Psychological outcomes amongst family medicine healthcare professionals during COVID-19 outbreak: A cross-sectional study in Croatia

Abstract

Background

Healthcare professionals (HCPs) in family medicine (FM) in Croatia work in a demanding environment caused by the SARS-CoV-2 pandemic. Besides particular circumstances in healthcare, an unknown virus, social distancing, and homeschooling, the capital was hit with the earthquake during the lockdown.

Objectives

To assess the prevalence of stress, anxiety, depression, posttraumatic stress disorder (PTSD) and the influence of demographic characteristics, professional differences, medical history, and specific stressors on the psychological outcomes.

Methods

A cross-sectional study with the online questionnaire containing the Depression, Anxiety and Stress Scale (DASS-21) and the Impact of Event Scale-Revised (IES-R) was conducted from 1st to 15 May 2020 in FM.

Results

HCPs (534, 35% response rate), predominantly female (84.5%), participated in the research. High prevalence of stress (30.9%), anxiety (33.1%), depression (30.7%), and PTSD (33.0%) were found. Female participants had higher results in the anxiety subscale of DASS-21 and IES-R scores. Pre-existing conditions were associated with higher levels of stress, anxiety, depression, and PTSD. The IES-R score for PTSD showed borderline correlation (p = 0.053) with working in regions with the highest incidence of COVID-19. Having schoolchildren made a difference on a stress subscale in DASS-21 (p < 0.043), but the earthquake did not have an impact.

Conclusion

Family physicians and nurses in FM in Croatia are under a great mental load during the COVID-19 outbreak. Results suggest that HCPs of the female sex, with pre-existing chronic conditions, work in regions with a high incidence of SARS-CoV-2 or have schoolchildren at greater risk of the poor psychological outcome.

Keywords:

• Family medicine
• stress
• anxiety
• depression
• PTSD

Acknowledgement

We thank Tamara Poljičanin, MD, PhD, Epidemiology Specialist, and Senior Research Associate from the Croatian Institute of Public Health, for help with statistical analysis.

We thank Mario Trošelj, MD, Epidemiology Specialist from Croatian Institute of Public Health, for the additional data from the Public Servants Registry (data on total population in Croatia of FP's and nurses concerning demographic characteristics and professional differences).

Author contributions

SVT and VBL have joint first authorship. SVT conceived the study, designed the research questionnaire, conducted the research online, collected all raw data, contributed to the data interpretation, and drafted the manuscript. VBL conceived the study, designed the questionnaire, conducted the research among FPs by acquiring the data, and contributed to the editing of the manuscript. Both authors have read and approved the manuscript.

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.