Association of depressive symptoms with incidence and mortality rates of COVID-19 over 2 years among healthcare workers in 20 countries: multi-country serial cross-sectional study

HEROES group

doi:10.1186/s12916-024-03585-8

Association of depressive symptoms with incidence and mortality rates of COVID-19 over 2 years among healthcare workers in 20 countries: multi-country serial cross-sectional study

HEROES group

Research output: Contribution to Journal › Article › Academic › peer-review

Abstract

BACKGROUND: Long-term deterioration in the mental health of healthcare workers (HCWs) has been reported during and after the COVID-19 pandemic. Determining the impact of COVID-19 incidence and mortality rates on the mental health of HCWs is essential to prepare for potential new pandemics. This study aimed to investigate the association of COVID-19 incidence and mortality rates with depressive symptoms over 2 years among HCWs in 20 countries during and after the COVID-19 pandemic.

METHODS: This was a multi-country serial cross-sectional study using data from the first and second survey waves of the COVID-19 HEalth caRe wOrkErS (HEROES) global study. The HEROES study prospectively collected data from HCWs at various health facilities. The target population included HCWs with both clinical and non-clinical roles. In most countries, healthcare centers were recruited based on convenience sampling. As an independent variable, daily COVID-19 incidence and mortality rates were calculated using confirmed cases and deaths reported by Johns Hopkins University. These rates represent the average for the 7 days preceding the participants' response date. The primary outcome was depressive symptoms, assessed by the Patient Health Questionnaire-9. A multilevel linear mixed model (LMM) was conducted to investigate the association of depressive symptoms with the average incidence and mortality rates.

RESULTS: A total of 32,223 responses from the participants who responded to all measures used in this study on either the first or second survey, and on both the first and second surveys in 20 countries were included in the analysis. The mean age was 40.1 (SD = 11.1), and 23,619 responses (73.3%) were from females. The 9323 responses (28.9%) were nurses and 9119 (28.3%) were physicians. LMM showed that the incidence rate was significantly and positively associated with depressive symptoms (coefficient = 0.008, standard error 0.003, p = 0.003). The mortality rate was significantly and positively associated with depressive symptoms (coefficient = 0.049, se = 0.020, p = 0.017).

CONCLUSIONS: This is the first study to show an association between COVID-19 incidence and mortality rates with depressive symptoms among HCWs during the first 2 years of the outbreak in multiple countries. This study's findings indicate that additional mental health support for HCWs was needed when the COVID-19 incidence and mortality rates increase during and after the early phase of the pandemic, and these findings may apply to future pandemics.

TRIAL REGISTRATION: Clinicaltrials.gov, NCT04352634.

Original language	English
Article number	386
Pages (from-to)	386
Journal	BMC Medicine
Volume	22
Issue number	1
DOIs	https://doi.org/10.1186/s12916-024-03585-8
Publication status	Published - 12 Sept 2024

Bibliographical note

Funding

This work was supported by the Japan Society for the Promotion of Science KAKENHI Grant Number JP23KJ0461 and The Health Care Science Institute Research Grant to Hiroki Asaoka, by Health and Labor Sciences Research Grants (19IA2014) to Daisuke Nishi, and by the Ministry of Health of the Czech Republic (NU22J-09\u201300064) to Dominika Seblova. The COVID-19 HEROES study in Italy was funded by the Italian Ministry of Education, Universities and Research (Bando FISR 2020IP_05308) and Fondazione di Sardegna (Bando 2020). The Colombia Heroes project is funded by the MInciencias (grant #: CT 860-2020), and by the UK Research and Innovation (UKRI) (grant #: ES/V013157/1). The funding organizations had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Funders	Funder number
Health Care Science Institute
Fondazione di Sardegna
Japan Society for the Promotion of Science	JP23KJ0461
Japan Society for the Promotion of Science
Ministerio de Ciencia, Tecnología e Innovación	CT 860-2020
Ministerio de Ciencia, Tecnología e Innovación
Ministero dell’Istruzione, dell’Università e della Ricerca	FISR 2020IP_05308
Ministero dell’Istruzione, dell’Università e della Ricerca
Ministerstvo Zdravotnictví Ceské Republiky	NU22J-09–00064
Ministerstvo Zdravotnictví Ceské Republiky
UK Research and Innovation	ES/V013157/1
UK Research and Innovation
Health and Labor Sciences Research Grants	19IA2014

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@article{584f163b35854d87b19222853d9e2a5f,

title = "Association of depressive symptoms with incidence and mortality rates of COVID-19 over 2 years among healthcare workers in 20 countries: multi-country serial cross-sectional study",

abstract = "BACKGROUND: Long-term deterioration in the mental health of healthcare workers (HCWs) has been reported during and after the COVID-19 pandemic. Determining the impact of COVID-19 incidence and mortality rates on the mental health of HCWs is essential to prepare for potential new pandemics. This study aimed to investigate the association of COVID-19 incidence and mortality rates with depressive symptoms over 2 years among HCWs in 20 countries during and after the COVID-19 pandemic.METHODS: This was a multi-country serial cross-sectional study using data from the first and second survey waves of the COVID-19 HEalth caRe wOrkErS (HEROES) global study. The HEROES study prospectively collected data from HCWs at various health facilities. The target population included HCWs with both clinical and non-clinical roles. In most countries, healthcare centers were recruited based on convenience sampling. As an independent variable, daily COVID-19 incidence and mortality rates were calculated using confirmed cases and deaths reported by Johns Hopkins University. These rates represent the average for the 7 days preceding the participants' response date. The primary outcome was depressive symptoms, assessed by the Patient Health Questionnaire-9. A multilevel linear mixed model (LMM) was conducted to investigate the association of depressive symptoms with the average incidence and mortality rates.RESULTS: A total of 32,223 responses from the participants who responded to all measures used in this study on either the first or second survey, and on both the first and second surveys in 20 countries were included in the analysis. The mean age was 40.1 (SD = 11.1), and 23,619 responses (73.3%) were from females. The 9323 responses (28.9%) were nurses and 9119 (28.3%) were physicians. LMM showed that the incidence rate was significantly and positively associated with depressive symptoms (coefficient = 0.008, standard error 0.003, p = 0.003). The mortality rate was significantly and positively associated with depressive symptoms (coefficient = 0.049, se = 0.020, p = 0.017).CONCLUSIONS: This is the first study to show an association between COVID-19 incidence and mortality rates with depressive symptoms among HCWs during the first 2 years of the outbreak in multiple countries. This study's findings indicate that additional mental health support for HCWs was needed when the COVID-19 incidence and mortality rates increase during and after the early phase of the pandemic, and these findings may apply to future pandemics.TRIAL REGISTRATION: Clinicaltrials.gov, NCT04352634.",

author = "Hiroki Asaoka and Kazuhiro Watanabe and Yuki Miyamoto and Alexandra Restrepo-Henao and {van der Ven}, Els and Moro, {Maria Francesca} and Alnasser, {Lubna A} and Olatunde Ayinde and Balalian, {Arin A} and Armando Basagoitia and Sol Durand-Arias and Mehmet Eskin and Eduardo Fern{\'a}ndez-Jim{\'e}nez and Ines, {Freytes Frey Marcela} and Luis Gim{\'e}nez and Hoek, {Hans W} and Jaldo, {Rodrigo Ezequiel} and Jutta Lindert and Humberto Maldonado and Gonzalo Mart{\'i}nez-Al{\'e}s and Roberto Mediavilla and Clare McCormack and Javier Narvaez and Uta Ouali and Aida Barrera-Perez and Erwin Calgua-Guerra and Jorge Ram{\'i}rez and Rodr{\'i}guez, {Ana Mar{\'i}a} and Dominika Seblova and {da Silva}, {Andrea Tenorio Correia} and Linda Valeri and Oye Gureje and Dinarte Ballester and Carta, {Mauro Giovanni} and Anna Isahakyan and Amira Jamoussi and Jana Seblova and Solis-Soto, {Maria Teresa} and Ruben Alvarado and Ezra Susser and Franco Mascayano and Daisuke Nishi and {HEROES group}",

note = "{\textcopyright} 2024. The Author(s).",

year = "2024",

month = sep,

day = "12",

doi = "10.1186/s12916-024-03585-8",

language = "English",

volume = "22",

pages = "386",

journal = "BMC Medicine",

issn = "1741-7015",

publisher = "BioMed Central",

number = "1",

}

TY - JOUR

T1 - Association of depressive symptoms with incidence and mortality rates of COVID-19 over 2 years among healthcare workers in 20 countries

T2 - multi-country serial cross-sectional study

AU - Asaoka, Hiroki

AU - Watanabe, Kazuhiro

AU - Miyamoto, Yuki

AU - Restrepo-Henao, Alexandra

AU - van der Ven, Els

AU - Moro, Maria Francesca

AU - Alnasser, Lubna A

AU - Ayinde, Olatunde

AU - Balalian, Arin A

AU - Basagoitia, Armando

AU - Durand-Arias, Sol

AU - Eskin, Mehmet

AU - Fernández-Jiménez, Eduardo

AU - Ines, Freytes Frey Marcela

AU - Giménez, Luis

AU - Hoek, Hans W

AU - Jaldo, Rodrigo Ezequiel

AU - Lindert, Jutta

AU - Maldonado, Humberto

AU - Martínez-Alés, Gonzalo

AU - Mediavilla, Roberto

AU - McCormack, Clare

AU - Narvaez, Javier

AU - Ouali, Uta

AU - Barrera-Perez, Aida

AU - Calgua-Guerra, Erwin

AU - Ramírez, Jorge

AU - Rodríguez, Ana María

AU - Seblova, Dominika

AU - da Silva, Andrea Tenorio Correia

AU - Valeri, Linda

AU - Gureje, Oye

AU - Ballester, Dinarte

AU - Carta, Mauro Giovanni

AU - Isahakyan, Anna

AU - Jamoussi, Amira

AU - Seblova, Jana

AU - Solis-Soto, Maria Teresa

AU - Alvarado, Ruben

AU - Susser, Ezra

AU - Mascayano, Franco

AU - Nishi, Daisuke

AU - HEROES group

PY - 2024/9/12

Y1 - 2024/9/12

N2 - BACKGROUND: Long-term deterioration in the mental health of healthcare workers (HCWs) has been reported during and after the COVID-19 pandemic. Determining the impact of COVID-19 incidence and mortality rates on the mental health of HCWs is essential to prepare for potential new pandemics. This study aimed to investigate the association of COVID-19 incidence and mortality rates with depressive symptoms over 2 years among HCWs in 20 countries during and after the COVID-19 pandemic.METHODS: This was a multi-country serial cross-sectional study using data from the first and second survey waves of the COVID-19 HEalth caRe wOrkErS (HEROES) global study. The HEROES study prospectively collected data from HCWs at various health facilities. The target population included HCWs with both clinical and non-clinical roles. In most countries, healthcare centers were recruited based on convenience sampling. As an independent variable, daily COVID-19 incidence and mortality rates were calculated using confirmed cases and deaths reported by Johns Hopkins University. These rates represent the average for the 7 days preceding the participants' response date. The primary outcome was depressive symptoms, assessed by the Patient Health Questionnaire-9. A multilevel linear mixed model (LMM) was conducted to investigate the association of depressive symptoms with the average incidence and mortality rates.RESULTS: A total of 32,223 responses from the participants who responded to all measures used in this study on either the first or second survey, and on both the first and second surveys in 20 countries were included in the analysis. The mean age was 40.1 (SD = 11.1), and 23,619 responses (73.3%) were from females. The 9323 responses (28.9%) were nurses and 9119 (28.3%) were physicians. LMM showed that the incidence rate was significantly and positively associated with depressive symptoms (coefficient = 0.008, standard error 0.003, p = 0.003). The mortality rate was significantly and positively associated with depressive symptoms (coefficient = 0.049, se = 0.020, p = 0.017).CONCLUSIONS: This is the first study to show an association between COVID-19 incidence and mortality rates with depressive symptoms among HCWs during the first 2 years of the outbreak in multiple countries. This study's findings indicate that additional mental health support for HCWs was needed when the COVID-19 incidence and mortality rates increase during and after the early phase of the pandemic, and these findings may apply to future pandemics.TRIAL REGISTRATION: Clinicaltrials.gov, NCT04352634.

AB - BACKGROUND: Long-term deterioration in the mental health of healthcare workers (HCWs) has been reported during and after the COVID-19 pandemic. Determining the impact of COVID-19 incidence and mortality rates on the mental health of HCWs is essential to prepare for potential new pandemics. This study aimed to investigate the association of COVID-19 incidence and mortality rates with depressive symptoms over 2 years among HCWs in 20 countries during and after the COVID-19 pandemic.METHODS: This was a multi-country serial cross-sectional study using data from the first and second survey waves of the COVID-19 HEalth caRe wOrkErS (HEROES) global study. The HEROES study prospectively collected data from HCWs at various health facilities. The target population included HCWs with both clinical and non-clinical roles. In most countries, healthcare centers were recruited based on convenience sampling. As an independent variable, daily COVID-19 incidence and mortality rates were calculated using confirmed cases and deaths reported by Johns Hopkins University. These rates represent the average for the 7 days preceding the participants' response date. The primary outcome was depressive symptoms, assessed by the Patient Health Questionnaire-9. A multilevel linear mixed model (LMM) was conducted to investigate the association of depressive symptoms with the average incidence and mortality rates.RESULTS: A total of 32,223 responses from the participants who responded to all measures used in this study on either the first or second survey, and on both the first and second surveys in 20 countries were included in the analysis. The mean age was 40.1 (SD = 11.1), and 23,619 responses (73.3%) were from females. The 9323 responses (28.9%) were nurses and 9119 (28.3%) were physicians. LMM showed that the incidence rate was significantly and positively associated with depressive symptoms (coefficient = 0.008, standard error 0.003, p = 0.003). The mortality rate was significantly and positively associated with depressive symptoms (coefficient = 0.049, se = 0.020, p = 0.017).CONCLUSIONS: This is the first study to show an association between COVID-19 incidence and mortality rates with depressive symptoms among HCWs during the first 2 years of the outbreak in multiple countries. This study's findings indicate that additional mental health support for HCWs was needed when the COVID-19 incidence and mortality rates increase during and after the early phase of the pandemic, and these findings may apply to future pandemics.TRIAL REGISTRATION: Clinicaltrials.gov, NCT04352634.

U2 - 10.1186/s12916-024-03585-8

DO - 10.1186/s12916-024-03585-8

M3 - Article

C2 - 39267052

SN - 1741-7015

VL - 22

SP - 386

JO - BMC Medicine

JF - BMC Medicine

IS - 1

M1 - 386

ER -

Association of depressive symptoms with incidence and mortality rates of COVID-19 over 2 years among healthcare workers in 20 countries: multi-country serial cross-sectional study

Abstract

Bibliographical note

Funding

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