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Open Access

Peer-reviewed

Research Article

Anxiety, low, stress, fright and social back up during COVID-xix pandemic among Jordanian healthcare workers

• Eman Alnazly,
• Omar K. Khraisat,
• Ahmad Chiliad. Al-Bashaireh,
• Christine L. Bryant

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• Published: March 12, 2021
• https://doi.org/10.1371/periodical.pone.0247679

Figures

Abstract

The emergence of Coronavirus disease 2019 (COVID-19) has affected health-care workers' psychological and mental health. Few studies have been conducted examining the psychological result of COVID-19 on health-intendance worker psychological health in Jordan. Therefore, the present written report aims to assess the respective levels of fear, feet, depression, stress, social back up, and the associated factors, experienced by Jordanian wellness-care workers during the COVID-19 Pandemic. This study adopted a cross-sectional, correlational design to collect data from 365 health-care workers in Amman, Jordan, from August 16th to 23rd, 2020. Along with collecting sociodemographic characteristics, the Fearfulness of COVID-19 Scale, the Depression, Anxiety, Stress Calibration, and the Multidimensional Scale of Perceived Social Support electronically administered to participants. The bulk of the participants (69.iii%) were registered nurses. The hateful overall score for the Fear of COVID-19 scale was 23.64 (SD + half dozen.85) which again exceeded the mid-signal for the total score range (21), indicating elevated level fright of the COVID-xix pandemic. Participants had displayed extremely astringent low forty%, extremely severe anxiety threescore%, and 35% severely distressed. Scores for depression (21.xxx ± 10.86), anxiety (twenty.37 ± ten.80), stress (23.33 ± 10.87) were besides high. Factors determined to be associated with psychological distress were being male person, married, anile twoscore years and older, and having more clinical experience. Cess of social support indicated moderate-to-high levels of perceived back up for all dimensions (meaning other: 5.17 ± 1.28, family: five.03 ± ane.30, friends: 5.05 ± i.30). Weak pregnant correlations were constitute between social back up and the other study variables (r < 0.22), indicating a weak association with fear, depression, anxiety, and stress, respectively. Overall, Jordanian health-intendance workers sample reported fear, low, feet, and stress. The associated factors were existence male, married, aged 40 years and older, and having more than clinical experience. Regarding social back up, participants primarily relied on support from their families, followed by support from friends.

Citation: Alnazly E, Khraisat OM, Al-Bashaireh AM, Bryant CL (2021) Anxiety, depression, stress, fear and social support during COVID-19 pandemic amongst Jordanian healthcare workers. PLoS ONE 16(iii): e0247679. https://doi.org/10.1371/journal.pone.0247679

Editor: Manuel Fernández-Alcántara, Universitat d'Alacante, Espana

Received: September 30, 2020; Accepted: February 11, 2021; Published: March 12, 2021

Copyright: © 2021 Alnazly et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted utilise, distribution, and reproduction in whatever medium, provided the original writer and source are credited.

Data Availability: All relevant data are within the paper and its Supporting Information files.

Funding: The authors received no specific funding for this work.

Competing interests: The authors have declared that no competing interests exist.

Introduction

On March 11th, 2020, the World Health System (WHO) alleged that the coronavirus illness 2019 (COVID-xix) outbreak had go a pandemic [1]. In December 2019, reports emerged from China regarding the initial detection of SARS-COV-2 as the source of the pneumonia outbreak of COVID-xix [two]. On January 26th,2020 the Jordanian National Epidemic Commission and the Jordanian Ministry of Health had met to put a plan in place to manage the pandemic. The recommendations had included the designation of several hospitals as handling centers for prospective patients with COVID-xix and established protocols to prevent the spread of the land's infectious disease even before the starting time case of COVID-nineteen was reported [3]. The Jordanian Ministry of Health had followed the Epidemic committee's recommendations and opened five hospitals located in different areas around the state designated for treating patients with COVID-19. Ministry of Wellness had equipped these hospitals with ventilators, personal protective equipment (PPE), including disposable gowns, masks, gloves, and face-shields, and trained infectious affliction medical staff [3]. Besides, the Jordanian Ministry of health brash all health-intendance workers from unlike sectors to wear PPE and implemented quarantine policies [three]. The beginning instance of COVID-19 in Jordan was reported on March 2nd [3], and on March 15th, the authorities airtight the land's borders, suspended schools, banned public gatherings, and issued a stay-at-abode order [three]. On March 17th, after a instance of COVID-19 was traced to a wedding in due north Jordan, the government implemented a curfew [4]. On March 25th, the government lifted the curfew partially and allowed essential services and schools to remain airtight. Ministry building of Wellness mandated social distancing, masks in public, and the cocky-quarantining of asymptomatic positive persons. By the end of Apr, there were 451 registered cases and viii deaths [4].

By mid-Baronial, the COVID-19 state of affairs in Hashemite kingdom of jordan began to worsen, with the recording of 20–xxx cases per day and toward the end of August, the daily cases were xxx–40 [4]. This quickly escalated to several hundred and and so to several grand cases a 24-hour interval, most probable due to a lack of public compliance with recommendations; consequently, the government imposed stricter safety measures and penalties for non-adherence [4].

In Jordan, during the calendar month of August, there were ii,034 confirmed cases (including l health-care workers), 456 people receiving treatment, 1,508 recovered cases, and 15 deaths [4]. On the global level, by August fifteen^th, 300,000 wellness-care workers worldwide had contracted COVID-xix, and two,500 had died [v]. Farther, over ane.8 1000000 new COVID-19 cases and 38,000 new deaths were reported worldwide during August; this meant a cumulative full of 25 one thousand thousand cases and 800,000 deaths since the commencement of the outbreak [six]. During the month of November, a full of 817 cases had been recorded amongst nurses, representing 5.5% of wellness-care workers, and 26 COVID-xix-related deaths had been recorded among physicians [7]. It should be noted that the figures above regarding example numbers among health-care workers about certainly practice non reverberate the actual number of cases amid health-care workers, as some infected people exhibit mild symptoms or no symptoms, meaning they are unlikely to be tested [8]. The COVID-xix has meaning negative impacts on wellness-intendance workers' psychological health, fostering issues such equally anxiety, depression, and sleep disturbance [ix]. This indicates the necessity of providing psychological support for health-care workers, such equally by implementing occupational wellness surveillance programs that railroad train and educate health-care workers in terms of their ability to address the communicable diseases and associated psychological distress [ix].

Moral injuries are a form of psychological distress that issue from performing an action that contradicts i's own moral and ethical code; such incidents tin can produce emotional guilt, shame, and anger [10]. These symptoms can contribute to mental-wellness difficulties, which can atomic number 82 to either psychological injury or psychological growth [10]. Whether an individual experiences the sometime or latter upshot is probable to be influenced by how he/she is supported earlier, during, and afterward the incident [11]. Wellness-care workers have been constitute to experience moral injuries, too every bit isolation, and at take a chance for occupational injuries, and life-threatening situations [ix]. Occupational defines as injuries relate to any illness caused by any biological agent that can be experienced while working or while commuting to work [12].

As a result of the pandemic, rapid spread and the associated increased mortality rate, the pandemic has caused public-wellness bug worldwide; further, the stress people feel in response to this situation has also had a astringent negative outcome [13]. Regarding wellness-care workers, COVID‐19 has caused issues such as high wellness-care demands, increased patient bloodshed, emotional and physical stress, and rationing of health-intendance supplies [14]. Farther, rapid increases in the number of suspected and confirmed positive cases, depression supplies of PPE, overwhelming work-loads, widespread media coverage of the pandemic, perceived inadequate organizational support, and an increased risk of contracting the disease and transmitting it to one'south ain family unit have also acquired psychological distress amid health-intendance workers [14–16]. It is essential to consider both the psychological and physiological influence of the pandemic on health-care workers. Failure to assess and address psychological responses to pandemic-associated stressors can negatively impact wellness-care workers' physiological and psychological operation [13]. Notably, during pandemics, health-care workers who provide care to patients are amidst the populations most likely to experience psychological distress, including depression and anxiety [fourteen–17].

Previous studies of COVID-xix pandemics have revealed that the psychological furnishings of infectious disease outbreaks can last long after the event, negatively impacting psychological well-being [xviii] and causing post-traumatic stress disorder, low, and stress among health-intendance workers [nineteen, 20]. In the context of the pandemic crisis, health-care workers are expected to deal with patients' traumatic experiences and the unexpected loss of friends, family, and colleagues. As a consequence, health-intendance workers are afflicted by psychological distress, including depression, anxiety, and stress [21]. Batra et al. [22] conducted a meta-analysis to provide new bear witness related to COVID-19 touch on health-care workers' psychological well-being. Among the main factors identified as causal in psychological distress are feet, depression, stress, mail-traumatic stress syndrome, indisposition, psychological distress, and burnout. Higher anxiety and depression levels were more prevalent among females than males and nurses compared to doctors and front-line workers compared to second-line health-intendance workers [22].

In that location are four categories of social back up: "emotional," "appraisal," "informational," and "instrumental" [23]. Social networks include an private's family unit, friends, neighbors, and other shut significant persons [23]. For health-care workers, social support reduces occupational stress and prevents common psychological distress and psychiatric symptoms; however, coworker support is also significant for health-care workers, equally it impacts self-efficacy and professional efficacy [24]. Notably, negative social support is associated with stress and anxiety among medical staff [xv].

COVID-19 is an infectious affliction that has afflicted virtually every nation in the world. Research has currently focused on addressing the general population's well-being with footling attention being directed toward health-care workers' psychological distress. Therefore, the present study aimed to appraise the fearfulness, depression, anxiety, stress, social support, and the associated factors among Jordanian health-care workers during the COVID-19 pandemic. Too, we aimed to investigate the bear on of sociodemographic characteristics on these variables.

Through this assay, we determined that health-care workers in Hashemite kingdom of jordan accept high levels of depression, feet, stress, and fear of COVID-nineteen, but that they also perceive high levels of social support.

Methods

Written report design and participants

This quantitative study featured a cross-sectional, descriptive, and correlational blueprint. The participants were 365 health-intendance workers from Amman, Jordan, who completed an online questionnaire distributed through Google Forms between August 16th and August 23rd, 2020 when COVID-19 situation in Jordan began to worsen, with the recording of 20–30 cases per day and this quickly escalated to several hundred and then to several thousand cases a twenty-four hours. Notwithstanding, the number of cases that required hospitalization was low. Individuals were approached for participation through social-media applications, text messaging, and emails.

The online Raosoft sample size calculation methodology was used in our written report [25]. Co-ordinate to this method a minimum of 378 participants is needed; given that the margin of error blastoff (α) = 0.05, the confidence level is = 95%, total population = 21,033 [26], and the response of distribution = fifty%. The sample size was also calculated using Krejcie and Morgan method, which provides a like sample size [27]. Our study was able to recruit a close number of 365 participants.

Participant recruitment

For initial recruitment, the present researchers contacted 24 health-care workers (Registered Nurses, Pharmacists, physicians, radiologist), who were known to the researchers. Through individual phone calls, the researchers informed these coworkers of the purpose and procedure of the study. The researchers then asked the group if they knew of any other wellness-care workers who met the inclusion criteria (see below), and if they could invite them to participate in this report. An informational certificate that provided details regarding the survey (i.e., the title of the report, the purpose and significance of the study, privacy information, and researchers' e-mail addresses and telephone numbers) was distributed to prospective participants. The grouping forwarded the informational document to other health-care workers through electronic mail, text message, or social media. Health-care workers who agreed to participate were contacted past a member of the research team through electronic mail or text message. Any questions these prospective participants had regarding the study were answered. A URL linking to the consent form was sent to each private who agreed to participate, and consent to participate was confirmed through electronic signature (i.e., the ticking of a box on the form). Afterwards consent was received, a URL for the Google Forms questionnaire was sent to the participants by text message or electronic mail. The researchers emailed the URL to 510 health-care workers, returned 365 (72%) responses.

Inclusion and exclusion criteria

Inclusion criteria for participation were: 1) being a health-care worker, 2) residing in Amman/Jordan, and 3) providing intendance for patients at the time of the survey. The exclusion criterion was not working the week prior to the information-drove period.

The e-survey

The survey was administered online, and the Checklist for Reporting Results of Internet East-Surveys (commonly known as "CHERRIES") [28] was used to report the results. The online questionnaire was developed using Google Forms. Google Forms represents a method of rapidly gathering participants' responses online. The survey answers were automatically collected in an EXCEL spreadsheet that was imported into SPSS for data analysis. To determine the practicability of the questionnaire, the constituent instruments were airplane pilot-tested beforehand on a group of 30 wellness-intendance workers; these individuals were excluded from the main study.

The enquiry instruments

Sociodemographic characteristics and wellness-related variables.

Participants' socio-demographic characteristics, including gender, age, education level, marital condition, profession, work blazon, and clinical experience, were collected.

The fearfulness of COVID-nineteen scale.

The participants were asked to report their level of fear regarding the COVID-19 Pandemic. The Fear of COVID-19 Scale (FCV-19S) is a seven-detail scale designed to measure fright of COVID-19 among the general population [29]. Answers are given using a five-indicate scale (1 = "strongly disagree," 2 = "disagree," 3 = "neither agree nor disagree," 4 = "concord," and "5 = strongly concord"). The scores for all 7 items are summed to obtain the total score; thus, the range for the total score is 7–35. College scores indicate greater fright of COVID-19. The scale has acceptable concurrent validity when compared with the Hospital Feet and Depression Scale and the Perceived Vulnerability to Disease Scale; further, the developers adamant that the Cronbach's alpha value for the FCV-19S is 0.82, and that its test-retest reliability is 0.72 [29]. For this report, the Cronbach'due south alpha value was 0.91.

Depression, feet, stress scale.

The Depression, Feet, Stress Scale (DASS) is designed to measure respondents' depression, anxiety, and stress, respectively, over the by 7 days [30]. The scale comprises 3 cocky-reported subscales, and has a total of 42 items. Each subscale comprises 14 items. Items are rated using a four-point Likert scale ranging from 0 to 3 (0 = "not at all," i = "to a considerable caste, or some of the time," 2 = "most of the time," iii = "all the time").

The respective scores for depression, anxiety, and stress were calculated past totaling the scores for the respective associated items, and the severity rating index was used to determine the respondent'south status in each regard. The severity rating index for each DASS subscale as follow (depression was comprising normal (0–ix), balmy (x–13), moderate (14–20), severe (21–27), and extremely severe (28+). Anxiety scoring comprising normal (0–7), mild (8–nine), moderate (ten–14), severe (fifteen–19), extremely severe 20+. Stress scoring comprising normal (0–xiv), mild (15–18), moderate (nineteen–25), sever (26–33), extremely severe (34+). In the original study, the Cronbach's blastoff values for low, anxiety, and stress were 0.91, 0.84, and 90, respectively [thirty]. For this study, the Cronbach's alpha values for depression, feet, and stress were 0.95, 0.94, and 0.96, respectively.

Multidimensional calibration of perceived social support.

The Multidimensional Scale of Perceived Social Support (MSPSS) is designed to determine respondents' perceptions regarding the adequacy of the support they receive from family, friends, and significant others. The MSPSS [31] is a 12-detail self-administered scale, and responses are given using a seven-point Likert scale (one = "very strongly disagree," ii = "strongly disagree," 3 = "mildly disagree," four = "neutral," v = "mildly agree," 6 = "strongly hold," vii = "very strongly agree"). The scale comprises three subscales: family unit, friends, and pregnant others. For each subscale, the mean score is determined by summing the scores for each associated item and dividing the result by 4. The full score is determined by summing the scores for each of the 12 items. For the original study, the Cronbach's blastoff values were 0.91, 0.87, and 0.85 for the significant others, family unit, and friends subscales, respectively. The reliability of the total calibration was 0.88. Further, the test-retest reliability afterward 2–three months was 0.91, 0.85, and 0.75 for the significant others, family, and friends subscales, respectively, and 0.85 for the overall scale [31]. For the nowadays study, the Cronbach's alpha values were 0.89, 0.86, and 0.87 for the significant other, family unit, and friends subscales, respectively.

Scale administration

The validity of three questionnaires was established using a panel of vi experts to ensure the validity of the questionnaires. The validity checked in terms of the survey questions measures what they were intended to measure (face validity), the survey contains questions that covered all aspects of the construct being measured (construct validity), and the extent to which a constructed measure out may chronicle to or predict any result for another measure (criterion validity) [32]. The six experts are kinesthesia members of PhD holders with a specialty in mental health, medical-surgical, and customs. All experts agreed that the questionnaires were valid.

The three scales were administered in English. The instruments were pilot-tested on 30 health-care workers who were known to the researchers; these individuals were excluded from the main study. The Cronbach's alpha values obtained through the pilot test were equally follows: FCV-19S = 0.86, DASS = 0.90, and MSPSS = 0.84. The exam-retest reliability for the same group was as follows: FCV-19S = 0.88, DASS = 0.82, and MSPSS = 0.lxxx.

Ethical considerations

This study was performed in accordance with the Declaration of Helsinki, and approving was obtained from the Human Subjects Review Board of Al Ahliyya Amman Academy (ID number: 2020-2019/fourteen/5) prior to the data collection. Written informed consent was obtained from all participants. The data were stored on a personal computer to which only the primary author had admission.

Statistical analyses

Data were entered and analyzed using SPSS software (IBM, SPSS Statistics, Version 24). Initially, the data were checked for missing data and outliers. In that location was no missing data because, on eastward-survey, we had a star on each question that participants could not motility to the side by side question without answering the previous question. The outliers were screened through visual cess for scattered plot diagrams, which revealed no outliers. Box Plot and histogram were used to bank check the normality, as well as the linearity was checked by Pearson correlation, and homogeneity was checked past The Levene's examination.

Descriptive statistics were used, including frequencies (n), percentages (%), ways, standard deviations (SDs), medians, and interquartile ranges (IQRs). Variations betwixt sub-categories of demographic variables were checked using chi-foursquare tests. Inferential statistics approaches were used to identify differences in demographic variables; these approaches included independent samples t-tests and variations beyond demographic sub-groups. Farther, Pearson's correlation coefficient was used to decide the relationships between variables and to establish the inter-correlation matrix. To lower the risk of type I errors, the statistical significance level was gear up at p < 0.05.

Results

The participants' sociodemographic characteristics are presented in Table 1. Participants were distributed over a range of demographic subgroups. Approximately 55% of the participants were women, and most were anile beneath fifty years (77.8%) and were married (57.5%). The median family size was three members. Nigh participants were registered nurses (63.0%), held a baccalaureate degree (69.iii%), and provided direct care to patients (75.ix%). Over 65.0% of the participants had over ten years of clinical experience. Questions regarding the COVID-19 Pandemic revealed that virtually of the participants (62.vii%) had never provided straight care for patients who had tested positive for COVID-19. Still, near of the participants (73.two%) reported receiving back up from work administrators during the COVID-xix Pandemic, and 58.4% reported high adherence to the stay-at-habitation regulations.

Cess of fear of COVID-xix

Tabular array 2 presents the results for the FCV-19S, which reflected the participants' fear of COVID-19. For each item, the hateful score exceeded the midpoint of 2.5, indicating a moderate level of fright. The total hateful score for the FCV-19S was 23.64, (SD = 6.85) which once more exceeded the mid-point for the total score range (21), indicating elevated level fear of the COVID-19 pandemic. Fig 1 shows the distribution of the fright level scores. Most participants 55% fear level was between 21–30 and 15% between 31–40 (Fig 1).

Assessment of low, feet, and stress

The hateful scores for each subscale of the DASS, are presented in Table 2. Participants displayed extremely severe depression (21.30 ± 10.86), extremely astringent anxiety (20.37 ± ten.eighty), and moderate stress (23.33 ± 10.87). Fig 2 illustrates, for low, feet, and stress, the distribution of the participants beyond the v levels of severity. Based on the information, approximately 35% of the participants had extremely severe depression, over 40% had moderate to severe low, and approximately 20% had normal to mild depression (Fig 2). For anxiety, approximately sixty% of the participants, reported extremely astringent anxiety. Regarding stress, the figure shows an uneven distribution over the severity levels, indicating inconsistent patterns of stress severity. Still, approximately 35% was severely distressed.

Perceived social back up

The results regarding the social back up received by the wellness-care workers from significant others, family members, and friends, respectively, are presented in Tabular array ii. For pregnant others, the results indicated that the participants perceived high levels of support from all associated sources; the scores for all items exceeded five out of 7. These loftier scores were reflected in the mean score for the subscale (5.17 out of 7), which exceeded the midpoint. Regarding the family subscale, for all associated items the mean scores were to a higher place the midpoint of 4, indicating adequate support from family members. The mean score for the subscale (5.03 out of seven) was also above the midpoint, indicating high recognition of family support. Similarly, for the friends subscale, for all items the mean scores were higher up the midpoint, and the mean score for the subscale (5.05 out of seven) indicated high recognition of support from friends. The total mean score for the MSPSS was 5.09 out of 7, indicating high perceived social support (Table 2).

Fig 3 shows the distribution of the scores for the three dimensions over iii levels of support (low, moderate, and loftier back up, respectively). The figure shows that all three dimensions are consistently distributed beyond the three levels. The highest frequency was reported for "high support," followed by "moderate support," and "low back up," respectively. This pattern was consistent beyond all three dimensions (Fig 3).

Variations across demographic sub-groups

The master differences between the demographic sub-groups in terms of the study variables (Table three) (fright, feet, depression, stress, and perceived social support) are listed beneath:

• Male person participants returned statistically higher scores for fear, depression, feet, and stress, respectively, when compared to female participants (p < 0.001, p = 0.001, p < 0.001, and p = 0.001, respectively). However, no statistical difference was found between males and females regarding social support.
• Married participants returned significantly higher scores for fear, depression, anxiety, and stress, respectively, when compared to unmarried participants (p = 0.015, p = 0.004, p = 0.019, and p = 0.012, respectively). In addition, married participants demonstrated higher social support when compared to single participants (p < 0.001).
• Participants aged over forty years showed statistically higher levels of fear, depression, anxiety, and stress, respectively, when compared with participants aged < 40 years (p < 0.001, p < 0.001, p = 0.001, and p < 0.001, respectively). Moreover, older participants (> 40 years sometime) showed higher perceived social back up than younger participants (< 40 years old; p = 0.001). The event of ANOVA (Table 4) revealed that pregnant relationship betwixt psychological distress and social support and age p ≤ 0.05.
• Similarly, participants with more clinical experience (over xx years) showed statistically college levels of fear, low, anxiety, and stress, respectively, when compared to participants with clinical feel of less than xx years (p < 0.001, p < 0.001, p < 0.001, p < 0.001, respectively). Further, participants with more than clinical experience reported more social support when compared to participants with shorter clinical experience (p = 0.018). The consequence of ANOVA (Tabular array 5) revealed that significant relationship betwixt psychological distress and social back up and clinical feel, p ≤ 0.05.

• Participants who provided care for patients who had tested positive for COVID-xix reported higher levels of fear, depression, anxiety, and stress, respectively, when compared to those who did not provide care for patients who were COVID-xix-positive (p < 0.001, p < 0.001, p = 0.002, p = 0.001, respectively).
• Participants who took vacation days during the pandemic reported lower levels of fear, depression, anxiety, and stress, respectively, than did those who did not take any holiday during that menstruum (p = 0.000, p = 0.002, p = 0.000, p = 0.000, respectively). However, in relation to social support, there was no pregnant difference betwixt the participants who took holiday days and those who did not accept vacation days (p = 0.319).
• No significant differences were observed betwixt professions (nurses, doctors, radiologists, and pharmacists) regarding any of the study variables (fear, depression, feet, stress, and social back up).

Factors influencing social back up during the COVID-19 pandemic

According to the correlation matrix presented in Tabular array 6, both clinical feel and social support have a weak significant positive correlation with fear, low, anxiety, and stress, with correlation values (r) being approximately 0.twenty and below. All the same, fear, low, feet, and stress were positively correlated, with correlation values (r) ranging betwixt 0.sixty and 0.90; this indicated stiff relationships.

Discussion

The findings of the nowadays written report provide insights into health-care workers' psychological status during the COVID-19 Pandemic. This written report analyzed a mixed group of wellness-care workers in Jordan 5 months after COVID-19 was declared a pandemic.

Factors associated with health-intendance workers' psychological distress were determined to include existence male person, married, aged 40 years and older, having more clinical experience, and working directly with patients who have been diagnosed with COVID-19. Fearfulness, depression, feet, and stress were positively correlated. All participants reported psychological distress; however, those who were xl years of historic period and older showed a statistically college level of psychological distress. The health-care workers' concerns were due to several factors. A possible reason for the high level of distress among older workers is that the risk of severe respiratory distress equally a result of COVID-19 increases with age, significant older adults are at higher gamble [33]. People at increased risk and those who live with or visit such people need to have precautions to protect themselves from getting COVID-19. Thus, older health-care workers may accept reported higher psychological distress because older people tin can have health issues that make them more prone to complications, and they could besides live with young children and/or have older people in their extended family, which could cause them to worry nigh bringing the virus home to their family members.

The current study's findings also indicated that wellness-intendance workers who took vacation days reported lower levels of depression, fear, feet, and stress, respectively. These results support those of Luceno-Moreno et al. [34], who established that long working hours contribute to psychological problems, and those of Barello et al. [35], who observed piece of work-related psychological pressure level, emotional burnout, and somatic symptoms among wellness-care workers in Italia. The impact of working long shifts, 12 hours and more, on nurses and wellness-care help found 24% of nurses and health-care assist were more likely to miss days of piece of work due to sickness [36]. Thus, wellness-care workers are encouraged to take vacations from work for helping health-care workers relax, which contributes to preventing stress. Therefore, during pandemic situations vacations from piece of work are necessary for reducing psychological distress among health-care workers, leading to lower levels of depression, fear, anxiety, and stress. Of course, the effectiveness of this can depend on the local quarantine policy and burden experienced by health-care workers.

The study results indicated weak correlations between years of clinical feel and fear, anxiety, and depression, respectively. The challenge that the pandemic brining to health-care workers such increment vigil of care and increased patients' book and, uncertainty wellness-care professional safety, as a result of reusing of personal protective equipment which was not function of health-care professional practice [37]. Health-care workers are hearing about potential surge, which was expected to hit harder, dealing with astringent ill patients and death. With experience, wellness-care workers may adapt to stressful working environment merely research, nonetheless, stressors may accrue and cause psychological distress [38].

Pappa et al. [39] conducted a systematic review and meta-analysis of the prevalence of anxiety, depression, and insomnia, respectively, amid health-care workers during the COVID-nineteen Pandemic. Anxiety was assessed across 12 studies, and a prevalence of 23.2% was returned; meanwhile, depression was assessed across 10 studies, and a prevalence of 22.8% was returned. The findings of Pappa et al. [39] back up the results of the current study, every bit they signal that health-intendance workers experience anxiety and depression during COVID-nineteen; however, Pappa et al.'south findings also contradict the results of the nowadays research, as the systematic review and meta-assay showed a higher prevalence of feet than depression. Our study institute higher depression than anxiety. Finally, Labrague and De Los Santos [xl] plant that 123 of 325 (37.8%) nurses examined had dysfunctional anxiety levels. Labrague and De Los Santos [forty] likewise indicated that COVID-19 feet is associated with social support, organizational support, and personal resilience. These findings support the current report results past showing that front end-line nurses are affected by anxiety during the COVID-19 Pandemic. To help wellness-care workers provide intendance under extremely hard clinical circumstances such every bit COVID-19 pandemic, the emotional and behavioral reactions vary amid health-care workers should be acknowledge and empowered through education and training to overcome fear and empathetic distress [37].

The results of our examination of social back up during the COVID-nineteen Pandemic indicated that health-care workers perceive themselves as receiving high levels of social support. Our findings showed that health-care workers gain social back up when providing care to patients. The health-intendance workers we examined perceived high levels of all types of social back up, with hateful particular scores exceeding 5 out of seven for all. The overall mean score (v.17 out of 7; determined by considering the means for all three subscales) was also above the midpoint. Thus, the results showed that, during the COVID-xix Pandemic, health-care workers gain support when providing care for patients. These results support the findings of a narrative review by Heath et al. [13], which showed that back up offered earlier and during an incident influences whether wellness-care professionals experience injury or psychological growth. Heath et al. [thirteen] also indicated that clinicians who accept good for you, meaningful personal and professional relationships are contented and have a lower risk of burnout. Heath et al. also showed that health-care professionals who have piece of work responsibilities that interfere with their home lives are more likely to experience burnout, leading to stress when providing care to patients [xiii]. Likewise, feeling the guilt of transmitting the infection to family members at dwelling house, wellness-care workers feel stigmatization. Self-stigma, more often than not, if health-care workers were in direct contact with infected patients, they preferred to stay away from them [41]. Moral injuries take been widely reported among health-care workers on duty during the COVID-nineteen pandemic [10]. The clinical and upstanding challenges that these workers face can foster psychological distress, and health-care workers with poor psychological wellness bear on the quality of care provided at their institutions, every bit well as their coworkers capability to piece of work [42]. Anticipating the problem may help lessen its impact, and early identification of psychological distress and health-care support is essential.

Indeed, COVID-19 infection becomes an occupational injury when wellness-intendance workers contract the virus through work or while commuting to piece of work [eleven]. To support wellness-care workers during hereafter health emergences (such every bit time to come infections or disasters) and protect them from such injuries, wellness-care leaders should, in accord with other regulatory agencies effectually the world, rapidly implement policy changes at institutional levels and at the local level to facilitate a shift in civilisation towards improved well-being and workplace environments.

Social support is necessary as coping mechanism to decrease health-intendance workers' psychological distress and promote positive feelings. Spinale et al. [43] reported that social support is correlated with spirituality. Spirituality is associated with transcendental values that are generally influenced past personal experiences and grounded in religious traditions; however, a comparable sentiment can be achieved in a not-religious context. Spirituality can foster positive feelings and promote physical and mental wellness [43]. People with greater spirituality have also been reported to experience higher levels of well-being [44]. Thus, improving spirituality among wellness-care workers during pandemics may assistance them relieve their physical and psychological distress, and also back up coworkers, patients, and patients' family members. This is especially of import during pandemics, as these are times when spiritual specialists or religious leaders are unable to closely contact patients and health-care workers.

In summary, the present findings show that wellness-intendance workers feel depressed, anxious, stressed, and fearful of the pandemic. This means that wellness-care workers are making critical decisions in the course of their work while experiencing notable distress. Direct support from management tin can aid staff develop positive perceptions about work, and can help them manage stress. Withal, inadequate protection, perceived stigma, and negative feedback from patients can exacerbate COVID-xix-related psychological distress [45, 46]. Besides, wellness-intendance workers who perceive high level of psychological distress, need psychological support [47]. Que et al. [45] suggested that psychosocial interventions should be provided in the early on stages of pandemics for health-care workers who are at adventure of experiencing psychological distress. According to our findings, adequate social support is essential for addressing stress, feet, and depression. Even so, additional research is required to explore the long-term furnishings of the COVID-19 Pandemic on psychological distress among health-care workers.

Strengths and limitations

The strength of this study is that it measured psychological distress and social back up among health-care workers five months after the WHO declared the COVID-19 outbreak a pandemic, and later public services in Jordan were reopened after the lockdown. The study also considered health-intendance workers' psychological concerns subsequently the pandemic was declared. This is a strength considering psychological distress among health-care workers during the pandemic has been somewhat understudied. On the other paw, this study besides contains limitations. I of the principal limitations is the cross-sectional nature of the written report. Psychological distress was merely evaluated cross-sectionally; consequently, we could not obtain information regarding existing causal relationships. Further, the data did non represent the entire population of health-intendance workers and the services in which they worked (intensive intendance, main care. . .), also, did not include other variables such as whether the participants had had whatsoever personal experience of loss or illness due to COVID in their family or friends, and, as a upshot, the findings cannot exist used to make useful generalizations regarding wellness-care workers every bit a whole, or to determine specific variables' correlations with specific groups of health-care workers. A larger sample of health-care workers recruited from various areas in Jordan is needed to verify the results. Moreover, further enquiry is needed to explore the long-term effects of the COVID-19 Pandemic on health-intendance workers.

Implications for wellness-care workers

The results of this study showed that the COVID-19 Pandemic has fostered psychological distress among health-care workers in Jordan, and wellness-care workers take become acutely witting of the threat of the virus' spread. Thus, safeguarding the psychological well-being of health-care workers is crucial during pandemic situations. Employers should attempt to place approaches that can improve psychological distress among such workers.

Most health-care workers have direct contact with patients, and this can cause loftier levels of feet. Managers and leaders should increase the back up available for health-intendance workers in their organizations and in health-intendance workers' own social networks. Early on identification of psychological stress is of import.

Being male, older, and having more clinical experience increase the risk of stress during pandemics. Thus, during such situations psychological support is essential for this group. Notwithstanding, older health-care workers should also proactively seek psychological support. Further, efforts should be made to develop coworker back up; health-intendance workers could aim to aid others implement effective decision-making in response to pandemic-related challenges.

Practical implications

The results of this study advise that measures should exist implemented to protect the mental well-being of health-care workers during the COVID-xix Pandemic. Leaders in health-care facilities should realize the importance of close relationships with wellness-intendance workers during the boggling times they are facing in this pandemic. In addition to ensuring that the physiological needs of wellness-intendance workers, such as availability of PPE and safe working environments, are met, leaders should reassure health-care workers that they and their families volition exist adequately supported should they become infected with COVID-19. This support should include medical, financial, and psychosocial assistance for both the health-intendance workers and their families. Moreover, leaders and managers of health-care facilities should make efforts to place sources of anxiety and fright among health-care workers, and should schedule rigorous assessments past professional psychologists and mental-health professionals. At the primary and secondary levels, regular meetings should be held with wellness-care workers to promote the development of healthy patterns of coping with the stressors of working with patients with or suspected of having COVID-19. At the secondary level of prevention, individual counseling for mental well-being concerns and early on treatment is essential. Teams of professional psychologists should be available at each institution for health-care workers to contact at any time, and prompt treatment should be provided, and equally follow-ups. In addition, peer support and grouping discussions should be encouraged.

The major issues for health-intendance workers are fearfulness, low, anxiety, and stress. The participants in this written report felt that they received high social back up, but they also showed higher psychological distress. These characteristics should exist considered when developing strategies to address this. It is not clear whether health-care workers physically distance themselves from their families as a upshot of lockdowns, social-distancing recommendations, and their close contact with patients. If so, social back up in the workplace could give health-care workers a sense of being a member of a social network; consequently, health-intendance workers should be provided with opportunities to establish and strengthen such professional relationships.

Farther, healing moral distress and occupational injuries are important. This requires collaboration between health-care workers, administrators, and representatives of the customs; in particular, an ethically open-door lawmaking for pandemic contexts should be established that can strengthen health-care workers' morals.

Conclusion

Our study demonstrated the presence of fear, depression, anxiety, and stress among health-care workers during the COVID-nineteen Pandemic. The health-care workers examined considered social support from families and friends to be important during the pandemic, and demonstrated a need for increased social support to suit to psychological distress. Factors determined to be associated with psychological distress were being male, married, aged 40 years or older, and having more clinical feel. The influence of these factors may be related to the environment in which health-care workers practice. Thus, this study suggests that health-care organizations pay attention to wellness-intendance workers' well-being and promote early assessment and identification of psychological distress. It is also necessary to accost social support through policy since, every bit a issue of social distancing, in that location are fewer opportunities for social interaction and to attend events. Social back up systems play an of import part in protecting wellness-care workers and reducing the prevalence of psychological distress.

Supporting information

Acknowledgments

I would like to give thanks health-care workers who took the time to complete the questionnaires. Without their response, this project would non have been possible.

References

1. ane. Globe Health Organization. Coronavirus disease (COVID-19) pandemic; 2020. Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019.
2. 2. Harapan H, Itoh N, Yufika A, Winardi Due west, Keam Due south, Te H, et al. Coronavirus illness 2019 (COVID-xix): A literature review. J Infect Public Health. 2020;13(5):667–673. pmid:32340833
   • View Article
   • PubMed/NCBI
   • Google Scholar
3. 3. Abufaraj MM. Hashemite kingdom of jordan's efforts to contain COVID-19: A conscientious interpretation of the encouraging numbers. Hashemite kingdom of jordan Times. 2020 Apr 1 [Cited 2020 December 21]. Available from: https://world wide web.jordantimes.com/stance/mohammad-majed-abufaraj/jordans-efforts-incorporate-covid-19-conscientious-interpretation-encouraging.
4. 4. Jordanian Ministry of Health. Hashemite kingdom of jordan'south official COVID-19 website; 2020. Available from: https://corona.moh.gov.jo.
5. 5. Erdem H, Lucey DR. Healthcare worker infections and deaths due to COVID-19: a survey from 37 nations and a telephone call for WHO to post national data on their website. Int J Infect Dis. 2021;102: 239–241. pmid:33130210
   • View Commodity
   • PubMed/NCBI
   • Google Scholar
6. half dozen. World Wellness Organization. Coronavirus disease (COVID-xix) dashboard; 2020. Available from: https://covid19.who.int/region/emro/country/jo
7. seven. Jordanian Ministry of Health. Department of communicable disease; 2021. Available from: https://corona.moh.gov.jo/en
8. 8. Chirico F, Nucera G., Magnavita Due north. Protecting the mental wellness of healthcare workers during the COVID-19 emergency. BJPsych International. 2020; 1–ii.
   • View Article
   • Google Scholar
9. 9. Chirico F, Magnavita N. The crucial role of occupational health surveillance for health-intendance workers during the COVID-xix Pandemic. Workplace Health Safe. 2021;69(ane): 5–six. pmid:32961069
   • View Article
   • PubMed/NCBI
   • Google Scholar
10. 10. Williamson Five, Murphy D, Greenberg North. COVID-nineteen and experiences of moral injury in front-line central workers. Occup Med. 2020;70(5): 317–319. pmid:32239155
    • View Article
    • PubMed/NCBI
    • Google Scholar
11. xi. Greenberg Due north, Docherty M, Gnanapragasam S, Wessely South. Managing mental health challenges faced by healthcare workers during covid-19 pandemic. BMJ. 2020;368: m1211. pmid:32217624
    • View Article
    • PubMed/NCBI
    • Google Scholar
12. 12. International Labour Office. ILO list of occupational diseases (revised 2010). Bachelor from: https://www.ilo.org/wcmsp5/groups/public/—ed_protect/—protrav/—safework/documents/publication/wcms_125137.pdf
13. thirteen. Heath C, Sommerfield A, von Ungern-Sternberg BS. Resilience strategies to manage psychological distress amid healthcare workers during the COVID-19 pandemic: a narrative review. Anesthesia. 2020;75(x): 1364–1371. pmid:32534465.
    • View Article
    • PubMed/NCBI
    • Google Scholar
14. 14. Maben J, Bridges J. Covid-19: Supporting nurses' psychological and mental wellness. J Clin Nurs. 2020;29(15–16): 2742–2750. pmid:32320509.
    • View Commodity
    • PubMed/NCBI
    • Google Scholar
15. 15. Xiao H, Zhang Y, Kong D, Li S, Yang N. The furnishings of social support on slumber quality of medical staff treating patients with coronavirus disease 2019 (COVID-19) in January and February 2020 in China. Med Sci Monit. 2020;26(26): e923549. pmid:32132521.
    • View Article
    • PubMed/NCBI
    • Google Scholar
16. 16. Preti E, Di Mattei V, Perego G, Ferrari F, Mazzetti M, Taranto P, et al. The psychological bear on of epidemic and pandemic outbreaks on healthcare workers: rapid review of the evidence. Curr Psychiatry Rep. 2020;22(viii): 43. pmid:32651717.
    • View Article
    • PubMed/NCBI
    • Google Scholar
17. 17. Lai J, Ma S, Wang Y, Cai Z, Hu J, Wei N, et al. Factors associated with mental health outcomes amid wellness care workers exposed to coronavirus disease 2019. JAMA Netw Open. 2020;3(iii): e203976. pmid:32202646.
    • View Article
    • PubMed/NCBI
    • Google Scholar
18. 18. Magnavita Northward, Tripepi M, Di Prinzio RR. Symptoms in Wellness Care Workers during the COVID-19 Epidemic. A Cross-Sectional Survey. Int J Environ Res Public Health. 2020 Jul twenty;17(fourteen):5218. pmid:32698320.
    • View Article
    • PubMed/NCBI
    • Google Scholar
19. 19. Maunder R. The experience of the 2003 SARS outbreak every bit a traumatic stress amid frontline healthcare workers in Toronto: lessons learned. Philos Trans R Soc Lond B. 2004;359(1447): 1117–1125. pmid:15306398.
    • View Article
    • PubMed/NCBI
    • Google Scholar
20. 20. Bisson JI, Tavakoly B, Witteveen AB, Ajdukovic D, Jehel L, Johnson VJ, et al. TENTS guidelines: evolution of postdisaster psychological care guidelines through a Delphi process. Br J Psychiatry. 2010;196(1): 69–74. pmid:20044665.
    • View Commodity
    • PubMed/NCBI
    • Google Scholar
21. 21. Li Y, Wang Y, Jiang J, Valdimarsdóttir UA, Fall K, Fang F, et al. Psychological distress amidst health professional person students during the COVID-19 outbreak. Psychol Med. 2020; 11:ane–3. pmid:32389148.
    • View Article
    • PubMed/NCBI
    • Google Scholar
22. 22. Batra K, Singh TP, Sharma K, Batra R, Schvaneveldt N. Investigating the psychological impact of COVID-19 among healthcare workers: A Meta-Analysis. Int J Environ Res Public Health. 2020; 5;17(23):9096. pmid:33291511
    • View Article
    • PubMed/NCBI
    • Google Scholar
23. 23. Cobb S. Presidential address-1976. Social support as a moderator of stress. Psychosom Med. 1976;38(5): 300–314. pmid:981490.
    • View Article
    • PubMed/NCBI
    • Google Scholar
24. 24. Mikkola L, Suutala E, Parviainen H. Social back up in the workplace for physicians in specialization training. Med Educ Online. 2018;23(1): 1435114. pmid:29464988.
    • View Article
    • PubMed/NCBI
    • Google Scholar
25. 25. Raosoft I. Sample size calculator. 2004. Bachelor from Sample Size Estimator by Raosoft, Inc.
26. 26. Jordanian Ministry of Health. Health statistics 2019; Available from: Human being Resources—Ministry of Wellness (moh.gov.jo)
27. 27. Krejcie RV, Morgan DW. Determining sample size for research activities. Educ Psychol Meas. 1970; thirty, 607–610
    • View Article
    • Google Scholar
28. 28. Eysenbach G. Improving the quality of web surveys: the Checklist for Reporting Results of Net E-Survey (CHERRIES). J Med Cyberspace Res. 2004;vi(iii): e34. pmid:15471760.
    • View Article
    • PubMed/NCBI
    • Google Scholar
29. 29. Ahorsu DK, Lin CY, Imani V, Saffari G, Griffiths Doctor, Pakpour AH. The fearfulness of COVID-xix calibration: development and initial validation. Int J Ment Health Addict. 2020;27: ane–9. pmid:32226353.
    • View Article
    • PubMed/NCBI
    • Google Scholar
30. 30. Lovibond PF, Lovibond SH. The construction of negative emotional states: comparison of the Depression Anxiety Stress scale (DASS) with the Beck Depression and Anxiety Inventories. Behav Res Ther. 1995;33(3): 335–343. pmid:7726811.
    • View Article
    • PubMed/NCBI
    • Google Scholar
31. 31. Zimet GD, Dahlem NW, Zimet SG, Fareley GK. The multidimensional scale of perceived social support. J Pers Assess. 1988;52: thirty–41.
    • View Article
    • Google Scholar
32. 32. Wong KL. Ong SF, Kuek TY. Amalgam a survey questionnaire to collect data on service quality of business academics. Eur J Soc Sci. 2012; 29: 209–221
    • View Commodity
    • Google Scholar
33. 33. Centers for Disease Control and Prevention. Older adult at greater risk of requiring hospitalization or dying if diagnosed with COVID-xix. Available from: https://www.cdc.gov/coronavirus/2019-ncov/demand-extra-precautions/older-adults.htm
34. 34. Luceno-Moreno L, Talavera-Velasco B, Garcia-Albuerne Y, Martin-Garcia J. Symptoms of posttraumatic stress, anxiety, depression, level of resilience and exhaustion in Spanish health personnel during the COVID-19 Pandemic. Int J Environ Res Public Health. 2020;17(xv): 5514. pmid:32751624.
    • View Article
    • PubMed/NCBI
    • Google Scholar
35. 35. Barello Southward, Palamenghi L, Graffigna G. Burnout and somatic symptoms among frontline healthcare professionals at the superlative of the Italian COVID-19 pandemic. Psychiatry Res. 2020;290: 113129. pmid:32485487
    • View Article
    • PubMed/NCBI
    • Google Scholar
36. 36. Dall'Ora C, Ball J, Redfern O, Recio-Saucedo A, Maruotti A, Meredith P, et al. Are long nursing shifts on hospital wards associated with sickness absenteeism? A longitudinal retrospective observational study. J Nurs Manag. 2019; 27(1):nineteen–26. pmid:29978584.
    • View Commodity
    • PubMed/NCBI
    • Google Scholar
37. 37. Wong AH, Pacella-LaBarbara ML, Ray JM, Ranney ML, Chang BP. Healing the healer: protecting emergency health care workers' mental health during COVID-19. Ann Emerg Med. 2020;76(4):379–384. pmid:32534830
    • View Article
    • PubMed/NCBI
    • Google Scholar
38. 38. Harrison R. Examining the psychological resilience of COVID-19 health care providers. 2020 December 17 [Cited 2020 Dec 21]. Available from https://medicine.yale.edu/news-article/29364
39. 39. Pappa South, Ntella V, Giannakas T, Giannakoulis VG, Papoutsi E, Katsaounou P. Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-xix pandemic: a systemic review and meta-analysis. Encephalon Behav Immun. 2020;88: 901–907. pmid:32437915.
    • View Article
    • PubMed/NCBI
    • Google Scholar
40. xl. Labrague LJ, De Los Santos J. COVID-xix feet among front-line nurses: predictive role of organizational back up, personal resilience and social support. J Nurs Manag. 2020;22(7): 1653–1661. pmid:32770780
    • View Article
    • PubMed/NCBI
    • Google Scholar
41. 41. Mostafa A, Sabry Due west, Mostafa NS. COVID-xix-related stigmatization among a sample of Egyptian healthcare workers. PLoS One. 2020 December eighteen;15(12):e0244172. pmid:33338064.
    • View Commodity
    • PubMed/NCBI
    • Google Scholar
42. 42. Rosa WE, Schlak AE, Rushton CH. A pattern for leadership during COVID-19. Nurs Manage. 2020;51(viii):28–34. pmid:32665503.
    • View Article
    • PubMed/NCBI
    • Google Scholar
43. 43. Spinale J, Cohen SD, Khetpal P, Peterson RA, Clougherty B, Puchalski CM, et al. Spirituality, social support, and survival in hemodialysis patients. Clin J Am Soc Nephrol. 2008;three(6): 1620–1627. pmid:18922991
    • View Article
    • PubMed/NCBI
    • Google Scholar
44. 44. Ivtzan I, Chan CP, Gardner HE, Prashar One thousand. Linking religion and spirituality with psychological well-existence: examining self-actualisation, meaning in life, and personal growth initiative. J Relig Health. 2013;52(3): 915–929. pmid:21968697
    • View Commodity
    • PubMed/NCBI
    • Google Scholar
45. 45. Que J, Shi L, Deng J, Liu J, Zhang L, Wu South, et al. Psychological impact of the COVID-19 pandemic on healthcare worker: a cantankerous-sectional study in China. Gen Psychiatr. 2020;33(three): e100259. pmid:32596640
    • View Article
    • PubMed/NCBI
    • Google Scholar
46. 46. Mo Y, Deng Fifty, Zhang L, Lang Q, Liao C, Wang N, et al. Piece of work stress amid Chinese nurses to support Wuhan in fighting against COVID-19 epidemic. J Nurs Manag. 2020;28(5): 1002–1009. pmid:32255222.
    • View Commodity
    • PubMed/NCBI
    • Google Scholar
47. 47. Conti C, Fontanesi Fifty, Lanzara R, Rosa I, Porcelli P. Fragile heroes. The psychological touch of the COVID-nineteen pandemic on wellness-intendance workers in Italian republic. PLoS One. 2020 November eighteen;15(11):e0242538. pmid:33206714.
    • View Article
    • PubMed/NCBI
    • Google Scholar

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Source: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0247679

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