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Multicenter Study
. 2024 Sep 12;22(1):386.
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

Hiroki Asaoka  1 , Kazuhiro Watanabe  2 , Yuki Miyamoto  3 , Alexandra Restrepo-Henao  4 , Els van der Ven  5 , Maria Francesca Moro  6 , Lubna A Alnasser  7 , Olatunde Ayinde  8 , Arin A Balalian  9 , Armando Basagoitia  10 , Sol Durand-Arias  11 , Mehmet Eskin  12 , Eduardo Fernández-Jiménez  13   14   15 , Freytes Frey Marcela Ines  16 , Luis Giménez  17 , Hans W Hoek  6   18   19 , Rodrigo Ezequiel Jaldo  20 , Jutta Lindert  21 , Humberto Maldonado  22 , Gonzalo Martínez-Alés  23 , Roberto Mediavilla  24   25   26 , Clare McCormack  27 , Javier Narvaez  28   29 , Uta Ouali  30   31 , Aida Barrera-Perez  32 , Erwin Calgua-Guerra  32 , Jorge Ramírez  33 , Ana María Rodríguez  34 , Dominika Seblova  35 , Andrea Tenorio Correia da Silva  36 , Linda Valeri  37 , Oye Gureje  8 , Dinarte Ballester  38 , Mauro Giovanni Carta  39 , Anna Isahakyan  40 , Amira Jamoussi  31   41 , Jana Seblova  35 , Maria Teresa Solis-Soto  42 , Ruben Alvarado  43 , Ezra Susser  44   45 , Franco Mascayano  6   45 , Daisuke Nishi  46 ; HEROES group
Affiliations
Multicenter Study

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

Hiroki Asaoka et al. BMC Med. .

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.

Keywords: COVID-19; Depressive symptoms; Healthcare worker; Incidence rate; Mortality rate; Multi-country study; Serial cross-sectional study.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Participant flow. The design of this study was a multi-country serial cross-sectional study, not a longitudinal study, although data were retrieved from the first and second surveys of the international COVID-19 HEalth caRe wOrkErS (HEROES) study. We analyzed the dataset of responses of the participants who responded to all measures used in this study
See this image and copyright information in PMC

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