­­COVID-19 and mental distress among health professionals in eight European countries during the third wave: a cross-sectional survey 

­­COVID-19 and mental distress among health professionals in eight European countries during the third wave: a cross-sectional survey | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article ­­COVID-19 and mental distress among health professionals in eight European countries during the third wave: a cross-sectional survey Frieder Dechent, Gwendolyn Mayer, Svenja Hummel, Moritz Steffen, and 11 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4481266/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 12 Sep, 2024 Read the published version in Scientific Reports → Version 1 posted 10 You are reading this latest preprint version Abstract Even during the third wave of the COVID-19 pandemic health professionals were facing mental health challenges. The aim of this study was to examine the mental health of doctors, nurses and other professional groups in Europe and to identify differences between the professional groups. We conducted a cross-sectional online survey in 8 European countries. We asked for demographic data, whether the participants were exposed to COVID-19 at work, for main information sources about the pandemic, the Depression Anxiety Stress Scale (DASS-21), and major stressors. A MANCOVA was carried out to find predictors of mental health among health care professionals. The sample (N = 1,398) consisted of 237 physicians, 459 nurses, and 351 other healthcare professionals and 351 non-medical professionals with no direct involvement in patient care. The mean mental health of all groups was affected to a mild degree. Major predictors were profession group for depression and anxiety with higher scores especially in the group of the nurses and for the group working directly with COVID-patients. In the third wave of the COVID-19 pandemic, the psychological burden on health professionals has remained high, with being nurse and working directly with COVID19 patients being particular risk factors for mental distress. We found as a main result that that nurses scored significantly higher on depression and anxiety than practitioners. Health sciences/Health care/Public health Health sciences/Health occupations COVID-19 Europe anxiety depression medical professionals mental health stress stressors Introduction Background After more than 3 years, the burden of disease in the general population due to the COVID-19 pandemic remains very high, with a total of over half a billion confirmed cases and more than 6 million deaths concerning Covid-19 [1]. Calculations of disability-adjusted life years (DALYs) with a loss of 305,641 life years in Germany [2] and 30,181 life years in Denmark [3] even more emphasize the severe consequences of COVID-19 in the European population. Various protective measures such as lockdowns, social distancing regulations, or vaccinations were imposed to contain the medical consequences [4], however an end of the Covid-19 impact is not in sight. This high burden of disease also places a particularly high burden on the health systems and, in association, on the mental health of health care professionals [5, 6]. Although there is no compelling evidence that the impact of the pandemic on mental health was more pronounced in health care professionals than in the general population [7, 8], there is considerable heterogeneity in this matter and much remains to be studied with regards to the identification of specific risk factors in this population. Much research so far has been done on the people who work in the health system and their mental distress. For example, in April 2020 numerous professionals in the health system in Spain showed symptoms of post-traumatic stress disorder, anxiety disorders, and depression, with women and younger people showing an increased risk [9]. A Portuguese study among physicians in 2020 showed that working directly with patients with COVID-19 also led to more symptoms of stress, depression, and anxiety, with female physicians being particularly affected [10]. A follow-up study over a year showed a significant decrease in stress and depression values, but the authors found a prospective connection between depression, stress, and symptoms of a post-traumatic stress disorder. Moreover, the female gender, but also the fear of being infected or infecting people close to them, and the reported insufficient access to protective material were identified as risk factors [11]. A higher burden on nurses in comparison to the physicians could be demonstrated in multiple studies [9, 12-15]. In addition to the professional group affiliation, direct contact with patients with COVID-19 and the respective medical ward also seem to play a role [16]. The workload in intensive care units in particular has been observed to directly increase mental health symptoms of the employees. This was particularly the case in England, where the number of ICU staff with mental health symptoms was high in younger nurses and fluctuated depending on the severity of the second wave [17]. In a study in Switzerland working in intensive care units was described with increased symptoms of anxiety and depression [18]. Investigating factors causing distress during the pandemic, the role of information and media consumption needs special consideration. Even before the outbreak of the COVID-19 pandemic social media consumption played a major role in mental well-being. A study showed that the emotions expressed by others on social media have an impact on the emotions of the user [19]. Current studies about the impact of social media use during the COVID-19 pandemic have also shown an increased mental burden on people who increasingly obtain their information in social networks [20, 21] and even chronic stress and panic have been observed due to the so called "infodemic" that comprises the fact that misinformation have been spread as a kind of "digital epidemic" [22]. However, little is known about the potential role of social media exposure on psychological distress among healthcare professionals. Objectives of the study This study aims at understanding the mental health and its conditions of physicians, nurses, other medical staff and non-medical professionals in the health care system of 8 European countries during the third wave of COVID-19 with increased sanitary measures in Europe. We aimed to focus on risk factors either specific to health-care professionals (e.g., working in ICU) or non-specific but overlooked so far in this specific population (e.g., exposure to social media). A key focus was put on the professional groups of physicians and nurses with regard to the severity of symptoms in their respective ward, stressors, working hours, and sources of COVID-related information. Methods Study Design and procedures A cross-sectional survey was carried out by means of an online questionnaire that has been developed for the purpose of this and two former studies, that were carried out in 2020 [ 23 , 24 ]. The questionnaire was made available on SoSciSurvey [ 25 ] and distributed within Europe in six languages (English, French, German, Italian, Portuguese, and Spanish). The link to the survey was distributed via email to personal and professional networks following a snowball sampling approach. Invitation emails were sent to colleagues at affiliations of all co-authors, i.e. clinical and research institutions in, France, Germany, Italy, Luxembourg, Portugal, Spain and Switzerland. It was then further distributed to related institutions and to partner organizations, hospitals, and professional associations. Participants were also recruited via personal networks or public social networking groups, such as medical or nursing groups at Twitter, LinkedIn, and Facebook. The survey was launched on 25th November 2021 and closed on 28th February 2022. The qualitative results of this survey that included answers in open text fields in this study period and those of the former study period were published elsewhere [ 26 ]. We follow the reporting guidelines of the STROBE statements for observational studies [ 27 ]. Ethical considerations The study was performed in accordance Declaration of Helsinki and was approved by the ethics committee of the Heidelberg University Medical Faculty (S-361/2020). Data collection was organized in compliance with the European General Data Protection Regulation (GDPR). The survey questionnaire was distributed in 8 European countries and all healthcare workers and associated staff at hospitals as well as non-medical staff were eligible to participate. Informed consent was obtained from the participants online prior to participation. No allowance was given for participating in the survey. All questionnaires were completed anonymously. Data security was granted by use of the SSL-encrypted platform SoSci Survey [ 25 ]. Measures The questionnaire has been described in detail in a former publication [ 24 ]. However, as some parts have been changed due to new requirements, the structure of the questionnaire will be repeated and the new sections described: in the first part, we asked for demographic data, exposure to people infected with COVID-19 in their daily life and at work, working hours per day, and the means by which people gain information about COVID-19 (multiple choice: Internet, social media, TV, communication with colleagues, other). Similar to the previous study [ 24 ] we asked the mental health status using the short version of the Depression-Anxiety Stress Scale (DASS-21) [ 24 , 28 , 29 ] and for stressors of nurses and physicians that has been derived from a previous study during SARS epidemic in 2003 [ 30 ]. The DASS questionnaire consists of 21 questions, seven each of which belong to the depression, anxiety, and stress subscale. Responses are given on a 4-point Likert scale ranging from “did not apply to me at all” = 0, to “applied to me very much or most of the time” = 3. The point values of each subscale are then multiplied by 2 for evaluation. Data Analysis The data was analyzed with IBM SPSS statistics 26 [ 31 ]. We collected data of 1,439 participants and removed all datasets that were filled out outside the targeted countries (n = 41). The final analysis comprised data of 1,398 participants. Missing values were omitted from the calculations without replacement. We calculated descriptive statistics and reported frequencies, means, standard deviations, and percentages. Following the manual of the DASS-21 [ 28 ], individual sum scores were calculated based on the depression, anxiety and stress subscales and multiplied by two. The depression subscale score was categorized as normal (0–9), mild (10–13), moderate (14–20), severe (21–27), and very severe depression (28+). The anxiety subscale score was categorized as normal (0–7), mild (8–9), moderate (10–14), severe (15–19), and extremely severe anxiety (20+). The total stress subscale score was categorized as normal (0–14), mild (15–18), moderate (19–25), severe (26–33), and extremely severe stress (34+) [ 5 ]. These subscales were then grouped as normal/mild; moderate; severe/very severe, following our previous approaches to ease the interpretation [ 23 , 24 ], as mild symptoms of mental disorders show a high prevalence regardless of a pandemic like COVID-19 [ 32 ]. We created four groups: 1) physicians (including physicians and dentists), 2) nurses, 3) other health care professionals, which included "other job in healthcare system" and "volunteer in the context of medical pandemic aid", and 4) non-medical staff consisting of professionals who usually do not work directly with the patients or their immediate environment. A multivariate analysis of covariance (MANCOVA) was computed for each of the three DASS-21 scores as the dependent variable, with the two predictors being the profession group and contact with people infected by COVID at work, and working hours per week, own infection with COVID, country where the participant is actually living, age and gender as a covariate. We chose a robust test statistic of Pillai in case of violation of assumptions of normality and homogeneity of covariance matrices. We chose a robust test statistic of Pillai in case of violation of assumptions of normality and homogeneity of covariance matrices [ 33 ]. We then focused on the groups of physicians and nurses only for whom we reported the three DASS-21 scores according to medical departments, as well as major stressors. A t-test was carried out for differences. Major ways of gaining information on COVID were calculated as frequencies and percentages. On the basis of this data, we carried out chi-square tests to find differences between the two groups. Finally, Eta-coefficients were calculated to show associations between DASS-21 scores and the use of information sources. In all analyses, p values < .05 were considered statistically significant. Results Participants The sample size was 1,398 people, of whom 237 were physicians, 459 were nurses, 351 comprised other healthcare professionals and 351 were non-medical professionals. The group of other health professionals consisted mainly of psychologists, educators, laboratory technicians, occupational therapists dance and movement therapists, pharmacists, and medical-technical assistants. The group of non-medical professionals was very heterogeneous. This group consisted mainly of administrative employees, secretaries, researchers, educators, and computer scientists. The ages of the participants ranged from 19 to 78 (median: 42 years). A total of 369 (26.4%) males, 1,024 (73.2%) females, and 5 non-binary people (0.4%) took part in the survey. The distribution of people across countries is shown in Table 1 . The distribution of the professional groups in the different countries are provided in the supplementary file 1. Table 1 Demographic characteristics of the study participants from November 2021 to February 2022 in 8 European countries Characteristics Participants, n (%) Age (years), mean (SD) 42.22 (10.6) Gender Male 369 (26.4) Female 1,024 (73.2) Non-binary 5 (0.4) Country Belgium 93 (6.7) France 322 (23.0) Germany 243 (17.4) Italy 120 (8.6) Luxemburg 348 (24.9) Portugal 44 (3.1) Spain 44 (3.1) Switzerland 184 (13.2) What is the population of the city you are living? less than 5,000 inhabitants 375 (26.8) between 5,000 and 20,000 inhabitants 400 (28.6) between 20,000 and 100,000 inhabitants 259 (18.5) between 100,000 and 500,000 inhabitants 273 (19.5) more than 500,000 inhabitants 91 (6.5) Education Secondary education 97 (6.9) Post-secondary non-tertiary education 331 (23.7) First stage of tertiary education 793 (56.7) Second stage of tertiary education 173 (12.4) Primary or lower 4 (0.3) Marital Status Single 233 (16.7) Married 644 (46.1) Divorced 102 (7.3) Widowed 7 (0.5) In relationship 393 (28.1) Other 19 (1.4) Children Yes 841 (60.2) No 557 (39.8) Profession Physician 234 (16.7) Dentist 3 (0.2) Nurse 459 (32.8) Other healthcare professionals 351 (25.1) Non-medical professionals 351 (25.1) Total 1,398 (100) Vaccination status and working conditions during COVID-19 during the third wave of the COVID-19 pandemic Results on the share of participants with infection, vaccination, contact to COVID at work, working hours and the respective medical unit are displayed in Table 2 . Table 2 Infection, Vaccination, Contact to COVID at work, Working hours and Medical Unit (frequencies and percentages) Characteristics Participants n (%) Are/ were you infected with COVID-19? Yes 295 (21.1) No 1,085 (77.6) Have you already received a COVID-19 vaccine? Yes, I have received the first dose of the COVID-19 vaccine 36 (2.6) Yes, I have received two doses on the COVID-19 vaccine 390 (27.9) No, I have not received a COVID-19 vaccine. 108 (7.7) Yes, I have received three doses on the COVID-19 vaccine 864 (61.8) Do you have contact at work with people infected with COVID-19? Yes 1,027 (73.5) No 371 (26.5) Working hours per week 70h 80 (5.7) In which medical unit do you work? (only for medical staff) ICU 99 (7.1) General inpatient department 316 (22.6) Outpatient department 98 (7.0) Emergency department 53 (3.8) Doctor's office 42 (3.0) Ambulant care 528 (37.8) Other 87 (6.2) Total Missing 1,223 (87.5) 175 (12.5) Total 1,398 (100) Opportunity to work from home (“home office”) In Table 3 professional groups are presented who had the opportunity to work remotely. Table 3 Professional groups who reported to be able to work remotely from November 2021 to February 2022 in 8 European countries Profession Participants, n (%) Physician 39 (16.5) Nurse 32 (7.0) Other healthcare professionals 73 (20.8) Non-medical professionals 175 (49.9) Total 319 (22.8) Mental Health (DASS-21) Across all professions and countries, a share of 23.3% (n = 326) report levels of depression that can be categorized as a severe/very severe degree. A share of 18.2% (n = 255) express severe/very severe levels of anxiety and 25.4% (n = 355) voice severe/very severe levels of stress. Nurses and non-medical staff show the highest degree of burden in all three symptom profiles. More details are presented in Table 4 . Details of DASS-21 scores in the different countries are provided in the supplementary file 2. Table 4 Results for the Depression Anxiety and Stress Scales-21 (DASS-21) for doctors, nurses, Other healthcare professionals and non-medical professionals from November 2021 to February 2022 in 8 European countries (means, standard deviations, frequencies and percentages) Participants, n Mean (SD) normal/mild, n (%) moderate, n (%) severe/very severe, n (%) DASS-21 depression Physicians 237 10.71 (11.03) 160 (67.5) 33 (13.9) 44 (18.6) Nurses 459 13.14 (11.09) 261 (56.9) 85 (18.5) 113 (24.6) Other healthcare professionals 351 12.17 (11.21) 212 (60.4) 60 (17.1) 79 (22.5) Non-medical professionals 351 13.14 (11.21) 200 (57.0) 61 (17.4) 90 (25.6) Total 1398 12.48 (11.10) 833 (59.6) 239 (17.1) 326 (23.3) DASS-21 anxiety Physicians 237 5.42 (7.36) 186 (78.5) 29 (12.2) 22 (9.3) Nurses 459 8.55 (8.87) 294 (64.1) 64 (13.9) 101 (22.0) Other healthcare professionals 351 7.72 (8.44) 236 (67.2) 55 (15.7) 60 (17.1) Non-medical professionals 351 8.86 (9.63) 214 (61.0) 65 (18.5) 72 (20.5) total 1398 7.89 (8.80) 930 (66.5) 213 (15.2) 255 (18.2) DASS-21 stress Physicians 237 16.15 (11.01) 149 (62.9) 35 (14.8) 53 (22.4) Nurses 459 17.45 (11.18) 272 (59.3) 67 (14.6) 120 (26.1) Other healthcare professionals 351 16.93 (11.08) 212 (60.4) 56 (16.0) 83 (23.6) Non-medical professionals 351 17.56 (11.81) 196 (55.8) 56 (16.0) 99 (28.2) total 1398 17.13 (11.29) 829 (59.3) 214 (15.3) 355 (25.4) Comparison of the mental health of physicians, nurses, other healthcare professionals and non-medical professionals and the professionals having contact with COVID patients vs. having no contact A statistical analysis with a MANCOVA with the working hours per week, possibility to work from home (“home office”), own infection with COVID, country where the participant is actually living, age and gender showed a significant effect for profession (Pillai trace = 0.016, F 3,000 =2,479, P = .008) and also for the fact of being in contact with COVID-19 patients or not (Pillai trace = 0.007, F 3,000 =3,432, P = .016). The covariates showed also significant results (Working hours (Pillai trace = 0.030, F 3,000 =14,163, P < .001); own infection with COVID-19 (Pillai trace = 0.009, F 3,000 =4,361, P = .005); country (Pillai trace = 0.013, F 3,000 =5,916, P < .001); age (Pillai trace = 0.017, F 3,000 =7,788, P < .001); gender (Pillai trace = 0.021, F 3,000 =9,843, P < .001). In the between-subject analysis for profession in two of three DASS-scores showed significant results (DASS-D P < .023, DASS-A P < .001, DASS-S P = 0.308). Physicians showed in all three DASS-scores the lowest scores (Table 4 ). For the people having contact at work with COVID-patients all three DASS-scores showed a significant difference (DASS-D P = .001, DASS-A = 0.032, DASS-S P = .016). Mental health in the medical units and workload of physicians and nurses Depending on the workplace, the highest values on all three scales were found among staff in the intensive care units, ahead of staff in the general medical units and the emergency units (Table 5 ). Table 5 Results for the Depression Anxiety and Stress Scales-21 (DASS-21) of physicians and nurses in the medical units (N = 696) from November 2021 to February 2022 in 8 European countries (means and standard deviations) N* Dass-21 Depression M (SD) Dass-21 Anxiety M (SD) Dass-21 Stress M (SD) ICU 85 15.04 (11.40) 9.95 (9.28) 20.21 (11.65) General inpatient department 231 12.00 (10.84) 6.97 (8.54) 16.53 (10.43) Outpatient department 61 11.44 (11.41) 6.69 (7.57) 15.54 (10.83) Emergency department 43 10.23 (9.85) 5.67 (6.82) 15.91 (9.10) Physician's office 38 9.95 (11.68) 4.74 (7.95) 13.79 (11.70) Ambulant care 165 11.60 (11.05) 7.58 (8.66) 16.40 (11.84) Other medical departments 64 14.59 (10.95) 8.88 (7.92) 19.78 (10.97) Total/mean 687 12.25 (11.06) 7.43 (8.47) 16.98 ( 11.11) *missing: n = 9 Over all four groups the correlation of working hours and DASS-21 Depression was significant with r (1396) = − .09 (p* = .001), while DASS-21 Anxiety was r(1396) = .03 (p = .35), and Dass-21 Stress was r (1396) = .14 (p* < .001). Job-related stressors of physicians and nurses Among the medical staff, “uncertainty about when the epidemic will be under control” was rated highest, followed by “worry about inflicting COVID-19 on family”, “worry about lack of manpower”, “frequent modification of infection control procedures”, and “coworkers being emotionally unstable“. Participants were less concerned about to get blamed by their commanding officers. An overview of all stressors in the order of reported severity can be found in Table 6 . Overall, all stressors were rated to a higher level by nurses than physicians. Table 6 Stressors for physicians (n = 237) and nurses (n = 459) during COVID-19 from November 2021 to February 2022 in 8 European countries (means and standard deviations) Items a physicians Mean (SD) nurses Mean (SD) All Mean (SD) P Uncertainty about when the epidemic will be under control 1.86 (0.95) 2.20 (0.85) 2.08 (0.90) < .001 Worry about inflicting COVID-19 on family 1.74 (1.09) 2.16 (0.96) 2.02 (1.02) < .001 Worry about lack of manpower 1.73 (1.07) 2.09 (1.00) 1.97 (1.04) < .001 Frequent modification of infection control procedures 1.55 (0.92) 1.83 (0.97) 1.73 (0.96) < .001 Coworkers being emotionally unstable 1.30 (0.98) 1.74 (0.99) 1.59 (1.00) < .001 Patients’ emotional reaction 1.21 (0.93) 1.69 (0.99) 1.53 (0.99) < .001 Deterioration of patients’ condition 1.21 (0.97) 1.68 (1.03) 1.52 (1.04) < .001 Protective gears cause physical discomfort 1.24 (0.96) 1.64 (1.09) 1.50 (1.06) < .001 Patient families’ emotional reaction 1.12 (0.96) 1.60 (1.00) 1.44 (1.01) < .001 Worry about nosocomial (= intra-hospital) spread 1.30 (0.96) 1.47 (1.03) 1.41 (1.01) .036 Worry about getting infected 1.21 (0.94) 1.52 (1.01) 1.41 (1.00) < .001 Conflict between duty and safety 1.00 (0.95) 1.45 (0.99) 1.30 (0.98) < .001 Being without properly fitted environment 1.07 (1.02) 1.37 (1.06) 1.27 (1.06) < .001 Documentation and reporting procedures unclear 1.06 (0.98) 1.37 (1.00) 1.26 (1.00) < .001 Worry about being negligent and endangering patients 1.11 (0.99) 1.32 (1.07) 1.25 (1.04) .005 Worry about lack of proper knowledge and equipment 1.00 (0.93) 1.26 (1.00) 1.17 (0.99) .001 Protective gears being a drag in providing quality care 0.86 (0.98) 1.29 (1.04) 1.15 (1.04) < .001 Be infected by the colleagues 0.87 (0.88) 1.22 (1.00) 1.10 (0.97) < .001 Coworkers displaying COVID-19-like symptoms 0.76 (0.82) 1.26 (0.99) 1.09 (0.96) < .001 Equivocal definition of the responsibility between doctors and nurses 0.67 (0.88) 1.29 (1.03) 1.08 (1.02) < .001 Yourself displaying COVID-19-like symptoms 0.78 (0.87) 1.19 (1.00) 1.05 (0.98) < .001 Worry about being negligent and endangering coworkers 0.84 (0.87) 1.05 (1.02) 0.98 (0.97) < .001 Blaming from commanding officers 0.49 (0.81) 1.04 (1.10) 0.85 (1.04) < .001 a Responses to the question: “When you think about COVID-19 in your life and work, how often did you think or worry about the following things?” (0 = not at all, 3 = very much) Information on COVID-19 In Table 7 , we see the different sources of information. Both television and social media were less frequently reported by physicians as being a main source of information about COVID-19 ( P < .001). Table 7 Answers to the question “How do you mainly inform yourself about COVID-19?” given by physicians and nurses from November 2021 to February 2022 in 8 European countries (frequencies and percentages or respective n; multiple choice possible) Medium Participants, n (%) Physicians Nurses Total Newspaper 92 (38.8) 230 (50.1) 322 (46.3) TV 73 (30.8) 268 (58.4) 341 (49.0) Social media 31 (13.1) 142 (30.9) 173 (24.9) Internet 165 (69.6) 276 (60.1) 441 (63.4) Communication with Colleagues 145 (61.2) 305 (66.4) 460 (64.7) Other 54 (22.8) 66 (14.4) 120 (17.3) A further analysis revealed a weak positive association in the depression, stress, and anxiety scales with the use of social media as a main source of information about COVID-19 (DASS-D η = 0.05; DASS-A η = 0.11; DASS-S η = 0.88). More associations could be shown for television and internet, but only in the case of anxiety (DASS-A η = 0.05 and η = 0.06 respectively). Discussion Principal Findings One of our main findings in this European wide study is that nurses and other medical and non-medical health workers had higher scores in depression and anxiety scores as measured by the DASS-21 in comparison to physicians. The study was carried out to ask for symptoms and predictors of the mental health of physicians, nurses, and other professions in and outside of direct patient care during the third wave of the pandemic in winter 2021/2022. In the analysis, we considered frequently described risk factors such as age, gender, workload and country of residence of the participants. In total, the proportion of nurses with moderate and severe depression was higher than that of physicians. For anxiety, too, the proportion of nurses in the moderate and severe categories was higher. Similar findings were also reported in different studies and reviews [ 12 , 15 , 34 , 35 ]. In a Belgian sample, there was no direct influence of whether someone works directly with COVID patients, but rather an influence of the professional group on burnout and anxiety symptoms as well as on insomnia [ 13 ]. A study of Italian health professionals showed that nurses suffered more from overall psychological distress than physicians [ 14 ]. This difference was also demonstrated in a Belgian study [ 36 ]. An Italian study [ 37 ] revealed a significantly higher risk for nurses and explained this, among other things, by the fact that nurses were less involved in the decision-making processes and also spent significantly more time directly exposed to the infectious patients during their work. Another main finding of our study was the correlation between the stress and depression scores and the working hours. This association can be supported by previous studies [ 38 ]. A Dutch investigation was able to show a connection between an increase in the prevalence of burnout, the occurrence of COVID-19, direct contact with COVID-19 patients, and the hours worked by professionals in ICUs [ 39 ]. Physicians and nurses who worked directly with COVID-19 patients also had higher values in all DASS scores in our study. This correlation is also described in other studies [ 10 , 40 ]. A similar association was found in an Australian sample, for example, where caregivers with direct contact with COVID-19 patients had the most pronounced emotional exhaustion, while non-medical professionals with no contact had the lowest scores [ 35 ]. A meta-analysis showed higher values for anxiety and depression in the group of professionals with contact to COVID-19 patients [ 41 ]. In this meta-analysis, women, married individuals, individuals with children, and nurses had relatively high scores. In summary, in addition to one's own exposure, fear for family members seems to play an important role through the fear of infecting them through one's own exposure. Other fears referred to staff shortage as well as the often-increased contact with seriously ill patients or the concern about the deterioration of their condition. Compared to the previous first-wave study by Hummel et al. [ 24 ] who used a comparable design, similar overall values were shown in the individual DASS scores, although it must of course be added that this is not a follow-up study. The most frequently mentioned stressors were “Uncertainty about when the epidemic will be under control” and “Worry about inflicting COVID-19 on family”, which were the same as in the previous study [ 24 ]. Especially the worry about infecting the family which was also described before [ 42 ]. For the stressors, the nurses consistently showed higher mean values than did the physicians, which basically fits with the mental burden of the nurses described above. What could be explained by the longer duration they have to work directly with the patients. In addition to the other stressors, deficits in the acquisition of knowledge are weighted significantly higher by the nurses than by the practitioners. Other results of our survey that included as well coping strategies, have been published elsewhere [ 26 ]. There, the acquisition of knowledge was also a successful coping strategy. There still seems to be a stressor in the third wave of the pandemic, although this problem was already recognized at the beginning of the pandemic [ 43 ]. This result is also comparable to former results that describe even a worsening of mental distress but in non-comparable time periods [ 44 – 46 ]. Another important result of our study was the correlation of the use of social media with higher values in all DASS scales, although this connection could not be seen for other sources of information. A possible explanation might argue that increased social media use and the associated increased exposure to corresponding content were associated with increased anxiety [ 20 , 21 ]. Interestingly, this connection has already been revealed by an experimental study before the pandemic [ 19 ], where the reduction of positive expressions led to fewer positive and more negative posts, and the reduction of negative posts led to opposite findings. On the other hand, loneliness, isolation, workload and fears might increase the use of social media as a means of compensation especially in the case of nurses who were burdened to a certain extent [ 47 ]. We found a weak positive correlation of social media use and DASS-scores. In line with the literature this should be interpreted as an indication why increased use of social media is associated with more stress and the associated increased values in the DASS scores in our study. Whether more stress leads to increased use of social media or a higher frequency of social media use evokes higher stress levels cannot be derived from our study. Future investigations are necessary to come to a causal conclusion regarding mental health and social media use in specific professional groups. Limitations Since the link to the online survey was distributed on the one hand through personal contacts and on the other hand via social networks, there was a very unequal distribution of the professional groups and of the gender of the participants in the different countries. In addition, non-occupational factors, such as the strictness of measures and the different dynamics of the pandemic in the individual countries over the survey period, certainly also played a role in mental health. We neither asked for details of institutional and governmental measures nor for the willingness of the participants to follow them. Overall, the participants cannot all be assigned to medical specialties or work areas, so that there could be an overrepresentation of employees in psychiatry. When asked about the sources of information, specific scientific journals were not asked about as a source of information for the participants. This can lead to a bias in the results, since a significant group of people and possibly a possible difference between the professional groups were not shown. Conclusion In summary, our study continued to provide numerous indications that the COVID-19 pandemic continued to be a significant stress factor for the healthcare system. When scores for stress were not statistically different, we found as a main result that that nurses scored significantly higher on depression and anxiety than practitioners. These differences were also reflected in the different levels of stressors that we evaluated for nurses and physicians. In addition to the positive correlation of working hours with stress and depression and the positive connection between direct contact with COVID-19 patients and increased anxiety, depression, and stress, the highest psychological burden was shown in employees of intensive care units. As a secondary result we found a weak positive correlation between social media use and the DASS-scores Further researches are needed to clarify the role of social digital media as negative influencer on the mental health of healthcare professionals. Declarations Conflict of interests The authors declare no conflict of interests. Author Contribution FD and GM contributed equally, they analysed the data and wrote the main manuscript text, SH reviewed the statistics, SM, CB, RA, RLD, OR, VF, IT, SF and CL collected data, CH, SW and JHS conceptualized the study and supervised the project. All authors reviewed the manuscript. Acknowledgement We thank all participants for sharing their experiences and taking part in our study. For the publication fee we acknowledge financial support by Deutsche Forschungsgemeinschaft within the funding programme „Open Access Publikationskosten“ as well as by Heidelberg University. Data Availability The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request. References World Health Organization. COVID-19 Weekly Epidemiological Update. 3 8 2022 2022. Rommel A, von der Lippe E, Plaß D, Ziese T, Diercke M, an der Heiden M, et al. The COVID-19 Disease Burden in Germany in 2020. Dtsch Arztebl Int 2021. https://doi.org/10.3238/arztebl.m2021.0147 . Pires SM, Redondo HG, Espenhain L, Jakobsen LS, Legarth R, Meaidi M, et al. Disability adjusted life years associated with COVID-19 in Denmark in the first year of the pandemic. BMC Public Health 2022;22:1315. https://doi.org/10.1186/s12889-022-13694-9 . Ge Y, Zhang W-B, Wu X, Ruktanonchai CW, Liu H, Wang J, et al. Untangling the changing impact of non-pharmaceutical interventions and vaccination on European COVID-19 trajectories. Nat Commun 2022;13:3106. https://doi.org/10.1038/s41467-022-30897-1 . Wynter K, Holton S, Trueman M, Bruce S, Sweeney S, Crowe S, et al. Hospital clinicians’ psychosocial well-being during the COVID-19 pandemic: longitudinal study. Occup Med (Chic Ill) 2022;72:215–24. https://doi.org/10.1093/occmed/kqac003 . Almalki AH, Alzahrani MS, Alshehri FS, Alharbi A, Alkhudaydi SF, Alshahrani RS, et al. The Psychological Impact of COVID-19 on Healthcare Workers in Saudi Arabia: A Year Later Into the Pandemic. Front Psychiatry 2021;12. https://doi.org/10.3389/fpsyt.2021.797545 . Kunzler AM, Röthke N, Günthner L, Stoffers-Winterling J, Tüscher O, Coenen M, et al. Mental burden and its risk and protective factors during the early phase of the SARS-CoV-2 pandemic: systematic review and meta-analyses. Global Health 2021;17:34. https://doi.org/10.1186/s12992-021-00670-y . Phiri P, Ramakrishnan R, Rathod S, Elliot K, Thayanandan T, Sandle N, et al. An evaluation of the mental health impact of SARS-CoV-2 on patients, general public and healthcare professionals: A systematic review and meta-analysis. EClinicalMedicine 2021;34:100806. https://doi.org/10.1016/j.eclinm.2021.100806 . Luceño-Moreno L, Talavera-Velasco B, García-Albuerne Y, Martín-García J. Symptoms of Posttraumatic Stress, Anxiety, Depression, Levels of Resilience and Burnout in Spanish Health Personnel during the COVID-19 Pandemic. Int J Environ Res Public Health 2020;17:5514. https://doi.org/10.3390/ijerph17155514 . Ferreira S, Sousa MM, Moreira PS, Sousa N, Picó-Pérez M, Morgado P. A Wake-up Call for Burnout in Portuguese Physicians During the COVID-19 Outbreak: National Survey Study. JMIR Public Health Surveill 2021;7:e24312. https://doi.org/10.2196/24312 . Mediavilla R, Fernández-Jiménez E, Martinez-Morata I, Jaramillo F, Andreo-Jover J, Morán-Sánchez I, et al. Sustained Negative Mental Health Outcomes Among Healthcare Workers Over the First Year of the COVID-19 Pandemic: A Prospective Cohort Study. Int J Public Health 2022;67. https://doi.org/10.3389/ijph.2022.1604553 . Pappa S, Ntella V, Giannakas T, Giannakoulis VG, Papoutsi E, Katsaounou P. Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis. Brain Behav Immun 2020;88:901–7. https://doi.org/10.1016/j.bbi.2020.05.026 . Tiete J, Guatteri M, Lachaux A, Matossian A, Hougardy J-M, Loas G, et al. Mental Health Outcomes in Healthcare Workers in COVID-19 and Non-COVID-19 Care Units: A Cross-Sectional Survey in Belgium. Front Psychol 2021;11. https://doi.org/10.3389/fpsyg.2020.612241 . Bonzini M, Comotti A, Fattori A, Cantù F, Colombo E, Tombola V, et al. One Year Facing COVID. Systematic Evaluation of Risk Factors Associated With Mental Distress Among Hospital Workers in Italy. Front Psychiatry 2022;13. https://doi.org/10.3389/fpsyt.2022.834753 . de Kock JH, Latham HA, Leslie SJ, Grindle M, Munoz S-A, Ellis L, et al. A rapid review of the impact of COVID-19 on the mental health of healthcare workers: implications for supporting psychological well-being. BMC Public Health 2021;21:104. https://doi.org/10.1186/s12889-020-10070-3 . Johnson SU, Ebrahimi O v., Hoffart A. PTSD symptoms among health workers and public service providers during the COVID-19 outbreak. PLoS One 2020;15:e0241032. https://doi.org/10.1371/journal.pone.0241032 . Hall CE, Milward J, Spoiala C, Bhogal JK, Weston D, Potts HWW, et al. The mental health of staff working on intensive care units over the COVID-19 winter surge of 2020 in England: a cross sectional survey. Br J Anaesth 2022;128:971–9. https://doi.org/10.1016/j.bja.2022.03.016 . Wozniak H, Benzakour L, Moullec G, Buetti N, Nguyen A, Corbaz S, et al. Mental health outcomes of ICU and non-ICU healthcare workers during the COVID-19 outbreak: a cross-sectional study. Ann Intensive Care 2021;11:106. https://doi.org/10.1186/s13613-021-00900-x . Kramer ADI, Guillory JE, Hancock JT. Experimental evidence of massive-scale emotional contagion through social networks. Proceedings of the National Academy of Sciences 2014;111:8788–90. https://doi.org/10.1073/pnas.1320040111 . Gao J, Zheng P, Jia Y, Chen H, Mao Y, Chen S, et al. Mental health problems and social media exposure during COVID-19 outbreak. PLoS One 2020;15:e0231924. https://doi.org/10.1371/journal.pone.0231924 . Ni MY, Yang L, Leung CMC, Li N, Yao XI, Wang Y, et al. Mental Health, Risk Factors, and Social Media Use During the COVID-19 Epidemic and Cordon Sanitaire Among the Community and Health Professionals in Wuhan, China: Cross-Sectional Survey. JMIR Ment Health 2020;7:e19009. https://doi.org/10.2196/19009 . Banerjee D, Meena KS. COVID-19 as an “Infodemic” in Public Health: Critical Role of the Social Media. Front Public Health 2021;9. https://doi.org/10.3389/fpubh.2021.610623 . Du J, Mayer G, Hummel S, Oetjen N, Gronewold N, Zafar A, et al. Mental Health Burden in Different Professions During the Final Stage of the COVID-19 Lockdown in China: Cross-sectional Survey Study. J Med Internet Res 2020;22:e24240. https://doi.org/10.2196/24240 . Hummel S, Oetjen N, Du J, Posenato E, Resende de Almeida RM, Losada R, et al. Mental Health Among Medical Professionals During the COVID-19 Pandemic in Eight European Countries: Cross-sectional Survey Study. J Med Internet Res 2021;23:e24983. https://doi.org/10.2196/24983 . Leiner DJ: SoSci Survey. In., vol. 2022, Version 3.1.06 edn; 2019. n.d. Hummel S, Michelsen I, Zafar A, Moritz S, Benoy C, Lemogne C, Almeida R, Losada R, Ribeiro O, Frisardi V et al: Unmet Psychosocial Needs of Health Care Professionals in Europe During the COVID-19 Pandemic: Mixed Methods Approach. JMIR Public Health Surveill 2023, 9:e45664. https://doi.org/10.2196/45664 . von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: Guidelines for Reporting Observational Studies. Ann Intern Med 2007;147:573. https://doi.org/10.7326/0003-4819-147-8-200710160-00010 . Lovibond SH, Lovibond PF: Manual for the depression anxiety stress scales: Psychology Foundation of Australia; 1996. n.d. Lee S-H, Juang Y-Y, Su Y-J, Lee H-L, Lin, Yi-Hui, Chao C-C. Facing SARS: psychological impacts on SARS team nurses and psychiatric services in a Taiwan general hospital. Gen Hosp Psychiatry 2005;27:352–8. https://doi.org/10.1016/j.genhosppsych.2005.04.007 . Lee S-H, Juang Y-Y, Su Y-J, Lee H-L, Lin, Yi-Hui, Chao C-C. Facing SARS: psychological impacts on SARS team nurses and psychiatric services in a Taiwan general hospital. Gen Hosp Psychiatry 2005;27:352–8. https://doi.org/10.1016/j.genhosppsych.2005.04.007 . Corp. I: IBM SPSS Statistics for Windows. In., 26.0 edn. Armonk, NY: IBM Corp.; 2019. n.d. GBD 2019 Mental Disorders Collaborators. Global, regional, and national burden of 12 mental disorders in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Psychiatry 2022;9:137–50. https://doi.org/10.1016/S2215-0366(21)00395-3 . Olson CL. Comparative Robustness of Six Tests in Multivariate Analysis of Variance. J Am Stat Assoc 1974;69:894–908. https://doi.org/10.1080/01621459.1974.10480224 . Hao Q, Wang D, Xie M, Tang Y, Dou Y, Zhu L, et al. Prevalence and Risk Factors of Mental Health Problems Among Healthcare Workers During the COVID-19 Pandemic: A Systematic Review and Meta-Analysis. Front Psychiatry 2021;12. https://doi.org/10.3389/fpsyt.2021.567381 . Maunder RG, Heeney ND, Hunter JJ, Strudwick G, Jeffs LP, Ginty L, et al. Trends in burnout and psychological distress in hospital staff over 12 months of the COVID-19 pandemic: a prospective longitudinal survey. Journal of Occupational Medicine and Toxicology 2022;17:11. https://doi.org/10.1186/s12995-022-00352-4 . Franck E, Goossens E, Haegdorens F, Geuens N, Portzky M, Tytens T, et al. Role of resilience in healthcare workers’ distress and somatization during the COVID-19 pandemic: A cross‐sectional study across Flanders, Belgium. Nurs Open 2022;9:1181–9. https://doi.org/10.1002/nop2.1159 . Lasalvia A, Bonetto C, Porru S, Carta A, Tardivo S, Bovo C, et al. Psychological impact of COVID-19 pandemic on healthcare workers in a highly burdened area of north-east Italy. Epidemiol Psychiatr Sci 2021;30:e1. https://doi.org/10.1017/S2045796020001158 . Fiabane E, Gabanelli P, la Rovere MT, Tremoli E, Pistarini C, Gorini A. Psychological and work-related factors associated with emotional exhaustion among healthcare professionals during the COVID ‐19 outbreak in Italian hospitals. Nurs Health Sci 2021;23:670–5. https://doi.org/10.1111/nhs.12871 . Kok N, van Gurp J, Teerenstra S, van der Hoeven H, Fuchs M, Hoedemaekers C, et al. Coronavirus Disease 2019 Immediately Increases Burnout Symptoms in ICU Professionals: A Longitudinal Cohort Study*. Crit Care Med 2021;49:419–27. https://doi.org/10.1097/CCM.0000000000004865 . Hu N, Deng H, Yang H, Wang C, Cui Y, Chen J, et al. The pooled prevalence of the mental problems of Chinese medical staff during the COVID-19 outbreak: A meta-analysis. J Affect Disord 2022;303:323–30. https://doi.org/10.1016/j.jad.2022.02.045 . Chen Y, Wang J, Geng Y, Fang Z, Zhu L, Chen Y, et al. Meta-analysis of the prevalence of anxiety and depression among frontline healthcare workers during the COVID-19 pandemic. Front Public Health 2022;10. https://doi.org/10.3389/fpubh.2022.984630 . Walton M, Murray E, Christian MD. Mental health care for medical staff and affiliated healthcare workers during the COVID-19 pandemic. Eur Heart J Acute Cardiovasc Care 2020;9:241–7. https://doi.org/10.1177/2048872620922795 . Frenkel MO, Pollak KM, Schilling O, Voigt L, Fritzsching B, Wrzus C, et al. Stressors faced by healthcare professionals and coping strategies during the early stage of the COVID-19 pandemic in Germany. PLoS One 2022;17:e0261502. https://doi.org/10.1371/journal.pone.0261502 . Probst-Hensch N, Jeong A, Keidel D, Imboden M, Lovison G. Depression trajectories during the COVID-19 pandemic in the high-quality health care setting of Switzerland: the COVCO-Basel cohort. Public Health 2023;217:65–73. https://doi.org/10.1016/j.puhe.2023.01.010 . Holton S, Wynter K, Peeters A, Georgalas A, Yeomanson A, Rasmussen B. Psychological wellbeing of Australian community health service staff during the COVID-19 pandemic: a longitudinal cohort study. BMC Health Serv Res 2023;23:405. https://doi.org/10.1186/s12913-023-09382-y . Th’ng F, Rao KA, Ge L, Neo HN, Molina JA De, Lim WY, et al. Longitudinal Study Comparing Mental Health Outcomes in Frontline Emergency Department Healthcare Workers through the Different Waves of the COVID-19 Pandemic. Int J Environ Res Public Health 2022;19:16878. https://doi.org/10.3390/ijerph192416878 . Häussl A, Ehmann E, Pacher A, Knödl K, Huber T, Neundlinger L, et al. Psychological, physical, and social effects of the COVID-19 pandemic on hospital nurses. Int Nurs Rev 2021;68:482–92. https://doi.org/10.1111/inr.12716 Additional Declarations No competing interests reported. Supplementary Files supplementaryfile1.docx supplementaryfile2.docx Cite Share Download PDF Status: Published Journal Publication published 12 Sep, 2024 Read the published version in Scientific Reports → Version 1 posted Editorial decision: Accepted 06 Sep, 2024 Reviews received at journal 14 Jul, 2024 Reviewers agreed at journal 22 Jun, 2024 Reviewers agreed at journal 21 Jun, 2024 Reviewers agreed at journal 17 Jun, 2024 Reviewers invited by journal 11 Jun, 2024 Editor assigned by journal 11 Jun, 2024 Editor invited by journal 04 Jun, 2024 Submission checks completed at journal 31 May, 2024 First submitted to journal 26 May, 2024 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. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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-4481266","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":313638512,"identity":"c68a7939-c5ad-42d9-ac62-ea2c9206a4b6","order_by":0,"name":"Frieder Dechent","email":"","orcid":"","institution":"Universitäre Psychiatrische Kliniken Basel","correspondingAuthor":false,"prefix":"","firstName":"Frieder","middleName":"","lastName":"Dechent","suffix":""},{"id":313638513,"identity":"81667984-0e8c-42d9-941c-0d108fa6507b","order_by":1,"name":"Gwendolyn Mayer","email":"data:image/png;base64,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","orcid":"","institution":"University Hospital Heidelberg","correspondingAuthor":true,"prefix":"","firstName":"Gwendolyn","middleName":"","lastName":"Mayer","suffix":""},{"id":313638514,"identity":"5906542d-4097-4f79-b8f9-2e1a22923931","order_by":2,"name":"Svenja Hummel","email":"","orcid":"","institution":"University Hospital Heidelberg","correspondingAuthor":false,"prefix":"","firstName":"Svenja","middleName":"","lastName":"Hummel","suffix":""},{"id":313638515,"identity":"4843717e-601b-4610-9713-24fce032a047","order_by":3,"name":"Moritz Steffen","email":"","orcid":"","institution":"University Medical Center Hamburg-Eppendorf","correspondingAuthor":false,"prefix":"","firstName":"Moritz","middleName":"","lastName":"Steffen","suffix":""},{"id":313638516,"identity":"c8ce8a32-8959-4ee7-a035-846c68d4d453","order_by":4,"name":"Charles Benoy","email":"","orcid":"","institution":"Centre Hospitalier de Luxembourg","correspondingAuthor":false,"prefix":"","firstName":"Charles","middleName":"","lastName":"Benoy","suffix":""},{"id":313638517,"identity":"4b613ec4-111f-4a5f-ab62-e75aff321167","order_by":5,"name":"Rosa Almeida","email":"","orcid":"","institution":"Fundación INTRAS","correspondingAuthor":false,"prefix":"","firstName":"Rosa","middleName":"","lastName":"Almeida","suffix":""},{"id":313638518,"identity":"975f13d2-1b17-4eb4-a1bc-00c0c5394653","order_by":6,"name":"Raquel Losada Duran","email":"","orcid":"","institution":"Fundación INTRAS","correspondingAuthor":false,"prefix":"","firstName":"Raquel","middleName":"Losada","lastName":"Duran","suffix":""},{"id":313638519,"identity":"25f9b448-a9d4-4e13-8d95-d0c7b0ea6aec","order_by":7,"name":"Oscar Ribeiro","email":"","orcid":"","institution":"University of Aveiro","correspondingAuthor":false,"prefix":"","firstName":"Oscar","middleName":"","lastName":"Ribeiro","suffix":""},{"id":313638520,"identity":"43e5335d-1f89-4096-9c42-a4d7f783cad8","order_by":8,"name":"Vincenza Frisardi","email":"","orcid":"","institution":"IRCCS Azienda Ospedaliero Universitaria di Bologna","correspondingAuthor":false,"prefix":"","firstName":"Vincenza","middleName":"","lastName":"Frisardi","suffix":""},{"id":313638521,"identity":"0e3426cb-72d4-4fe9-86d1-91d5e99fb342","order_by":9,"name":"Ilaria Tarricone","email":"","orcid":"","institution":"University of Bologna","correspondingAuthor":false,"prefix":"","firstName":"Ilaria","middleName":"","lastName":"Tarricone","suffix":""},{"id":313638522,"identity":"de6d4355-9e9d-4068-98ee-92d38b8ddbf6","order_by":10,"name":"Silvia Ferrari","email":"","orcid":"","institution":"University of Modena and Reggio Emilia","correspondingAuthor":false,"prefix":"","firstName":"Silvia","middleName":"","lastName":"Ferrari","suffix":""},{"id":313638523,"identity":"2f64a90b-c879-4bb6-8ccf-423344b33857","order_by":11,"name":"Cedric Lemogne","email":"","orcid":"","institution":"Hôpital Corentin-Celton","correspondingAuthor":false,"prefix":"","firstName":"Cedric","middleName":"","lastName":"Lemogne","suffix":""},{"id":313638524,"identity":"7ea1abdf-0727-428e-9df6-c072ded10d0a","order_by":12,"name":"Christian Huber","email":"","orcid":"","institution":"Universitäre Psychiatrische Kliniken Basel","correspondingAuthor":false,"prefix":"","firstName":"Christian","middleName":"","lastName":"Huber","suffix":""},{"id":313638525,"identity":"90009914-8065-4273-b08d-81e5deaec8a4","order_by":13,"name":"Steffi Weidt","email":"","orcid":"","institution":"Psychiatrie St. Gallen","correspondingAuthor":false,"prefix":"","firstName":"Steffi","middleName":"","lastName":"Weidt","suffix":""},{"id":313638531,"identity":"eaaa48c8-bfb7-47e2-a83b-bdf7d2c5769c","order_by":14,"name":"Jobst-Hendrik Schultz","email":"","orcid":"","institution":"University Hospital Heidelberg","correspondingAuthor":false,"prefix":"","firstName":"Jobst-Hendrik","middleName":"","lastName":"Schultz","suffix":""}],"badges":[],"createdAt":"2024-05-26 20:08:21","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4481266/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4481266/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1038/s41598-024-72396-x","type":"published","date":"2024-09-12T15:56:54+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":64618894,"identity":"f523df7f-34ab-4a58-85d8-05f664fdefa0","added_by":"auto","created_at":"2024-09-16 16:06:41","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1165156,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4481266/v1/eb3feb41-984c-40cf-a001-fac8fddd0401.pdf"},{"id":58276847,"identity":"fb6ca0b0-5898-4b46-9f90-1676dd369c58","added_by":"auto","created_at":"2024-06-13 09:53:00","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":13439,"visible":true,"origin":"","legend":"","description":"","filename":"supplementaryfile1.docx","url":"https://assets-eu.researchsquare.com/files/rs-4481266/v1/356aa46ee543f9b90de96fa1.docx"},{"id":58276848,"identity":"61a51e61-86cd-4920-a2d9-65a915e244b7","added_by":"auto","created_at":"2024-06-13 09:53:00","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":15238,"visible":true,"origin":"","legend":"","description":"","filename":"supplementaryfile2.docx","url":"https://assets-eu.researchsquare.com/files/rs-4481266/v1/4d3ea2566cc8489733503017.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"­­COVID-19 and mental distress among health professionals in eight European countries during the third wave: a cross-sectional survey ","fulltext":[{"header":"Introduction","content":"\u003ch2\u003eBackground\u003c/h2\u003e\n\u003cp\u003eAfter more than 3 years, the burden of disease in the general population due to the COVID-19 pandemic remains very high, with a total of over half a billion confirmed cases and more than 6 million deaths concerning Covid-19 [1]. Calculations of disability-adjusted life years (DALYs) with a loss of 305,641 life years in Germany [2] and 30,181 life years in Denmark [3] even more emphasize the severe consequences of COVID-19 in the European population. Various protective measures such as lockdowns, social distancing regulations, or vaccinations were imposed to contain the medical consequences [4], however an end of the Covid-19 impact is not in sight. This high burden of disease also places a particularly high burden on the health systems and, in association, on the mental health of health care professionals\u0026nbsp;[5, 6]. Although there is no compelling evidence that the impact of the pandemic on mental health was more pronounced in health care professionals than in the general population [7, 8], there is considerable heterogeneity in this matter and much remains to be studied with regards to the identification of specific risk factors in this population.\u003c/p\u003e\n\u003cp\u003eMuch research so far has been done on the people who work in the health system and their mental distress. For example, in April 2020 numerous professionals in the health system in Spain showed symptoms of post-traumatic stress disorder, anxiety disorders, and depression, with women and younger people showing an increased risk [9]. A Portuguese study among physicians in 2020 showed that working directly with patients with COVID-19 also led to more symptoms of stress, depression, and anxiety, with female physicians being particularly affected [10]. A follow-up study over a year showed a significant decrease in stress and depression values, but the authors found a prospective connection between depression, stress, and symptoms of a post-traumatic stress disorder. Moreover, the female gender, but also the fear of being infected or infecting people close to them, and the reported insufficient access to protective material were identified as risk factors [11]. A higher burden on nurses in comparison to the physicians could be demonstrated in multiple studies [9, 12-15].\u003c/p\u003e\n\u003cp\u003eIn addition to the professional group affiliation, direct contact with patients with COVID-19 and the respective medical ward also seem to play a role\u0026nbsp;[16]. The workload in intensive care units in particular has been observed to directly increase mental health symptoms of the employees. This was particularly the case in England, where the number of ICU staff with mental health symptoms was high in younger nurses and fluctuated depending on the severity of the second wave [17]. In a study in Switzerland working in intensive care units was described with increased symptoms of anxiety and depression [18].\u003c/p\u003e\n\u003cp\u003eInvestigating factors causing distress during the pandemic, the role of information and media consumption needs special consideration. Even before the outbreak of the COVID-19 pandemic social media consumption played a major role in mental well-being. A study showed that the emotions expressed by others on social media have an impact on the emotions of the user [19]. Current studies about the impact of social media use during the COVID-19 pandemic have also shown an increased mental burden on people who increasingly obtain their information in social networks [20, 21] and even chronic stress and panic have been observed due to the so called \u0026quot;infodemic\u0026quot; that comprises the fact that misinformation have been spread as a kind of \u0026quot;digital epidemic\u0026quot; [22]. However, little is known about the potential role of social media exposure on psychological distress among healthcare professionals.\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eObjectives of the study\u003c/h2\u003e\n\u003cp\u003eThis study aims at understanding the mental health and its conditions of physicians, nurses, other medical staff and non-medical professionals in the health care system of 8 European countries during the third wave of COVID-19 with increased sanitary measures in Europe.\u003c/p\u003e\n\u003cp\u003eWe aimed to focus on risk factors either specific to health-care professionals (e.g., working in ICU) or non-specific but overlooked so far in this specific population (e.g., exposure to social media).\u003c/p\u003e\n\u003cp\u003eA key focus was put on the professional groups of physicians and nurses with regard to the severity of symptoms in their respective ward, stressors, working hours, and sources of COVID-related information.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design and procedures\u003c/h2\u003e \u003cp\u003eA cross-sectional survey was carried out by means of an online questionnaire that has been developed for the purpose of this and two former studies, that were carried out in 2020 [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. The questionnaire was made available on SoSciSurvey [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e] and distributed within Europe in six languages (English, French, German, Italian, Portuguese, and Spanish). The link to the survey was distributed via email to personal and professional networks following a snowball sampling approach. Invitation emails were sent to colleagues at affiliations of all co-authors, i.e. clinical and research institutions in, France, Germany, Italy, Luxembourg, Portugal, Spain and Switzerland. It was then further distributed to related institutions and to partner organizations, hospitals, and professional associations. Participants were also recruited via personal networks or public social networking groups, such as medical or nursing groups at Twitter, LinkedIn, and Facebook. The survey was launched on 25th November 2021 and closed on 28th February 2022.\u003c/p\u003e \u003cp\u003eThe qualitative results of this survey that included answers in open text fields in this study period and those of the former study period were published elsewhere [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWe follow the reporting guidelines of the STROBE statements for observational studies [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eEthical considerations\u003c/h2\u003e \u003cp\u003e The study was performed in accordance Declaration of Helsinki and was approved by the ethics committee of the Heidelberg University Medical Faculty (S-361/2020). Data collection was organized in compliance with the European General Data Protection Regulation (GDPR). The survey questionnaire was distributed in 8 European countries and all healthcare workers and associated staff at hospitals as well as non-medical staff were eligible to participate. Informed consent was obtained from the participants online prior to participation. No allowance was given for participating in the survey. All questionnaires were completed anonymously. Data security was granted by use of the SSL-encrypted platform SoSci Survey [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eMeasures\u003c/h2\u003e \u003cp\u003eThe questionnaire has been described in detail in a former publication [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. However, as some parts have been changed due to new requirements, the structure of the questionnaire will be repeated and the new sections described: in the first part, we asked for demographic data, exposure to people infected with COVID-19 in their daily life and at work, working hours per day, and the means by which people gain information about COVID-19 (multiple choice: Internet, social media, TV, communication with colleagues, other). Similar to the previous study [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e] we asked the mental health status using the short version of the Depression-Anxiety Stress Scale (DASS-21) [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e] and for stressors of nurses and physicians that has been derived from a previous study during SARS epidemic in 2003 [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. The DASS questionnaire consists of 21 questions, seven each of which belong to the depression, anxiety, and stress subscale. Responses are given on a 4-point Likert scale ranging from \u0026ldquo;did not apply to me at all\u0026rdquo; = 0, to \u0026ldquo;applied to me very much or most of the time\u0026rdquo; = 3. The point values of each subscale are then multiplied by 2 for evaluation.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eData Analysis\u003c/h2\u003e \u003cp\u003eThe data was analyzed with IBM SPSS statistics 26 [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. We collected data of 1,439 participants and removed all datasets that were filled out outside the targeted countries (n\u0026thinsp;=\u0026thinsp;41). The final analysis comprised data of 1,398 participants. Missing values were omitted from the calculations without replacement.\u003c/p\u003e \u003cp\u003eWe calculated descriptive statistics and reported frequencies, means, standard deviations, and percentages.\u003c/p\u003e \u003cp\u003eFollowing the manual of the DASS-21 [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e], individual sum scores were calculated based on the depression, anxiety and stress subscales and multiplied by two. The depression subscale score was categorized as normal (0\u0026ndash;9), mild (10\u0026ndash;13), moderate (14\u0026ndash;20), severe (21\u0026ndash;27), and very severe depression (28+). The anxiety subscale score was categorized as normal (0\u0026ndash;7), mild (8\u0026ndash;9), moderate (10\u0026ndash;14), severe (15\u0026ndash;19), and extremely severe anxiety (20+). The total stress subscale score was categorized as normal (0\u0026ndash;14), mild (15\u0026ndash;18), moderate (19\u0026ndash;25), severe (26\u0026ndash;33), and extremely severe stress (34+) [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. These subscales were then grouped as normal/mild; moderate; severe/very severe, following our previous approaches to ease the interpretation [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e], as mild symptoms of mental disorders show a high prevalence regardless of a pandemic like COVID-19 [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWe created four groups: 1) physicians (including physicians and dentists), 2) nurses, 3) other health care professionals, which included \"other job in healthcare system\" and \"volunteer in the context of medical pandemic aid\", and 4) non-medical staff consisting of professionals who usually do not work directly with the patients or their immediate environment.\u003c/p\u003e \u003cp\u003eA multivariate analysis of covariance (MANCOVA) was computed for each of the three DASS-21 scores as the dependent variable, with the two predictors being the profession group and contact with people infected by COVID at work, and working hours per week, own infection with COVID, country where the participant is actually living, age and gender as a covariate. We chose a robust test statistic of Pillai in case of violation of assumptions of normality and homogeneity of covariance matrices. We chose a robust test statistic of Pillai in case of violation of assumptions of normality and homogeneity of covariance matrices [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e We then focused on the groups of physicians and nurses only for whom we reported the three DASS-21 scores according to medical departments, as well as major stressors. A t-test was carried out for differences. Major ways of gaining information on COVID were calculated as frequencies and percentages. On the basis of this data, we carried out chi-square tests to find differences between the two groups. Finally, Eta-coefficients were calculated to show associations between DASS-21 scores and the use of information sources.\u003c/p\u003e \u003cp\u003eIn all analyses, p values\u0026thinsp;\u0026lt;\u0026thinsp;.05 were considered statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eParticipants\u003c/h2\u003e \u003cp\u003eThe sample size was 1,398 people, of whom 237 were physicians, 459 were nurses, 351 comprised other healthcare professionals and 351 were non-medical professionals. The group of other health professionals consisted mainly of psychologists, educators, laboratory technicians, occupational therapists dance and movement therapists, pharmacists, and medical-technical assistants. The group of non-medical professionals was very heterogeneous. This group consisted mainly of administrative employees, secretaries, researchers, educators, and computer scientists. The ages of the participants ranged from 19 to 78 (median: 42 years). A total of 369 (26.4%) males, 1,024 (73.2%) females, and 5 non-binary people (0.4%) took part in the survey.\u003c/p\u003e \u003cp\u003eThe distribution of people across countries is shown in Table \u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The distribution of the professional groups in the different countries are provided in the supplementary file 1.\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\u003eDemographic characteristics of the study participants from November 2021 to February 2022 in 8 European countries\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=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eParticipants, n (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eAge (years), mean (SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42.22 (10.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e369 (26.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1,024 (73.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNon-binary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (0.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCountry\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBelgium\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e93 (6.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e322 (23.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGermany\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e243 (17.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eItaly\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e120 (8.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLuxemburg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e348 (24.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePortugal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44 (3.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSpain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44 (3.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSwitzerland\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e184 (13.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWhat is the population of the city you are living?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eless than 5,000 inhabitants\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e375 (26.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ebetween 5,000 and 20,000 inhabitants\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e400 (28.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ebetween 20,000 and 100,000 inhabitants\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e259 (18.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ebetween 100,000 and 500,000 inhabitants\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e273 (19.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003emore than 500,000 inhabitants\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e91 (6.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEducation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSecondary education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e97 (6.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePost-secondary non-tertiary education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e331 (23.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFirst stage of tertiary education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e793 (56.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSecond stage of tertiary education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e173 (12.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrimary or lower\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (0.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMarital Status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e233 (16.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e644 (46.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDivorced\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e102 (7.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWidowed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (0.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIn relationship\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e393 (28.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19 (1.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eChildren\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e841 (60.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e557 (39.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eProfession\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePhysician\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e234 (16.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDentist\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (0.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e459 (32.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther healthcare professionals\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e351 (25.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNon-medical professionals\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e351 (25.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e1,398 (100)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eVaccination status and working conditions during COVID-19 during the third wave of the COVID-19 pandemic\u003c/h2\u003e \u003cp\u003eResults on the share of participants with infection, vaccination, contact to COVID at work, working hours and the respective medical unit are displayed in Table \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\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 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eInfection, Vaccination, Contact to COVID at work, Working hours and Medical Unit (frequencies and percentages)\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=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eParticipants \u003c/p\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eAre/ were you infected with COVID-19?\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e295 (21.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1,085 (77.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHave you already received a COVID-19 vaccine?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes, I have received the first dose of the COVID-19 vaccine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36 (2.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes, I have received two doses on the COVID-19 vaccine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e390 (27.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo, I have not received a COVID-19 vaccine.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e108 (7.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes, I have received three doses on the COVID-19 vaccine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e864 (61.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDo you have contact at work with people infected with COVID-19?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1,027 (73.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e371 (26.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWorking hours per week\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;20h\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32 (2.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20-30h\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e78 (5.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30-40h\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e298 (21.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40-50h\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e506 (36.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e50-60h\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e268 (19.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e60-70h\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e136 (9.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;70h\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e80 (5.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIn which medical unit do you work? (only for medical staff)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eICU\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e99 (7.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGeneral inpatient department\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e316 (22.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOutpatient department\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e98 (7.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEmergency department\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e53 (3.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDoctor's office\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42 (3.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAmbulant care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e528 (37.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e87 (6.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003cp\u003eMissing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1,223 (87.5)\u003c/p\u003e \u003cp\u003e175 (12.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e1,398 (100)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eOpportunity to work from home (\u0026ldquo;home office\u0026rdquo;)\u003c/h2\u003e \u003cp\u003eIn Table \u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e professional groups are presented who had the opportunity to work remotely.\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 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eProfessional groups who reported to be able to work remotely from November 2021 to February 2022 in 8 European countries\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\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 \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProfession\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eParticipants, n (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePhysician\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e39 (16.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e32 (7.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther healthcare professionals\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e73 (20.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-medical professionals\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e175 (49.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e319 (22.8)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eMental Health (DASS-21)\u003c/h2\u003e \u003cp\u003eAcross all professions and countries, a share of 23.3% (n\u0026thinsp;=\u0026thinsp;326) report levels of depression that can be categorized as a severe/very severe degree. A share of 18.2% (n\u0026thinsp;=\u0026thinsp;255) express severe/very severe levels of anxiety and 25.4% (n\u0026thinsp;=\u0026thinsp;355) voice severe/very severe levels of stress. Nurses and non-medical staff show the highest degree of burden in all three symptom profiles. More details are presented in Table \u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e. Details of DASS-21 scores in the different countries are provided in the supplementary file 2.\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 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eResults for the Depression Anxiety and Stress Scales-21 (DASS-21) for doctors, nurses, Other healthcare professionals and non-medical professionals from November 2021 to February 2022 in 8 European countries (means, standard deviations, frequencies and percentages)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eParticipants, n\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMean (SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003enormal/mild, n (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003emoderate, n (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003esevere/very severe, n (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003eDASS-21 depression\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePhysicians\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e237\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10.71 (11.03)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e160 (67.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e33 (13.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e44 (18.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNurses\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e459\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13.14 (11.09)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e261 (56.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e85 (18.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e113 (24.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther healthcare professionals\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e351\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c7\" namest=\"c4\"\u003e \u003cp\u003e12.17 (11.21) 212 (60.4) 60 (17.1) 79 (22.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNon-medical professionals\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e351\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c7\" namest=\"c4\"\u003e \u003cp\u003e13.14 (11.21) 200 (57.0) 61 (17.4) 90 (25.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e1398\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e12.48 (11.10)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e833 (59.6)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e239 (17.1)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e326 (23.3)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDASS-21 anxiety\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePhysicians\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e237\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.42 (7.36)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e186 (78.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e29 (12.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e22 (9.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNurses\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e459\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8.55 (8.87)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e294 (64.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e64 (13.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e101 (22.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther healthcare professionals\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e351\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c7\" namest=\"c4\"\u003e \u003cp\u003e7.72 (8.44) 236 (67.2) 55 (15.7) 60 (17.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNon-medical professionals\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e351\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c7\" namest=\"c4\"\u003e \u003cp\u003e8.86 (9.63) 214 (61.0) 65 (18.5) 72 (20.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003etotal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e1398\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e7.89 (8.80)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e930 (66.5)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e213 (15.2)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e255 (18.2)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDASS-21 stress\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePhysicians\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e237\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16.15 (11.01)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e149 (62.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e35 (14.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e53 (22.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNurses\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e459\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17.45 (11.18)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e272 (59.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e67 (14.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e120 (26.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther healthcare professionals\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e351\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c7\" namest=\"c4\"\u003e \u003cp\u003e16.93 (11.08) 212 (60.4) 56 (16.0) 83 (23.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNon-medical professionals\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e351\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c7\" namest=\"c4\"\u003e \u003cp\u003e17.56 (11.81) 196 (55.8) 56 (16.0) 99 (28.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003etotal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e1398\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e17.13 (11.29)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e829 (59.3)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e214 (15.3)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e355 (25.4)\u003c/b\u003e\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\u003eComparison of the mental health of physicians, nurses, other healthcare professionals and non-medical professionals and the professionals having contact with COVID patients vs. having no contact\u003c/b\u003e \u003c/p\u003e \u003cp\u003eA statistical analysis with a MANCOVA with the working hours per week, possibility to work from home (\u0026ldquo;home office\u0026rdquo;), own infection with COVID, country where the participant is actually living, age and gender showed a significant effect for profession (Pillai trace\u0026thinsp;=\u0026thinsp;0.016, F\u003csub\u003e3,000\u003c/sub\u003e=2,479, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.008) and also for the fact of being in contact with COVID-19 patients or not (Pillai trace\u0026thinsp;=\u0026thinsp;0.007, F\u003csub\u003e3,000\u003c/sub\u003e=3,432, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.016). The covariates showed also significant results (Working hours (Pillai trace\u0026thinsp;=\u0026thinsp;0.030, F\u003csub\u003e3,000\u003c/sub\u003e=14,163, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001); own infection with COVID-19 (Pillai trace\u0026thinsp;=\u0026thinsp;0.009, F\u003csub\u003e3,000\u003c/sub\u003e=4,361, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.005); country (Pillai trace\u0026thinsp;=\u0026thinsp;0.013, F\u003csub\u003e3,000\u003c/sub\u003e=5,916, P\u0026thinsp;\u0026lt;\u0026thinsp;.001); age (Pillai trace\u0026thinsp;=\u0026thinsp;0.017, F\u003csub\u003e3,000\u003c/sub\u003e=7,788, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001); gender (Pillai trace\u0026thinsp;=\u0026thinsp;0.021, F\u003csub\u003e3,000\u003c/sub\u003e=9,843, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001).\u003c/p\u003e \u003cp\u003eIn the between-subject analysis for profession in two of three DASS-scores showed significant results (DASS-D P\u0026thinsp;\u0026lt;\u0026thinsp;.023, DASS-A P\u0026thinsp;\u0026lt;\u0026thinsp;.001, DASS-S P\u0026thinsp;=\u0026thinsp;0.308). Physicians showed in all three DASS-scores the lowest scores (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). For the people having contact at work with COVID-patients all three DASS-scores showed a significant difference (DASS-D P\u0026thinsp;=\u0026thinsp;.001, DASS-A\u0026thinsp;=\u0026thinsp;0.032, DASS-S P\u0026thinsp;=\u0026thinsp;.016).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eMental health in the medical units and workload of physicians and nurses\u003c/h2\u003e \u003cp\u003eDepending on the workplace, the highest values on all three scales were found among staff in the intensive care units, ahead of staff in the general medical units and the emergency units (Table \u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\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 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eResults for the Depression Anxiety and Stress Scales-21 (DASS-21) of physicians and nurses in the medical units (N\u0026thinsp;=\u0026thinsp;696) from November 2021 to February 2022 in 8 European countries (means and standard deviations)\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\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN*\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDass-21 Depression\u003c/p\u003e \u003cp\u003eM (SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eDass-21 Anxiety\u003c/p\u003e \u003cp\u003eM (SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eDass-21 Stress\u003c/p\u003e \u003cp\u003eM (SD)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eICU\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15.04 (11.40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e9.95 (9.28)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e20.21 (11.65)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGeneral inpatient department\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e231\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12.00 (10.84)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6.97 (8.54)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e16.53 (10.43)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOutpatient department\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11.44 (11.41)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6.69 (7.57)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e15.54 (10.83)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmergency department\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10.23 (9.85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5.67 (6.82)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e15.91 (9.10)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePhysician's office\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9.95 (11.68)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.74 (7.95)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e13.79 (11.70)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAmbulant care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e165\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11.60 (11.05)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7.58 (8.66)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e16.40 (11.84)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther medical departments\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14.59 (10.95)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8.88 (7.92)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e19.78 (10.97)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTotal/mean\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e687\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e12.25 (11.06)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e7.43 (8.47)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e16.98 (\u003c/b\u003e11.11)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e*missing: n\u0026thinsp;=\u0026thinsp;9\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eOver all four groups the correlation of working hours and DASS-21 Depression was significant with r (1396)\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;.09 (p* = .001), while DASS-21 Anxiety was r(1396)\u0026thinsp;=\u0026thinsp;.03 (p\u0026thinsp;=\u0026thinsp;.35), and Dass-21 Stress was r (1396)\u0026thinsp;=\u0026thinsp;.14 (p* \u0026lt; .001).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eJob-related stressors of physicians and nurses\u003c/h2\u003e \u003cp\u003eAmong the medical staff, \u0026ldquo;uncertainty about when the epidemic will be under control\u0026rdquo; was rated highest, followed by \u0026ldquo;worry about inflicting COVID-19 on family\u0026rdquo;, \u0026ldquo;worry about lack of manpower\u0026rdquo;, \u0026ldquo;frequent modification of infection control procedures\u0026rdquo;, and \u0026ldquo;coworkers being emotionally unstable\u0026ldquo;. Participants were less concerned about to get blamed by their commanding officers. An overview of all stressors in the order of reported severity can be found in Table \u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e. Overall, all stressors were rated to a higher level by nurses than physicians.\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 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eStressors for physicians (n\u0026thinsp;=\u0026thinsp;237) and nurses (n\u0026thinsp;=\u0026thinsp;459) during COVID-19 from November 2021 to February 2022 in 8 European countries (means and standard deviations)\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=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItems\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ephysicians\u003c/p\u003e \u003cp\u003eMean (SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003enurses\u003c/p\u003e \u003cp\u003eMean (SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAll\u003c/p\u003e \u003cp\u003eMean (SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUncertainty about when the epidemic will be under control\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.86 (0.95)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.20 (0.85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.08 (0.90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWorry about inflicting COVID-19 on family\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.74 (1.09)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.16 (0.96)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.02 (1.02)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWorry about lack of manpower\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.73 (1.07)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.09 (1.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.97 (1.04)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFrequent modification of infection control procedures\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.55 (0.92)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.83 (0.97)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.73 (0.96)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCoworkers being emotionally unstable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.30 (0.98)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.74 (0.99)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.59 (1.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePatients\u0026rsquo; emotional reaction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.21 (0.93)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.69 (0.99)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.53 (0.99)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDeterioration of patients\u0026rsquo; condition\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.21 (0.97)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.68 (1.03)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.52 (1.04)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProtective gears cause physical discomfort\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.24 (0.96)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.64 (1.09)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.50 (1.06)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePatient families\u0026rsquo; emotional reaction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.12 (0.96)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.60 (1.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.44 (1.01)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWorry about nosocomial (=\u0026thinsp;intra-hospital) spread\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.30 (0.96)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.47 (1.03)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.41 (1.01)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.036\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWorry about getting infected\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.21 (0.94)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.52 (1.01)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.41 (1.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConflict between duty and safety\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.00 (0.95)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.45 (0.99)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.30 (0.98)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBeing without properly fitted environment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.07 (1.02)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.37 (1.06)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.27 (1.06)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDocumentation and reporting procedures unclear\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.06 (0.98)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.37 (1.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.26 (1.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWorry about being negligent and endangering patients\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.11 (0.99)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.32 (1.07)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.25 (1.04)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.005\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWorry about lack of proper knowledge and equipment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.00 (0.93)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.26 (1.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.17 (0.99)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProtective gears being a drag in providing quality care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.86 (0.98)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.29 (1.04)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.15 (1.04)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBe infected by the colleagues\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.87 (0.88)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.22 (1.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.10 (0.97)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCoworkers displaying COVID-19-like symptoms\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.76 (0.82)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.26 (0.99)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.09 (0.96)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEquivocal definition of the responsibility between doctors and nurses\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.67 (0.88)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.29 (1.03)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.08 (1.02)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYourself displaying COVID-19-like symptoms\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.78 (0.87)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.19 (1.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.05 (0.98)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWorry about being negligent and endangering coworkers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.84 (0.87)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.05 (1.02)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.98 (0.97)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBlaming from commanding officers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.49 (0.81)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.04 (1.10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.85 (1.04)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003csup\u003ea\u003c/sup\u003eResponses to the question: \u0026ldquo;When you think about COVID-19 in your life and work, how often did you think or worry about the following things?\u0026rdquo; (0\u0026thinsp;=\u0026thinsp;not at all, 3\u0026thinsp;=\u0026thinsp;very much)\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eInformation on COVID-19\u003c/h2\u003e \u003cp\u003eIn Table \u003cspan refid=\"Tab7\" class=\"InternalRef\"\u003e7\u003c/span\u003e, we see the different sources of information. Both television and social media were less frequently reported by physicians as being a main source of information about COVID-19 (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab7\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 7\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAnswers to the question \u0026ldquo;How do you mainly inform yourself about COVID-19?\u0026rdquo; given by physicians and nurses from November 2021 to February 2022 in 8 European countries (frequencies and percentages or respective n; multiple choice possible)\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\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMedium\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eParticipants, n (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePhysicians\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNurses\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNewspaper\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e92 (38.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e230 (50.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e322 (46.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e73 (30.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e268 (58.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e341 (49.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSocial media\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e31 (13.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e142 (30.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e173 (24.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInternet\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e165 (69.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e276 (60.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e441 (63.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCommunication with Colleagues\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e145 (61.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e305 (66.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e460 (64.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e54 (22.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e66 (14.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e120 (17.3)\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\u003eA further analysis revealed a weak positive association in the depression, stress, and anxiety scales with the use of social media as a main source of information about COVID-19 (DASS-D \u003cem\u003eη\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.05; DASS-A \u003cem\u003eη\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.11; DASS-S \u003cem\u003eη\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.88). More associations could be shown for television and internet, but only in the case of anxiety (DASS-A \u003cem\u003eη\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.05 and \u003cem\u003eη\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.06 respectively).\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003ePrincipal Findings\u003c/h2\u003e \u003cp\u003eOne of our main findings in this European wide study is that nurses and other medical and non-medical health workers had higher scores in depression and anxiety scores as measured by the DASS-21 in comparison to physicians. The study was carried out to ask for symptoms and predictors of the mental health of physicians, nurses, and other professions in and outside of direct patient care during the third wave of the pandemic in winter 2021/2022. In the analysis, we considered frequently described risk factors such as age, gender, workload and country of residence of the participants. In total, the proportion of nurses with moderate and severe depression was higher than that of physicians. For anxiety, too, the proportion of nurses in the moderate and severe categories was higher. Similar findings were also reported in different studies and reviews [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. In a Belgian sample, there was no direct influence of whether someone works directly with COVID patients, but rather an influence of the professional group on burnout and anxiety symptoms as well as on insomnia [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. A study of Italian health professionals showed that nurses suffered more from overall psychological distress than physicians [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. This difference was also demonstrated in a Belgian study [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. An Italian study [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e] revealed a significantly higher risk for nurses and explained this, among other things, by the fact that nurses were less involved in the decision-making processes and also spent significantly more time directly exposed to the infectious patients during their work.\u003c/p\u003e \u003cp\u003eAnother main finding of our study was the correlation between the stress and depression scores and the working hours. This association can be supported by previous studies [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. A Dutch investigation was able to show a connection between an increase in the prevalence of burnout, the occurrence of COVID-19, direct contact with COVID-19 patients, and the hours worked by professionals in ICUs [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePhysicians and nurses who worked directly with COVID-19 patients also had higher values in all DASS scores in our study. This correlation is also described in other studies [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. A similar association was found in an Australian sample, for example, where caregivers with direct contact with COVID-19 patients had the most pronounced emotional exhaustion, while non-medical professionals with no contact had the lowest scores [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. A meta-analysis showed higher values for anxiety and depression in the group of professionals with contact to COVID-19 patients [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. In this meta-analysis, women, married individuals, individuals with children, and nurses had relatively high scores. In summary, in addition to one's own exposure, fear for family members seems to play an important role through the fear of infecting them through one's own exposure. Other fears referred to staff shortage as well as the often-increased contact with seriously ill patients or the concern about the deterioration of their condition. Compared to the previous first-wave study by Hummel et al. [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e] who used a comparable design, similar overall values were shown in the individual DASS scores, although it must of course be added that this is not a follow-up study.\u003c/p\u003e \u003cp\u003eThe most frequently mentioned stressors were \u0026ldquo;Uncertainty about when the epidemic will be under control\u0026rdquo; and \u0026ldquo;Worry about inflicting COVID-19 on family\u0026rdquo;, which were the same as in the previous study [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Especially the worry about infecting the family which was also described before [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. For the stressors, the nurses consistently showed higher mean values than did the physicians, which basically fits with the mental burden of the nurses described above. What could be explained by the longer duration they have to work directly with the patients. In addition to the other stressors, deficits in the acquisition of knowledge are weighted significantly higher by the nurses than by the practitioners. Other results of our survey that included as well coping strategies, have been published elsewhere [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. There, the acquisition of knowledge was also a successful coping strategy. There still seems to be a stressor in the third wave of the pandemic, although this problem was already recognized at the beginning of the pandemic [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]. This result is also comparable to former results that describe even a worsening of mental distress but in non-comparable time periods [\u003cspan additionalcitationids=\"CR45\" citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAnother important result of our study was the correlation of the use of social media with higher values in all DASS scales, although this connection could not be seen for other sources of information. A possible explanation might argue that increased social media use and the associated increased exposure to corresponding content were associated with increased anxiety [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Interestingly, this connection has already been revealed by an experimental study before the pandemic [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e], where the reduction of positive expressions led to fewer positive and more negative posts, and the reduction of negative posts led to opposite findings. On the other hand, loneliness, isolation, workload and fears might increase the use of social media as a means of compensation especially in the case of nurses who were burdened to a certain extent [\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e]. We found a weak positive correlation of social media use and DASS-scores. In line with the literature this should be interpreted as an indication why increased use of social media is associated with more stress and the associated increased values in the DASS scores in our study. Whether more stress leads to increased use of social media or a higher frequency of social media use evokes higher stress levels cannot be derived from our study. Future investigations are necessary to come to a causal conclusion regarding mental health and social media use in specific professional groups.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eSince the link to the online survey was distributed on the one hand through personal contacts and on the other hand via social networks, there was a very unequal distribution of the professional groups and of the gender of the participants in the different countries. In addition, non-occupational factors, such as the strictness of measures and the different dynamics of the pandemic in the individual countries over the survey period, certainly also played a role in mental health. We neither asked for details of institutional and governmental measures nor for the willingness of the participants to follow them. Overall, the participants cannot all be assigned to medical specialties or work areas, so that there could be an overrepresentation of employees in psychiatry. When asked about the sources of information, specific scientific journals were not asked about as a source of information for the participants. This can lead to a bias in the results, since a significant group of people and possibly a possible difference between the professional groups were not shown.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn summary, our study continued to provide numerous indications that the COVID-19 pandemic continued to be a significant stress factor for the healthcare system. When scores for stress were not statistically different, we found as a main result that that nurses scored significantly higher on depression and anxiety than practitioners. These differences were also reflected in the different levels of stressors that we evaluated for nurses and physicians. In addition to the positive correlation of working hours with stress and depression and the positive connection between direct contact with COVID-19 patients and increased anxiety, depression, and stress, the highest psychological burden was shown in employees of intensive care units. As a secondary result we found a weak positive correlation between social media use and the DASS-scores Further researches are needed to clarify the role of social digital media as negative \u003cem\u003einfluencer\u003c/em\u003e on the mental health of healthcare professionals.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003ch2\u003eConflict of interests\u003c/h2\u003e \u003cp\u003eThe authors declare no conflict of interests.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eFD and GM contributed equally, they analysed the data and wrote the main manuscript text, SH reviewed the statistics, SM, CB, RA, RLD, OR, VF, IT, SF and CL collected data, CH, SW and JHS conceptualized the study and supervised the project. All authors reviewed the manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eWe thank all participants for sharing their experiences and taking part in our study. For the publication fee we acknowledge financial support by Deutsche Forschungsgemeinschaft within the funding programme \u0026bdquo;Open Access Publikationskosten\u0026ldquo; as well as by Heidelberg University.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWorld Health Organization. COVID-19 Weekly Epidemiological Update. 3 8 2022 2022.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRommel A, von der Lippe E, Pla\u0026szlig; D, Ziese T, Diercke M, an der Heiden M, et al. The COVID-19 Disease Burden in Germany in 2020. Dtsch Arztebl Int 2021. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3238/arztebl.m2021.0147\u003c/span\u003e\u003cspan address=\"10.3238/arztebl.m2021.0147\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePires SM, Redondo HG, Espenhain L, Jakobsen LS, Legarth R, Meaidi M, et al. Disability adjusted life years associated with COVID-19 in Denmark in the first year of the pandemic. BMC Public Health 2022;22:1315. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s12889-022-13694-9\u003c/span\u003e\u003cspan address=\"10.1186/s12889-022-13694-9\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGe Y, Zhang W-B, Wu X, Ruktanonchai CW, Liu H, Wang J, et al. Untangling the changing impact of non-pharmaceutical interventions and vaccination on European COVID-19 trajectories. Nat Commun 2022;13:3106. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1038/s41467-022-30897-1\u003c/span\u003e\u003cspan address=\"10.1038/s41467-022-30897-1\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWynter K, Holton S, Trueman M, Bruce S, Sweeney S, Crowe S, et al. Hospital clinicians\u0026rsquo; psychosocial well-being during the COVID-19 pandemic: longitudinal study. Occup Med (Chic Ill) 2022;72:215\u0026ndash;24. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1093/occmed/kqac003\u003c/span\u003e\u003cspan address=\"10.1093/occmed/kqac003\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlmalki AH, Alzahrani MS, Alshehri FS, Alharbi A, Alkhudaydi SF, Alshahrani RS, et al. The Psychological Impact of COVID-19 on Healthcare Workers in Saudi Arabia: A Year Later Into the Pandemic. Front Psychiatry 2021;12. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3389/fpsyt.2021.797545\u003c/span\u003e\u003cspan address=\"10.3389/fpsyt.2021.797545\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKunzler AM, R\u0026ouml;thke N, G\u0026uuml;nthner L, Stoffers-Winterling J, T\u0026uuml;scher O, Coenen M, et al. Mental burden and its risk and protective factors during the early phase of the SARS-CoV-2 pandemic: systematic review and meta-analyses. Global Health 2021;17:34. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s12992-021-00670-y\u003c/span\u003e\u003cspan address=\"10.1186/s12992-021-00670-y\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePhiri P, Ramakrishnan R, Rathod S, Elliot K, Thayanandan T, Sandle N, et al. An evaluation of the mental health impact of SARS-CoV-2 on patients, general public and healthcare professionals: A systematic review and meta-analysis. EClinicalMedicine 2021;34:100806. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.eclinm.2021.100806\u003c/span\u003e\u003cspan address=\"10.1016/j.eclinm.2021.100806\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLuce\u0026ntilde;o-Moreno L, Talavera-Velasco B, Garc\u0026iacute;a-Albuerne Y, Mart\u0026iacute;n-Garc\u0026iacute;a J. Symptoms of Posttraumatic Stress, Anxiety, Depression, Levels of Resilience and Burnout in Spanish Health Personnel during the COVID-19 Pandemic. Int J Environ Res Public Health 2020;17:5514. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3390/ijerph17155514\u003c/span\u003e\u003cspan address=\"10.3390/ijerph17155514\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFerreira S, Sousa MM, Moreira PS, Sousa N, Pic\u0026oacute;-P\u0026eacute;rez M, Morgado P. A Wake-up Call for Burnout in Portuguese Physicians During the COVID-19 Outbreak: National Survey Study. JMIR Public Health Surveill 2021;7:e24312. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.2196/24312\u003c/span\u003e\u003cspan address=\"10.2196/24312\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMediavilla R, Fern\u0026aacute;ndez-Jim\u0026eacute;nez E, Martinez-Morata I, Jaramillo F, Andreo-Jover J, Mor\u0026aacute;n-S\u0026aacute;nchez I, et al. Sustained Negative Mental Health Outcomes Among Healthcare Workers Over the First Year of the COVID-19 Pandemic: A Prospective Cohort Study. Int J Public Health 2022;67. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3389/ijph.2022.1604553\u003c/span\u003e\u003cspan address=\"10.3389/ijph.2022.1604553\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\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. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.bbi.2020.05.026\u003c/span\u003e\u003cspan address=\"10.1016/j.bbi.2020.05.026\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTiete J, Guatteri M, Lachaux A, Matossian A, Hougardy J-M, Loas G, et al. Mental Health Outcomes in Healthcare Workers in COVID-19 and Non-COVID-19 Care Units: A Cross-Sectional Survey in Belgium. Front Psychol 2021;11. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3389/fpsyg.2020.612241\u003c/span\u003e\u003cspan address=\"10.3389/fpsyg.2020.612241\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBonzini M, Comotti A, Fattori A, Cant\u0026ugrave; F, Colombo E, Tombola V, et al. One Year Facing COVID. Systematic Evaluation of Risk Factors Associated With Mental Distress Among Hospital Workers in Italy. Front Psychiatry 2022;13. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3389/fpsyt.2022.834753\u003c/span\u003e\u003cspan address=\"10.3389/fpsyt.2022.834753\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ede Kock JH, Latham HA, Leslie SJ, Grindle M, Munoz S-A, Ellis L, et al. A rapid review of the impact of COVID-19 on the mental health of healthcare workers: implications for supporting psychological well-being. BMC Public Health 2021;21:104. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s12889-020-10070-3\u003c/span\u003e\u003cspan address=\"10.1186/s12889-020-10070-3\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJohnson SU, Ebrahimi O v., Hoffart A. PTSD symptoms among health workers and public service providers during the COVID-19 outbreak. PLoS One 2020;15:e0241032. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1371/journal.pone.0241032\u003c/span\u003e\u003cspan address=\"10.1371/journal.pone.0241032\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHall CE, Milward J, Spoiala C, Bhogal JK, Weston D, Potts HWW, et al. The mental health of staff working on intensive care units over the COVID-19 winter surge of 2020 in England: a cross sectional survey. Br J Anaesth 2022;128:971\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.bja.2022.03.016\u003c/span\u003e\u003cspan address=\"10.1016/j.bja.2022.03.016\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWozniak H, Benzakour L, Moullec G, Buetti N, Nguyen A, Corbaz S, et al. Mental health outcomes of ICU and non-ICU healthcare workers during the COVID-19 outbreak: a cross-sectional study. Ann Intensive Care 2021;11:106. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s13613-021-00900-x\u003c/span\u003e\u003cspan address=\"10.1186/s13613-021-00900-x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKramer ADI, Guillory JE, Hancock JT. Experimental evidence of massive-scale emotional contagion through social networks. Proceedings of the National Academy of Sciences 2014;111:8788\u0026ndash;90. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1073/pnas.1320040111\u003c/span\u003e\u003cspan address=\"10.1073/pnas.1320040111\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGao J, Zheng P, Jia Y, Chen H, Mao Y, Chen S, et al. Mental health problems and social media exposure during COVID-19 outbreak. PLoS One 2020;15:e0231924. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1371/journal.pone.0231924\u003c/span\u003e\u003cspan address=\"10.1371/journal.pone.0231924\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNi MY, Yang L, Leung CMC, Li N, Yao XI, Wang Y, et al. Mental Health, Risk Factors, and Social Media Use During the COVID-19 Epidemic and Cordon Sanitaire Among the Community and Health Professionals in Wuhan, China: Cross-Sectional Survey. JMIR Ment Health 2020;7:e19009. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.2196/19009\u003c/span\u003e\u003cspan address=\"10.2196/19009\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBanerjee D, Meena KS. COVID-19 as an \u0026ldquo;Infodemic\u0026rdquo; in Public Health: Critical Role of the Social Media. Front Public Health 2021;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3389/fpubh.2021.610623\u003c/span\u003e\u003cspan address=\"10.3389/fpubh.2021.610623\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDu J, Mayer G, Hummel S, Oetjen N, Gronewold N, Zafar A, et al. Mental Health Burden in Different Professions During the Final Stage of the COVID-19 Lockdown in China: Cross-sectional Survey Study. J Med Internet Res 2020;22:e24240. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.2196/24240\u003c/span\u003e\u003cspan address=\"10.2196/24240\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHummel S, Oetjen N, Du J, Posenato E, Resende de Almeida RM, Losada R, et al. Mental Health Among Medical Professionals During the COVID-19 Pandemic in Eight European Countries: Cross-sectional Survey Study. J Med Internet Res 2021;23:e24983. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.2196/24983\u003c/span\u003e\u003cspan address=\"10.2196/24983\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLeiner DJ: SoSci Survey. In., vol. 2022, Version 3.1.06 edn; 2019. n.d.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHummel S, Michelsen I, Zafar A, Moritz S, Benoy C, Lemogne C, Almeida R, Losada R, Ribeiro O, Frisardi V et al: Unmet Psychosocial Needs of Health Care Professionals in Europe During the COVID-19 Pandemic: Mixed Methods Approach. JMIR Public Health Surveill 2023, 9:e45664. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.2196/45664\u003c/span\u003e\u003cspan address=\"10.2196/45664\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003evon Elm E, Altman DG, Egger M, Pocock SJ, G\u0026oslash;tzsche PC, Vandenbroucke JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: Guidelines for Reporting Observational Studies. Ann Intern Med 2007;147:573. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.7326/0003-4819-147-8-200710160-00010\u003c/span\u003e\u003cspan address=\"10.7326/0003-4819-147-8-200710160-00010\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLovibond SH, Lovibond PF: Manual for the depression anxiety stress scales: Psychology Foundation of Australia; 1996. n.d.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLee S-H, Juang Y-Y, Su Y-J, Lee H-L, Lin, Yi-Hui, Chao C-C. Facing SARS: psychological impacts on SARS team nurses and psychiatric services in a Taiwan general hospital. Gen Hosp Psychiatry 2005;27:352\u0026ndash;8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.genhosppsych.2005.04.007\u003c/span\u003e\u003cspan address=\"10.1016/j.genhosppsych.2005.04.007\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLee S-H, Juang Y-Y, Su Y-J, Lee H-L, Lin, Yi-Hui, Chao C-C. Facing SARS: psychological impacts on SARS team nurses and psychiatric services in a Taiwan general hospital. Gen Hosp Psychiatry 2005;27:352\u0026ndash;8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.genhosppsych.2005.04.007\u003c/span\u003e\u003cspan address=\"10.1016/j.genhosppsych.2005.04.007\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCorp. I: IBM SPSS Statistics for Windows. In., 26.0 edn. Armonk, NY: IBM Corp.; 2019. n.d.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGBD 2019 Mental Disorders Collaborators. Global, regional, and national burden of 12 mental disorders in 204 countries and territories, 1990\u0026ndash;2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Psychiatry 2022;9:137\u0026ndash;50. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/S2215-0366(21)00395-3\u003c/span\u003e\u003cspan address=\"10.1016/S2215-0366(21)00395-3\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOlson CL. Comparative Robustness of Six Tests in Multivariate Analysis of Variance. J Am Stat Assoc 1974;69:894\u0026ndash;908. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1080/01621459.1974.10480224\u003c/span\u003e\u003cspan address=\"10.1080/01621459.1974.10480224\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHao Q, Wang D, Xie M, Tang Y, Dou Y, Zhu L, et al. Prevalence and Risk Factors of Mental Health Problems Among Healthcare Workers During the COVID-19 Pandemic: A Systematic Review and Meta-Analysis. Front Psychiatry 2021;12. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3389/fpsyt.2021.567381\u003c/span\u003e\u003cspan address=\"10.3389/fpsyt.2021.567381\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMaunder RG, Heeney ND, Hunter JJ, Strudwick G, Jeffs LP, Ginty L, et al. Trends in burnout and psychological distress in hospital staff over 12 months of the COVID-19 pandemic: a prospective longitudinal survey. Journal of Occupational Medicine and Toxicology 2022;17:11. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s12995-022-00352-4\u003c/span\u003e\u003cspan address=\"10.1186/s12995-022-00352-4\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFranck E, Goossens E, Haegdorens F, Geuens N, Portzky M, Tytens T, et al. Role of resilience in healthcare workers\u0026rsquo; distress and somatization during the COVID-19 pandemic: A cross‐sectional study across Flanders, Belgium. Nurs Open 2022;9:1181\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1002/nop2.1159\u003c/span\u003e\u003cspan address=\"10.1002/nop2.1159\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLasalvia A, Bonetto C, Porru S, Carta A, Tardivo S, Bovo C, et al. Psychological impact of COVID-19 pandemic on healthcare workers in a highly burdened area of north-east Italy. Epidemiol Psychiatr Sci 2021;30:e1. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1017/S2045796020001158\u003c/span\u003e\u003cspan address=\"10.1017/S2045796020001158\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFiabane E, Gabanelli P, la Rovere MT, Tremoli E, Pistarini C, Gorini A. Psychological and work-related factors associated with emotional exhaustion among healthcare professionals during the \u0026lt;\u0026thinsp;scp\u0026thinsp;\u0026gt;\u0026thinsp;COVID\u0026lt;/scp\u0026gt; ‐19 outbreak in Italian hospitals. Nurs Health Sci 2021;23:670\u0026ndash;5. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/nhs.12871\u003c/span\u003e\u003cspan address=\"10.1111/nhs.12871\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKok N, van Gurp J, Teerenstra S, van der Hoeven H, Fuchs M, Hoedemaekers C, et al. Coronavirus Disease 2019 Immediately Increases Burnout Symptoms in ICU Professionals: A Longitudinal Cohort Study*. Crit Care Med 2021;49:419\u0026ndash;27. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1097/CCM.0000000000004865\u003c/span\u003e\u003cspan address=\"10.1097/CCM.0000000000004865\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHu N, Deng H, Yang H, Wang C, Cui Y, Chen J, et al. The pooled prevalence of the mental problems of Chinese medical staff during the COVID-19 outbreak: A meta-analysis. J Affect Disord 2022;303:323\u0026ndash;30. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.jad.2022.02.045\u003c/span\u003e\u003cspan address=\"10.1016/j.jad.2022.02.045\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChen Y, Wang J, Geng Y, Fang Z, Zhu L, Chen Y, et al. Meta-analysis of the prevalence of anxiety and depression among frontline healthcare workers during the COVID-19 pandemic. Front Public Health 2022;10. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3389/fpubh.2022.984630\u003c/span\u003e\u003cspan address=\"10.3389/fpubh.2022.984630\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWalton M, Murray E, Christian MD. Mental health care for medical staff and affiliated healthcare workers during the COVID-19 pandemic. Eur Heart J Acute Cardiovasc Care 2020;9:241\u0026ndash;7. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1177/2048872620922795\u003c/span\u003e\u003cspan address=\"10.1177/2048872620922795\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFrenkel MO, Pollak KM, Schilling O, Voigt L, Fritzsching B, Wrzus C, et al. Stressors faced by healthcare professionals and coping strategies during the early stage of the COVID-19 pandemic in Germany. PLoS One 2022;17:e0261502. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1371/journal.pone.0261502\u003c/span\u003e\u003cspan address=\"10.1371/journal.pone.0261502\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eProbst-Hensch N, Jeong A, Keidel D, Imboden M, Lovison G. Depression trajectories during the COVID-19 pandemic in the high-quality health care setting of Switzerland: the COVCO-Basel cohort. Public Health 2023;217:65\u0026ndash;73. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.puhe.2023.01.010\u003c/span\u003e\u003cspan address=\"10.1016/j.puhe.2023.01.010\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHolton S, Wynter K, Peeters A, Georgalas A, Yeomanson A, Rasmussen B. Psychological wellbeing of Australian community health service staff during the COVID-19 pandemic: a longitudinal cohort study. BMC Health Serv Res 2023;23:405. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s12913-023-09382-y\u003c/span\u003e\u003cspan address=\"10.1186/s12913-023-09382-y\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTh\u0026rsquo;ng F, Rao KA, Ge L, Neo HN, Molina JA De, Lim WY, et al. Longitudinal Study Comparing Mental Health Outcomes in Frontline Emergency Department Healthcare Workers through the Different Waves of the COVID-19 Pandemic. Int J Environ Res Public Health 2022;19:16878. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3390/ijerph192416878\u003c/span\u003e\u003cspan address=\"10.3390/ijerph192416878\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eH\u0026auml;ussl A, Ehmann E, Pacher A, Kn\u0026ouml;dl K, Huber T, Neundlinger L, et al. Psychological, physical, and social effects of the COVID-19 pandemic on hospital nurses. Int Nurs Rev 2021;68:482\u0026ndash;92. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/inr.12716\u003c/span\u003e\u003cspan address=\"10.1111/inr.12716\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\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":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"COVID-19, Europe, anxiety, depression, medical professionals, mental health, stress, stressors","lastPublishedDoi":"10.21203/rs.3.rs-4481266/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4481266/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eEven during the third wave of the COVID-19 pandemic health professionals were facing mental health challenges. The aim of this study was to examine the mental health of doctors, nurses and other professional groups in Europe and to identify differences between the professional groups. We conducted a cross-sectional online survey in 8 European countries. We asked for demographic data, whether the participants were exposed to COVID-19 at work, for main information sources about the pandemic, the Depression Anxiety Stress Scale (DASS-21), and major stressors. A MANCOVA was carried out to find predictors of mental health among health care professionals. The sample (N\u0026thinsp;=\u0026thinsp;1,398) consisted of 237 physicians, 459 nurses, and 351 other healthcare professionals and 351 non-medical professionals with no direct involvement in patient care. The mean mental health of all groups was affected to a mild degree. Major predictors were profession group for depression and anxiety with higher scores especially in the group of the nurses and for the group working directly with COVID-patients. In the third wave of the COVID-19 pandemic, the psychological burden on health professionals has remained high, with being nurse and working directly with COVID19 patients being particular risk factors for mental distress. We found as a main result that that nurses scored significantly higher on depression and anxiety than practitioners.\u003c/p\u003e","manuscriptTitle":"­­COVID-19 and mental distress among health professionals in eight European countries during the third wave: a cross-sectional survey ","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-06-13 09:52:55","doi":"10.21203/rs.3.rs-4481266/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Accepted","date":"2024-09-06T06:29:07+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-07-14T09:19:47+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"299558248209395817964706138637432637582","date":"2024-06-22T10:42:18+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"256050577319991120893204869645786694850","date":"2024-06-21T22:22:11+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"87011204003628691015190954484957295590","date":"2024-06-17T07:20:29+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-06-12T01:55:00+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-06-12T01:53:36+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-06-04T10:25:47+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-05-31T10:32:27+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2024-05-26T20:02:09+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"fc903370-f886-4462-9dbc-c8e449cdc66d","owner":[],"postedDate":"June 13th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":33162947,"name":"Health sciences/Health care/Public health"},{"id":33162948,"name":"Health sciences/Health occupations"}],"tags":[],"updatedAt":"2024-09-16T15:58:55+00:00","versionOfRecord":{"articleIdentity":"rs-4481266","link":"https://doi.org/10.1038/s41598-024-72396-x","journal":{"identity":"scientific-reports","isVorOnly":false,"title":"Scientific Reports"},"publishedOn":"2024-09-12 15:56:54","publishedOnDateReadable":"September 12th, 2024"},"versionCreatedAt":"2024-06-13 09:52:55","video":"","vorDoi":"10.1038/s41598-024-72396-x","vorDoiUrl":"https://doi.org/10.1038/s41598-024-72396-x","workflowStages":[]},"version":"v1","identity":"rs-4481266","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4481266","identity":"rs-4481266","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}