Abstract
Objective: Although there are a sufficient number of studies on the mental impacts of the COVID-19 pandemic on healthcare workers (HCWs) in the early phase, few studies have evaluated these impacts in the vaccination phase. This study aimed to assess the prevalence of mental disorders and their associated factors among HCWs in the vaccination phase of the COVID-19 pandemic.

Methods: A cross-sectional, web-based survey collected demographic data with the structured 25-item questionnaire, COVID-19 infection status and exposure, and mental health measurements between 13 March 2021 and 20 April 2021, in Turkey. Depression, anxiety, insomnia, distress, resilience, and burnout were assessed by the 9-item patient health questionnaire (PHQ-9), the 7-item generalized anxiety disorder questionnaire (GAD-7), the Jenkins sleep scale (JSS), the 10-item perceived stress scale (PSS-10), the brief resilience scale (BRS), and two subscales of the Maslach burnout inventory (MBI): emotional exhaustion (EE) and depersonalization (DP), respectively. Thereafter, binary logistic regression was performed to explore the risk factors of those HCWs with poor mental health outcomes.

Results: A total of 573 HCWs completed the survey. Of the 573 responding participants, 309 (53.9%) were medical doctors, 119 (20.8%) were nurses, and 145 (25.3%) were other HCWs. Overall, 37.5%, 31.9%, 36.3%, and 19.2% of all HCWs reported symptoms of depression, anxiety, insomnia, and suicidal ideation, respectively. Moreover, 77% perceived moderate to high-stress, 49.9% described emotional exhaustion, and 11.3% of HCWs expressed depersonalization. A considerable proportion of participants reported exposure to violence (39.4%) and mobbing (38.6%) during the pandemic. We found a positive relation between getting COVID- 19 vaccine and anxiety (odds ratio [OR], 1.80; 95%CI, 1.01–3.21; p = 0.046). Being a woman (for depression, OR, 2.26; 95% CI, 1.48-3.45; p<0.001; for resilience, OR, 0.55; 95% CI, 0.38-0.80; p=0.002),working on the frontline (for emotional exhaustion, OR, 1.82; 95% CI, 1.26-2.62;p=0.001), being exposed to mobbing (for anxiety, OR, 2.86; 95% CI, 1.93-4.25;p<0.001; for depression, OR, 3.70; 95% CI, 2.55-5.36; p<0.001), being victim of the violence in the pandemic (for depersonalization, OR, 2.82; 95% CI, 1.58-5.03; p<0.001; for insomnia, OR, 2.03; 95% CI, 1.40-2.94; p<0.001), the loss of a loved one due to COVID-19 (for perceived stress, OR, 2.14; 95% CI, 1.22-3.75; p=0.008), having a mental disorder (for resilience, OR, 0.53; 95% CI, 0.30-0.94; p=0.031) and self-medicating with alcohol (for anxiety, OR, 2.86; 95% CI, 1.92-4.25; p<0.001) were associated with worsened mental health outcomes.

Conclusions: COVID-19 is still affecting the mental health of HCWs in the vaccination phase. These findings advance the understanding of risk factors for the poor mental health of HCWs during a pandemic. The results revealed that receiving psychological interventions for occupational mental health during the pandemic is important for HCWs.

Key words: mental health, healthcare professionals, occupational health, psychological impact, SARS-CoV-2, coronavirus, anxiety, depression, distress, vaccine