Document Type : Original Article

Authors

1 Health in Disasters and Emergencies Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran

2 Student of Epidemiology, Department of Biostatics and Epidemiology, Faculty of Public Health, Kerman University of Medical Sciences, Kerman, Iran

3 Department of Public Health, Sirjan School of Medical Sciences, Sirjan, Iran

4 Department of Clinical Science and Education Karolinska Instituted, Stockholm, Sweden

5 Health in Emergency and Disaster Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran

Abstract

BACKGROUND: Following the global emergency of coronavirus disease 2019 (COVID‑19),
health‑care workers, especially nurses were encountered with an increasing workload. Therefore, due
to the importance of this issue, the present study aimed to examine stress, anxiety, and depression
levels among nurses during the COVID‑19 pandemic in Iran.
MATERIALS AND METHODS: This cross‑sectional study was conducted in four educational hospitals
affiliated to Kerman University of Medical Sciences in 2020. The standard Depression, Anxiety and
Stress Scale‑21 questionnaire was applied to assess the levels of stress, anxiety, and depression
in nurse personnel with a census method (n = 403). Data were analyzed using descriptive statistics
and analytic statistics such as Kolmogorov–Smirnov, Mann–Whitney, Kruskal–Wallis, and multiple
linear regression tests through the version 20, SPSS Inc., Chicago, IL, USA, Software at the level
of P < 0.05.
RESULTS: The results of the study showed that the mean scores of depressions (9.18 ± 4.45),
stress (9.62 ± 4.94), and anxiety (10.32 ± 4.85) in nurses were at moderate level. A significant
relationship was observed between stressed, anxious, and depressed participants in the gender,
marital status, level of education, and working hours per month. No statistically significant relationship
was found between other demographic variables including age, work experience, and employment
status with anxiety, depression, and stress categories.
CONCLUSION: The results of this study can increase the awareness of health system managers,
especially hospitals, about the level of stress, anxiety, and depression and can help in order to provide
psychological support programs for improving the mental health of nurses during the COVID‑19
pandemic.

Keywords

1. Nie A, Su X, Zhang S, Guan W, Li J. Psychological impact of
COVID-19 outbreak on frontline nurses: A cross-sectional survey
study. J Clin Nurs 2020;29:4217-26.
2. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features
of patients infected with 2019 novel coronavirus in Wuhan, China.
Lancet 2020;395:497-506.
3. Morens DM, TaubenbergerJK. Influenza cataclysm, 1918. N Engl  J Med 2018;379:2285-7.
4. Fitzgerald G, Aitken P, ShabanRZ, Patrick J, Arbon P, McCarthy S,
et al. Pandemic (H1N1 influenza 2009 and Australian emergency
departments: Implications for policy, practice and pandemic
preparedness. Emerg Med Australas 2012;24:159-65.
5. Lu W, Wang H, Lin Y, Li L. Psychological status of medical
workforce during the COVID-19 pandemic: A cross-sectional
study. Psychiatry Res 2020;288:112936.
6. Hosseinzadeh-Shanjani Z, Hajimiri K, Rostami B, Ramazani S,
Dadashi M. Stress, anxiety, and depression levels among
healthcare staff during the COVID-19 epidemic. Basic Clin
Neurosci 2020;11:163-70.
7. Liu CY, Yang YZ, Zhang XM, Xu X, Dou QL, Zhang WW, et al. The
prevalence and influencing factors in anxiety in medical workers
fighting COVID‑19 in China: A cross‑sectional survey. Epidemiol
Infect 2020;148:e98.
8. Emamjomeh SM, Bahrami M. Effect of a supportive-educative
program in the math class for stress, anxiety, and depression in
female students in the third level of junior high school: An action
research. J Educ Health Promot 2015;4:10.
9. Rafati F, Nouhi E, Sabzevari S, Dehghan-Nayeri N. Coping
strategies of nursing students for dealing with stress in clinical
setting: A qualitative study. Electron Physician 2017;9:6120-8.
10. Dehghan H, Azmoon H, Souri S, Akbari J. The effects of state
anxiety and thermal comfort on sleep quality and eye fatigue in
shift work nurses. J Educ Health Promot 2014;3:72.
11. Liu Y, Gayle AA, Wilder-Smith A, Rocklöv J. The reproductive
number of COVID-19 is higher compared to SARS coronavirus.
J Travel Med 2020;27:1-4.
12. Bell V, Wade D. Mental health of clinical staff working in high-risk
epidemic and pandemic health emergencies: A rapid review of the
evidence and meta-analysis. Soc Psychiatry Psychiatr Epidemiol.
2021 Jan; 56 (1):1-11.
13. Nie A, Su X, Zhang S, Guan W, Li J. Psychological impact of
COVID-19 outbreak on frontline nurses: A cross-sectional survey
study. J Clin Nurs. 2020 Nov; 29 (21-22):4217-4226.
14. Shahrour G, Dardas LA. Acute stress disorder, coping self-efficacy
and subsequent psychological distress among nurses amid
COVID-19. J Nurs Manag. 2020 Oct; 28 (7):1686-1695.
15. Labrague LJ, De Los Santos JA. COVID-19 anxiety among frontline nurses: Predictive role of organisational support, personal
resilience and social support. J Nurs Manage 2020;28:1653-61.
16. Pouralizadeh M, Bostani Z, Maroufizadeh S, Ghanbari A,
Khoshbakht M, Alavi SA, et al. Anxiety and depression and the
related factors in nurses of Guilan University of Medical Sciences
hospitals during COVID-19: A web-based cross-sectional study.
Int J Afr Nurs Sci 2020;13:100233.
17. Lai CC, Shih TP, Ko WC, Tang HJ, Hsueh PR. Severe acute
respiratory syndrome coronavirus 2 (SARS-CoV-2) and
coronavirus disease-2019 (COVID-19): The epidemic and the
challenges. Int J Antimicrobe Agents. 2020 Mar; 55 (3):105924.
18. Alimolaie A. A review of coronavirus disease-2019 (COVID-19).
Biol Sci Promot 2020;3:152-7.
19. Braquehais MD, Vargas-Cáceres S, Gómez-Durán E, Nieva G,
Valero S, Casas M, et al. The impact of the COVID-19 pandemic
on the mental health of healthcare professionals. QJM Int J Med
2020;113:613-7.
20. Krishnamoorthy Y, Nagarajan R, Saya GK, Menon V. Prevalence
of psychological morbidities among general population,
healthcare workers and COVID-19 patients amidst the COVID-19
pandemic: A systematic review and meta-analysis. Psychiatry Res
2020;293:113382.
21. Ali AM, Green J. Differential item functioning of the Arabic
version of the depression Anxiety Stress Scale-21 (DASS-21).
Asian J Psychiatr 2017;4:56-8.
22. Cao J, Wei J, Zhu H, Duan Y, Geng W, Hong X, et al. A study of
basic needs and psychological wellbeing of medical workers in
the fever clinic of a tertiary general hospital in Beijing during the
COVID-19 Outbreak. Psychother Psychosom 2020; 89:252-4.
23. Wu W, Zhang Y, Wang P, Zhang L, Wang G, Lei G, Xiao Q, Cao X,
Bian Y, Xie S, Huang F, Luo N, Zhang J, Luo M. Psychological
stress of medical staffs during outbreak of COVID-19 and
adjustment strategy. J Med Virol. 2020 Oct; 92 (10):1962-1970.
24. Rathnayake S, Ekanayaka J. Depression, anxiety, and stress
among undergraduate nursing students in a public university
in Sri Lanka. Int J Caring Sci. 2016;9:1020-32.
25. Nemati M, Ebrahimi B, Nemati F. Assessment of Iranian nurses’
knowledge and anxiety toward COVID-19 during the current
outbreak in Iran. Arch Clin Infect Dis 2020;15:1-5.
26. Poursadeghiyan M, Abbasi M, Mehri A, Hami M, Raei M,
Ebrahimi MH. Relationship between job stress and anxiety,
depression and job satisfaction in nurses in Iran. Soc Sci
2016;11:2349-55.
27. Bentley MA, Crawford JM, Wilkins J, Fernandez AR, Studnek JR.
An assessment of depression, anxiety, and stress among nationally
certified EMS professionals. Prehosp Emerg Care 2013;17:330‑8.
28. Kurd N, Jamshidzad M, Poornajaf M, Charkhandaz Yeghaneh R,
Karimi S, Soleimani S, Nasrolahi A. Evaluating Occupational
Stress and Associated Burnout Based on Demand–Control Model
among EMS Personnel in Ilam. Int J Occup Hyg. 12 (2):95-106.
29. Khazaei A, Esmaeili M, Navab E. The most and least stressful
prehospital emergencies from emergency medical technicians’
view point; a cross-sectional study. Arch Acad Emerg Med
2019;7:e20.
30. Sampaio F, Sequeira C, Teixeira L. Nurses’ mental health during
the Covid-19 outbreak: A cross-sectional study. J Occup Environ
Med 2020;62:783-7.
31. 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.
32. Sahebi A, Nejati‑Zarnaqi B, Moayedi S, Yousefi K, Torres M,
Golitaleb M. The prevalence of anxiety and depression among
healthcare workers during the COVID-19 pandemic: An umbrella
review of meta-analyses. Prog Neuropsychopharmacology Biol
Psychiatry. 2021 Apr 20;107:110247