiety Inventory (STAI), a widely used and validated instrument for measuring anxiety (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Responses were recorded using Likert-type scales, with higher scores indicating greater dispositional anxiety.\u003c/p\u003e \u003cp\u003e \u003cb\u003eState Anxiety -\u003c/b\u003e State anxiety was assessed using items derived from the State\u0026ndash;Trait Anxiety Inventory (STAI), a validated instrument designed to measure transient emotional states (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). These items captured transient emotional experiences, including feelings of nervousness, worry, tension, calmness, and overall mood.\u003c/p\u003e \u003cp\u003e \u003cb\u003eIntolerance of Uncertainty -\u003c/b\u003e Intolerance of uncertainty was measured using the 12-item Intolerance of Uncertainty Scale (IUS-12), a validated instrument previously developed and widely used in psychological research (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). The scale captures both cognitive and behavioral responses to uncertainty.\u003c/p\u003e \u003cp\u003eThe questionnaire used in this study was adapted from a previously published study conducted among nurses and midwives during the COVID-19 outbreak (Aksoy \u0026amp; Ko\u0026ccedil;ak, 2020), with permission obtained from the original authors. The instrument included the State\u0026ndash;Trait Anxiety Inventory (STAI) and the Intolerance of Uncertainty Scale (IUS-12), both of which are standardized and validated measures.\u003c/p\u003e \u003cp\u003e \u003cb\u003eReliability and Validity Considerations -\u003c/b\u003e Both instruments have been previously published and validated in multiple populations. Previous studies have consistently demonstrated satisfactory reliability and validity of these measures across diverse populations, including healthcare professionals.\u003c/p\u003e \u003cp\u003eFor the purposes of this study, the instruments were carefully adapted into the Albanian language. Particular attention was given to preserving the original conceptual meaning of each item while ensuring cultural and linguistic appropriateness. This process aimed to maintain conceptual equivalence with the original versions.\u003c/p\u003e \u003cp\u003eGiven their extensive validation in prior research and their relevance to the constructs under investigation, these instruments were considered appropriate for assessing anxiety and intolerance of uncertainty in the present sample.\u003c/p\u003e \u003cp\u003e \u003cb\u003eData Collection Procedure -\u003c/b\u003e Data were collected using structured, self-administered questionnaires distributed in clinical settings by trained research personnel. Participants completed the questionnaires independently to minimize response bias and ensure authenticity of responses. Completed questionnaires were returned in sealed envelopes, ensuring anonymity and confidentiality of the collected data. No identifying personal information was recorded.\u003c/p\u003e \u003cp\u003e \u003cb\u003eStatistical Analysis -\u003c/b\u003e Data were analyzed using the Statistical Package for the Social Sciences (SPSS). Descriptive statistics were calculated to summarize participant characteristics and levels of state anxiety, trait anxiety, and intolerance of uncertainty.\u003c/p\u003e \u003cp\u003eGroup comparisons were conducted using independent samples t-tests and one-way analysis of variance (ANOVA), as appropriate. Pearson correlation analysis was performed to examine associations between continuous variables. To identify predictors of trait anxiety, multiple linear regression analysis was conducted. Intolerance of uncertainty, presence of chronic health conditions, and professional experience were included as independent variables. Sociodemographic variables, including age and gender, were entered as control variables to account for potential confounding effects.\u003c/p\u003e \u003cp\u003eStatistical significance was set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003cp\u003e\u003cb\u003eEthical Considerations -\u003c/b\u003e The study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki. Ethical approval was obtained from the relevant institutional ethics committee prior to data collection.\u003c/p\u003e \u003cp\u003e Participation was voluntary, and all participants provided informed consent. Confidentiality and anonymity were strictly maintained throughout the study, and data were used solely for research purposes.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e \u003cb\u003eParticipant characteristics.\u003c/b\u003e A total of 1,201 nurses and midwives participated in the study, with a mean age of 39.5\u0026thinsp;\u0026plusmn;\u0026thinsp;10.9 years. The majority of participants were female (85.2%) and worked primarily in urban healthcare settings (89.8%). Most respondents were nurses (80%), while midwives accounted for 19.8% of the sample. In terms of professional experience, 37.9% had between 6 and 15 years of work experience, and 26% had less than five years of experience. Additionally, 22.7% of participants reported the presence of at least one chronic health condition, including hypertension, thyroid disorders, or diabetes.\u003c/p\u003e \u003cp\u003e \u003cb\u003eState anxiety.\u003c/b\u003e Participants reported a combination of positive affect and worry-related indicators. Higher endorsements for positive mood and happiness were observed, with 63.9% reporting being in a good mood and 61.4% feeling happy at the time of assessment. Concurrently, 44.3% reported feeling worried and 42.7% expressed concern about future outcomes. Key state anxiety indicators are summarized in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e5\u003c/span\u003e, while detailed item responses are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDistribution of Responses to State Anxiety Items\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNot at all n (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSomewhat n (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eModerately n (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eVery much n (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI currently feel calm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e363 (30.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e478 (40.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e195 (16.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e143 (12.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI feel secure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e303 (26.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e508 (43.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e238 (20.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e117 (10.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI feel nervous\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e202 (17.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e533 (45.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e363 (31.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e70 (6.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI feel self-pity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e478 (40.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e383 (32.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e236 (20.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e76 (6.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI feel at ease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e389 (33.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e371 (32.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e232 (20.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e163 (14.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI am not enjoying things\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e437 (37.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e350 (30.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e178 (15.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e192 (16.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI worry about what will happen to me\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e218 (18.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e451 (38.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e318 (27.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e179 (15.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI feel rested\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e512 (43.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e393 (33.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e196 (16.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e68 (5.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI feel worried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e202 (17.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e447 (38.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e361 (31.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e155 (13.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI feel comfortable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e548 (47.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e354 (30.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e178 (15.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e81 (7.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI feel confident\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e131 (11.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e378 (32.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e376 (32.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e268 (23.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI am in a bad mood\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e246 (21.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e533 (46.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e279 (24.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e97 (8.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI feel angry\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e358 (31.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e477 (41.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e206 (17.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e107 (9.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI feel tense\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e310 (27.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e469 (40.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e278 (24.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e90 (7.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI feel relieved\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e499 (44.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e348 (31.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e179 (16.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e92 (8.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI am satisfied with my situation during COVID-19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e681 (59.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e247 (21.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e143 (12.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e84 (7.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI feel worried now\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e496 (42.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e466 (39.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e148 (12.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e58 (5.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI feel emotionally overwhelmed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e488 (42.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e403 (35.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e183 (16.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e69 (6.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI feel happy now\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e162 (13.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e287 (24.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e430 (37.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e284 (24.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI am in a good mood now\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e117 (9.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e310 (26.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e404 (34.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e351 (29.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eKey State Anxiety Indicators (Top Items by \u0026ldquo;Moderately/Very much\u0026rdquo;)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eState anxiety item\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eModerately n (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eVery much n (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eModerately/Very much n (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI feel confident\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e376 (32.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e268 (23.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e644 (55.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI am in a good mood now\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e404 (34.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e351 (29.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e755 (63.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI feel happy now\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e430 (37.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e284 (24.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e714 (61.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI worry about what will happen to me\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e318 (27.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e179 (15.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e497 (42.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI feel worried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e361 (31.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e155 (13.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e516 (44.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI feel nervous\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e363 (31.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e70 (6.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e433 (37.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI feel tense\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e278 (24.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e90 (7.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e368 (32.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI am not enjoying things\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e178 (15.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e192 (16.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e370 (32.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eTrait anxiety.\u003c/b\u003e A substantial proportion of participants reported recurrent worry and emotional sensitivity. For example, 66.7% indicated that they worry about minor matters, and 72.2% reported taking disappointments seriously. Additionally, 66.8% reported frequent sadness. Key trait anxiety indicators are summarized in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e6\u003c/span\u003e, with full distributions provided in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDistribution of Responses to Trait Anxiety Items\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAlmost never n (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSometimes n (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOften n (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAlmost always n (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI am usually in a good mood\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e137 (11.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e669 (56.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e295 (25.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e77 (6.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI usually get tired easily\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e269 (23.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e562 (48.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e250 (21.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e87 (7.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI cry easily\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e55 (4.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e238 (21.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e357 (31.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e484 (42.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI want to be as happy as others\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e236 (20.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e604 (52.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e234 (20.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e86 (7.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI miss opportunities because I cannot decide quickly\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e164 (14.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e543 (47.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e352 (30.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e89 (7.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI feel fatigued\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e72 (6.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e367 (31.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e464 (39.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e268 (22.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI am usually calm and composed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e265 (22.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e623 (53.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e229 (19.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e48 (4.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDifficulties accumulate beyond my control\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e293 (25.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e530 (45.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e286 (24.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e63 (5.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI worry about minor matters\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e55 (4.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e323 (28.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e510 (44.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e247 (21.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI am usually happy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e154 (13.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e514 (44.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e335 (29.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e147 (12.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI take everything seriously and worry\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e325 (27.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e575 (49.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e196 (16.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e74 (6.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI usually feel insecure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e99 (8.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e367 (31.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e508 (43.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e194 (16.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI usually feel secure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e264 (22.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e440 (37.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e316 (27.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e144 (12.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI avoid confronting difficult situations\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e335 (28.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e582 (50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e182 (15.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e65 (5.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI usually feel sad\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e78 (6.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e307 (26.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e462 (39.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e312 (26.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI am generally satisfied with my life\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e341 (29.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e476 (41.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e232 (20.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e105 (9.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMinor thoughts bother me\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e380 (32.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e438 (37.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e227 (19.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e122 (10.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI take disappointments seriously\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e98 (8.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e228 (19.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e437 (37.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e407 (34.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI am a determined person\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e340 (29.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e488 (41.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e234 (20.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e107 (9.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eKey Trait Anxiety Indicators (Top Items by \u0026ldquo;Often/Almost always\u0026rdquo;)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTrait anxiety item\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOften n (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAlmost always n (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOften/Almost always n (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI cry easily\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e357 (31.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e484 (42.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e841 (74.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI take disappointments seriously\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e437 (37.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e407 (34.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e844 (72.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI usually feel sad\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e462 (39.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e312 (26.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e774 (66.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI worry about minor matters\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e510 (44.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e247 (21.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e757 (66.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI usually feel insecure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e508 (43.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e194 (16.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e702 (60.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI feel fatigued\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e464 (39.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e268 (22.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e732 (62.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI miss opportunities because I cannot decide quickly\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e352 (30.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e89 (7.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e441 (38.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eIntolerance of uncertainty.\u003c/b\u003e Participants reported moderate levels of intolerance of uncertainty. The highest mean score was observed for the item reflecting the need to organize situations in detail in advance (M\u0026thinsp;=\u0026thinsp;3.22, SD\u0026thinsp;=\u0026thinsp;1.25), followed by the need to anticipate future events (M\u0026thinsp;=\u0026thinsp;2.91, SD\u0026thinsp;=\u0026thinsp;1.33).\u003c/p\u003e \u003cp\u003eLower mean scores were observed for items reflecting direct functional impairment, such as difficulty acting under uncertainty (M\u0026thinsp;=\u0026thinsp;2.26, SD\u0026thinsp;=\u0026thinsp;1.24) and perceived restriction in daily functioning (M\u0026thinsp;=\u0026thinsp;2.36, SD\u0026thinsp;=\u0026thinsp;1.27).\u003c/p\u003e \u003cp\u003eStandard deviations ranging from 1.20 to 1.35 indicated variability in responses across participants.\u003c/p\u003e \u003cp\u003eMean responses for the Intolerance of Uncertainty Scale (IUS-12) are presented in Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMean Scores for Intolerance of Uncertainty Items\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean (M)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eStandard Deviation (SD)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnexpected events upset me greatly\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI get frustrated if I do not have all the information I need\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI always need to look ahead to avoid surprises\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.23\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEven small unexpected events can disrupt everything\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.22\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI want to know what the future holds for me\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.33\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI cannot tolerate being caught off guard\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.28\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI need to organize everything in detail in advance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.25\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUncertainty prevents me from living life fully\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.27\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUncertainty makes it difficult to act\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.24\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI cannot function well when things are uncertain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.29\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEven small doubts interfere with my actions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.31\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI avoid uncertain situations\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.35\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eOverall pattern.\u003c/b\u003e State anxiety demonstrated a moderate level (M\u0026thinsp;=\u0026thinsp;2.15, SD\u0026thinsp;=\u0026thinsp;0.90), while trait anxiety showed a slightly higher mean score (M\u0026thinsp;=\u0026thinsp;2.40, SD\u0026thinsp;=\u0026thinsp;0.86). Intolerance of uncertainty also remained within the moderate range (M\u0026thinsp;=\u0026thinsp;2.64, SD\u0026thinsp;=\u0026thinsp;1.01). Mean scores across constructs are summarized in Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e4\u003c/span\u003e and illustrated in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSummary of Mean Scores Across Study Constructs\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConstruct\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean (M)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eStandard Deviation (SD)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eState anxiety\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.90\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTrait anxiety\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.86\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntolerance of uncertainty (IUS-12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study examined levels of state anxiety, trait anxiety, and intolerance of uncertainty among nurses and midwives in the post-pandemic period. The findings revealed moderate levels across all three constructs, suggesting that psychological burden persists even after the stabilization of healthcare systems. These findings are consistent with previous research examining long-term mental health outcomes among healthcare workers following major health crises (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). These results indicate that the impact of the COVID-19 pandemic on healthcare professionals extends beyond the acute crisis phase and continues to influence emotional wellbeing.\u003c/p\u003e \u003cp\u003eA key finding of this study is the distinction between state anxiety and trait anxiety. While state anxiety remained at moderate levels, trait anxiety was slightly higher, reflecting a more stable and enduring tendency toward emotional distress. This pattern supports existing literature suggesting that prolonged exposure to large-scale health crises may lead to longer-term changes in emotional regulation and psychological functioning (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Rather than representing a temporary response, anxiety in this context appears to reflect a more persistent dispositional pattern.\u003c/p\u003e \u003cp\u003eThe observed moderate levels of intolerance of uncertainty further reinforce this interpretation. Participants demonstrated an increased need for predictability, structure, and anticipatory control, without exhibiting severe functional impairment. Previous research has consistently identified intolerance of uncertainty as a central factor associated with anxiety across both clinical and occupational contexts (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). In healthcare environments characterized by ongoing uncertainty, evolving protocols, and systemic pressures, this tendency may contribute to the maintenance of emotional distress even after the acute phase of the pandemic has passed (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Recent studies have further confirmed the role of intolerance of uncertainty and resilience mechanisms in shaping post-pandemic mental health outcomes among healthcare professionals (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eImportantly, the study identified significant associations between trait anxiety, chronic health conditions, and professional experience. Participants with chronic conditions reported higher levels of anxiety, which may reflect increased perceived vulnerability and heightened health-related concerns. Similarly, lower professional experience was associated with higher anxiety levels, suggesting that less experienced healthcare professionals may have fewer coping resources or reduced resilience when facing prolonged uncertainty. These findings are consistent with previous studies highlighting the role of individual health status and professional experience in shaping psychological responses in high-demand healthcare environments (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eWhen compared with studies conducted during the acute phases of the COVID-19 pandemic, which reported elevated levels of state anxiety and acute psychological distress (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e), the present findings suggest a shift toward more stable and enduring patterns of anxiety in the post-pandemic context. This transition indicates that psychological responses may evolve over time, moving from acute stress reactions to more persistent emotional tendencies influenced by both individual and contextual factors. Systematic reviews continue to highlight the persistent psychological burden among healthcare workers beyond the acute phase of the pandemic (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eFrom a professional and organizational perspective, these findings highlight the importance of conceptualizing psychological adaptation as a long-term process rather than a simple return to pre-crisis baseline functioning. Even in the absence of emergency conditions, underlying emotional vulnerability may persist and continue to affect performance, decision-making, and overall wellbeing among healthcare staff.\u003c/p\u003e \u003cp\u003eOverall, this study contributes to the existing literature by focusing on the post-pandemic period and by examining the combined role of intolerance of uncertainty and individual vulnerability factors in shaping sustained anxiety among healthcare professionals. It provides further evidence that the psychological consequences of global health crises may extend well beyond their immediate impact.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eStrengths and Limitations\u003c/h2\u003e \u003cp\u003eThis study benefits from a large and diverse sample of nurses and midwives across multiple healthcare settings, enhancing the robustness and ecological validity of the findings. The inclusion of both hospital and primary care professionals allows for a broader understanding of psychological responses across different clinical environments.\u003c/p\u003e \u003cp\u003eHowever, several limitations should be acknowledged. The cross-sectional design limits the ability to draw causal inferences regarding the relationships between variables. The use of a convenience sampling strategy may introduce selection bias and limit generalizability. Additionally, reliance on self-reported measures may be subject to response bias, including social desirability and recall bias. Finally, cultural and organizational factors specific to the study context may influence perceptions of uncertainty and anxiety, and should be considered when interpreting the findings.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eImplications for Practice\u003c/h3\u003e\n\u003cp\u003eThe findings of this study suggest that psychological support strategies in the post-pandemic period should extend beyond addressing acute stress and instead focus on long-term adaptation processes. Interventions aimed at improving tolerance of uncertainty, strengthening coping mechanisms, and enhancing resilience may be particularly beneficial.\u003c/p\u003e \u003cp\u003eSpecial attention should be directed toward early-career healthcare professionals and those with chronic health conditions, as these groups appear to be more vulnerable to sustained anxiety. Organizational policies that promote supportive work environments, ongoing mental health monitoring, and targeted interventions may play a critical role in maintaining workforce wellbeing in the post-pandemic era.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe findings of this study indicate that nurses and midwives in the post-pandemic period continue to experience moderate levels of anxiety and intolerance of uncertainty, suggesting that psychological adaptation following prolonged systemic stress may involve stabilization rather than full recovery.\u003c/p\u003e \u003cp\u003eImportantly, anxiety in this context appears to reflect a more enduring dispositional tendency rather than a transient situational response. The observed associations between intolerance of uncertainty, chronic health conditions, and professional experience highlight the combined role of individual vulnerability and professional context in shaping long-term emotional outcomes.\u003c/p\u003e \u003cp\u003eThese results emphasize that the psychological impact of large-scale health crises may extend beyond the acute phase and become embedded in everyday professional functioning. Future research should adopt longitudinal approaches to better understand the evolution of anxiety over time and to identify mechanisms that support long-term psychological adaptation in healthcare settings.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003ch2\u003eCONFLICT OF INTEREST\u003c/h2\u003e \u003cp\u003eThe authors declare that they have no conflict of interest related to this study.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eCONSENT FOR PUBLICATION\u003c/strong\u003e \u003cp\u003eNot applicable.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e\u003cstrong\u003eETHICS APPROVAL STATEMENT\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study received ethical approval from the Ethics Council of the University of Medicine, Tirana, Albania (Protocol No. 825/2, Decision No. 10, March 18, 2024), and authorizations from 17 university, regional, and municipal hospitals across Albania. All participants provided informed consent, and confidentiality and anonymity were strictly maintained.\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eFUNDING\u003c/h2\u003e \u003cp\u003eThis research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eA.C. conceptualized and designed the study, drafted the initial manuscript, and coordinated the overall project. E.R. supervised the study, contributed to questionnaire development, data management, and manuscript revision. A.S. provided statistical support, contributed to data interpretation, and critically revised the manuscript. A.B. contributed to manuscript writing, performed the statistical analysis, and interpreted the results. F.Z. contributed to data collection, conducted the literature review, and revised the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\u003ch2\u003eACKNOWLEDGEMENTS\u003c/h2\u003e \u003cp\u003eThe authors would like to thank all nurses and midwives who participated in this study for their time and for sharing their experiences during the post-pandemic period. We also acknowledge the participating hospitals and primary healthcare centers for facilitating data collection and for their continued efforts to support the mental wellbeing of their staff.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets generated and/or analyzed during the current study are not publicly available due to ethical and confidentiality restrictions but are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eLai J, Ma S, Wang Y, Cai Z, Hu J, Wei N, et al. Factors associated with mental health outcomes among health care workers exposed to COVID-19. JAMA Netw Open. 2020;3(3):e203976.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShanafelt T, Ripp J, Trockel M. Understanding and addressing sources of anxiety among health care professionals during the COVID-19 pandemic. JAMA. 2020;323(21):2133\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhou Y, Wang W, Sun Y, Qian W, Liu Z, Wang R, et al. The prevalence and risk factors of psychological disturbances of frontline medical staff during COVID-19: A systematic review. BMC Nurs. 2023;22:14.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eB\u0026auml;uerle A, Teufel M, Musche V, et al. Mental health burden of the COVID-19 outbreak in Germany. Int J Public Health. 2024;69:1605675.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCarleton RN. Into the unknown: A review of contemporary models involving uncertainty. J Anxiety Disord. 2016;39:30\u0026ndash;43.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDugas MJ, Gagnon F, Ladouceur R, Freeston MH. Generalized anxiety disorder: A preliminary test of a conceptual model. Behav Res Ther. 1998;36(2):215\u0026ndash;26.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCarleton RN, Norton MAPJ, Asmundson GJG. Fearing the unknown: A short version of the Intolerance of Uncertainty Scale. J Anxiety Disord. 2007;21(1):105\u0026ndash;17.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHale W, Richmond M, Bennett J, et al. Intolerance of uncertainty and anxiety among healthcare professionals. J Anxiety Disord. 2022;86:102529.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRobertson HD, Elliott AM, Burton C, et al. Resilience of primary healthcare professionals: A systematic review. Br J Gen Pract. 2016;66(647):e423\u0026ndash;33.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLiu X, Chen J, Wang D, Li X. Professional experience and psychological resilience among nurses. J Clin Nurs. 2025;34(1\u0026ndash;2):112\u0026ndash;20.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSpielberger CD, Gorsuch RL, Lushene R, et al. Manual for the State-Trait Anxiety Inventory. Palo Alto: Consulting Psychologists; 1983.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGreenberg N, Weston D, Hall C, Caulfield T, Williamson V, Fong K. Mental health of staff working in intensive care during COVID-19 and beyond. Occup Med (Lond). 2021;71(2):62\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVindegaard N, Benros ME. COVID-19 pandemic and mental health consequences: Systematic review of the current evidence. Brain Behav Immun. 2020;89:531\u0026ndash;42.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePappa 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\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSantab\u0026aacute;rbara J, Bueno-Notivol J, Lipnicki DM, et al. Prevalence of anxiety in health care professionals during COVID-19 and post-pandemic periods: A meta-analysis. J Affect Disord. 2023;320:456\u0026ndash;65.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMcEvoy PM, Mahoney AEJ. Achieving certainty about the structure of intolerance of uncertainty in a treatment-seeking sample with anxiety and depression. J Anxiety Disord. 2012;26(3):367\u0026ndash;75.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSatici B, Saricali M, Satici SA, Griffiths MD. Intolerance of uncertainty and mental health: Serial mediation by rumination and fear of COVID-19. Int J Ment Health Addict. 2022;20:1591\u0026ndash;604.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLabrague LJ. Psychological resilience, coping behaviours and social support among health care workers during the COVID-19 pandemic: A systematic review. J Nurs Manag. 2021;29(7):1893\u0026ndash;901.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDe Kock JH, Latham HA, Leslie SJ, et al. A rapid review of the impact of COVID-19 on the mental health of healthcare workers. BMJ Open. 2021;11:e043420.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMertens G, Gerritsen L, Duijndam S, Salemink E, Engelhard IM. Fear of the coronavirus (COVID-19): Predictors in an online study conducted in March 2020. J Anxiety Disord. 2020;74:102258.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAksoy YE, Ko\u0026ccedil;ak V. Psychological effects of nurses and midwives due to COVID-19 outbreak: The case of Turkey. Arch Psychiatr Nurs. 2020;34(5):427\u0026ndash;33.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"post-pandemic, nurses, midwives, trait anxiety, intolerance of uncertainty, chronic conditions","lastPublishedDoi":"10.21203/rs.3.rs-9394982/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9394982/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eAlthough healthcare systems have largely stabilized following the COVID-19 pandemic, the long-term psychological adaptation of nurses and midwives remains insufficiently understood. Persistent exposure to uncertainty and individual health-related vulnerabilities may contribute to sustained anxiety beyond the acute crisis phase.\u003c/p\u003e\u003ch2\u003eAim\u003c/h2\u003e \u003cp\u003eThis study aimed to assess levels of state anxiety, trait anxiety, and intolerance of uncertainty among nurses and midwives in the post-pandemic period, and to examine whether intolerance of uncertainty, chronic health conditions, and professional experience are associated with elevated trait anxiety.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003e A cross-sectional analytical study was conducted among 1,201 nurses and midwives working in hospital and primary care settings. Data were collected using structured questionnaires, including measures based on the State\u0026ndash;Trait Anxiety Inventory (STAI) and the 12-item Intolerance of Uncertainty Scale (IUS-12). Descriptive and inferential statistical analyses, including multiple linear regression, were performed using SPSS. Statistical significance was set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eParticipants reported moderate levels of state anxiety (M\u0026thinsp;=\u0026thinsp;2.15, SD\u0026thinsp;=\u0026thinsp;0.90), trait anxiety (M\u0026thinsp;=\u0026thinsp;2.40, SD\u0026thinsp;=\u0026thinsp;0.86), and intolerance of uncertainty (M\u0026thinsp;=\u0026thinsp;2.64, SD\u0026thinsp;=\u0026thinsp;1.01). Higher intolerance of uncertainty and the presence of chronic health conditions were significantly associated with increased trait anxiety (p\u0026thinsp;\u0026lt;\u0026thinsp;0.01), while lower professional experience also emerged as a contributing factor.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eNurses and midwives continue to experience moderate levels of anxiety and intolerance of uncertainty in the post-pandemic period, suggesting that psychological adaptation may involve stabilization rather than full recovery. The findings highlight the role of both individual vulnerability and professional context in shaping long-term emotional outcomes and underscore the need for sustained, targeted interventions to support healthcare workforce wellbeing.\u003c/p\u003e","manuscriptTitle":"Post-Pandemic Anxiety Among Nurses and Midwives: The Role of Intolerance of Uncertainty, Chronic Conditions, and Professional Experience","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-05-11 07:06:45","doi":"10.21203/rs.3.rs-9394982/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-05-17T18:12:47+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"306126185508431622488669134309126057952","date":"2026-05-07T19:04:47+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"38762182384544781320623199463561523779","date":"2026-05-07T07:59:13+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-28T16:06:49+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-04-27T17:26:26+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-04-24T06:44:23+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-04-22T21:06:03+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Nursing","date":"2026-04-22T21:02:08+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"c3eaf759-8b0b-446d-9abe-6c1fee77a302","owner":[],"postedDate":"May 11th, 2026","published":true,"recentEditorialEvents":[{"type":"editorInvitedReview","content":"","date":"2026-05-17T18:12:47+00:00","index":90,"fulltext":""},{"type":"reviewerAgreed","content":"306126185508431622488669134309126057952","date":"2026-05-07T19:04:47+00:00","index":83,"fulltext":""},{"type":"reviewerAgreed","content":"38762182384544781320623199463561523779","date":"2026-05-07T07:59:13+00:00","index":81,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-11T07:06:45+00:00","versionOfRecord":[],"versionCreatedAt":"2026-05-11 07:06:45","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9394982","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9394982","identity":"rs-9394982","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}