A multinational, multicentre study on the psychological outcomes and associated physical symptoms amongst healthcare workers during COVID-19 outbreak

Brain Behav Immun. 2020 Aug:88:559-565. doi: 10.1016/j.bbi.2020.04.049. Epub 2020 Apr 21.


Objective: Since the declaration of the coronavirus 2019 (COVID-19) outbreak as pandemic, there are reports on the increased prevalence of physical symptoms observed in the general population. We investigated the association between psychological outcomes and physical symptoms among healthcare workers.

Methods: Healthcare workers from 5 major hospitals, involved in the care for COVID-19 patients, in Singapore and India were invited to participate in a study by performing a self-administered questionnaire within the period of February 19 to April 17, 2020. Healthcare workers included doctors, nurses, allied healthcare workers, administrators, clerical staff and maintenance workers. This questionnaire collected information on demographics, medical history, symptom prevalence in the past month, Depression Anxiety Stress Scales (DASS-21) and the Impact of Events Scale-Revised (IES-R) instrument. The prevalence of physical symptoms displayed by healthcare workers and the associations between physical symptoms and psychological outcomes of depression, anxiety, stress, and post-traumatic stress disorder (PTSD) were evaluated.

Results: Out of the 906 healthcare workers who participated in the survey, 48 (5.3%) screened positive for moderate to very-severe depression, 79 (8.7%) for moderate to extremely-severe anxiety, 20 (2.2%) for moderate to extremely-severe stress, and 34 (3.8%) for moderate to severe levels of psychological distress. The commonest reported symptom was headache (32.3%), with a large number of participants (33.4%) reporting more than four symptoms. Participants who had experienced symptoms in the preceding month were more likely to be older, have pre-existing comorbidities and a positive screen for depression, anxiety, stress, and PTSD. After adjusting for age, gender and comorbidities, it was found that depression (OR 2.79, 95% CI 1.54-5.07, p = 0.001), anxiety (OR 2.18, 95% CI 1.36-3.48, p = 0.001), stress (OR 3.06, 95% CI 1.27-7.41, p = 0.13), and PTSD (OR 2.20, 95% CI 1.12-4.35, p = 0.023) remained significantly associated with the presence of physical symptoms experienced in the preceding month. Linear regression revealed that the presence of physical symptoms was associated with higher mean scores in the IES-R, DASS Anxiety, Stress and Depression subscales.

Conclusions: Our study demonstrates a significant association between the prevalence of physical symptoms and psychological outcomes among healthcare workers during the COVID-19 outbreak. We postulate that this association may be bi-directional, and that timely psychological interventions for healthcare workers with physical symptoms should be considered once an infection has been excluded.

Keywords: Anxiety; COVID-19; Depression; Healthcare workers; Pandemic; Physical symptoms; Psychological impact; Stress.

Publication types

  • Multicenter Study

MeSH terms

  • Adult
  • Allied Health Personnel / psychology
  • Allied Health Personnel / statistics & numerical data
  • Anxiety / epidemiology*
  • Betacoronavirus
  • COVID-19
  • Coronavirus Infections*
  • Depression / epidemiology*
  • Female
  • Headache / epidemiology
  • Health Personnel / psychology
  • Health Personnel / statistics & numerical data*
  • Humans
  • India / epidemiology
  • Internationality
  • Lethargy / epidemiology
  • Male
  • Nurses / psychology
  • Nurses / statistics & numerical data
  • Pandemics*
  • Pharyngitis / epidemiology
  • Physicians / psychology
  • Physicians / statistics & numerical data
  • Pneumonia, Viral*
  • Prevalence
  • SARS-CoV-2
  • Singapore / epidemiology
  • Sleep Initiation and Maintenance Disorders / epidemiology
  • Stress Disorders, Post-Traumatic / epidemiology*
  • Stress, Psychological / epidemiology*
  • Surveys and Questionnaires