Depresijas un ģeneralizētas trauksmes simptomu biežums, tā izmaiņas un saistītie faktori medicīnas personāla populācijā Covid-19 pandēmijas laikā Latvijā

Introduction. On 11 March 2020, the Covid-19 pandemic was declared worldwide.
From the very beginning of the pandemic, it was clear that the mental health of medical
personnel, and therefore the functioning of the healthcare system, would be significantly
negatively affected. Early studies conducted during the initial stages of the pandemic were
cross-sectional in design, with researchers expressing concern that the state of mental health
might deteriorate over time. Given that the Latvian healthcare system was already facing
several risks before the pandemic, it is important to assess the mental health dynamics of
Latvian healthcare workers during the pandemic and identify factors associated with changes
in mental health indicators – sociodemographic, work environment, and personality factors,
with special attention to the role of self-esteem.
Objective. The aim of the Thesis is to determine the prevalence of depression and
generalised anxiety symptoms in the population of Latvian healthcare workers during
the Covid-19 emergency situation, its changes in dynamics and related factors.
Materials and Methods. The study design consists of a quantitative cross-sectional
survey with a follow-up of participants over 7 rounds of data collection (T0–T6). The first round
(T0) occurred from 28 April to 2 June 2020. The second round (T1) occurred 3 months after
T0 (July–September 2020), T2 – 6 months after T0 (October–December 2020), T3 – 10 months
after T0 (March 2021), T4 – 13 months after T0 (June 2021), T5 – 16 months after T0
(September 2021), and T6 – 19 months after T0 (December 2021).
The participants were selected by convenience sampling – a non-probability sampling
approach, representing persons from various healthcare institutions: general practitioners’
practices, State Emergency Medical Services, Rīga Stradiņš University’s Institute of
Stomatology, and level III–V hospitals. Physicians, physician assistants, nurses, and other
healthcare workers were invited to participate. Data collection for the first round was conducted
in both paper and electronic formats, with subsequent rounds conducted electronically.
Follow-up was only conducted with respondents who participated in the initial cross-sectional
survey and provided their contact information to confirm their willingness to participate in
further research via electronic surveys. No new participants were added in the study.
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The study was conducted using a self-administered questionnaire, which included
questions on sociodemographic status, work environment, and personality factors, a depression
symptom survey, a generalised anxiety symptom survey, and a self-esteem survey.
Descriptive statistical methods such as medians, interquartile ranges, frequency
calculations, proportions, and cross-tabulation analysis were used. The chi-square test was
applied to determine differences. Odds ratios (OR) and 95 % confidence intervals were
calculated using binary logistic regression analysis. Incidence and survival were calculated
using Kaplan-Meier survival functions. A Generalised Linear Mixed Model was used to
identify factors related to the chances of developing new cases of clinically significant
depression and generalised anxiety. Data analysis was performed using the statistical software
BM SPSS version 29 and Jamovi version 4.1. The results are described according to STROBE
guidelines.
Results. The data analysis included 844 respondents from the first round of the study.
At the beginning of the Covid-19 state of emergency in Latvia, the prevalence of clinically
significant depressive symptoms in the study sample was 24.9 % (n = 208), and the prevalence
of clinically significant generalised anxiety symptoms was 17.3 % (n = 145). After adjustment
for socio-demographic and occupational factors, younger age, postgraduate aducation, working
in general practice, and a greater number of working hours were associated with higher odds of
clinically significant depressive symptoms. Among personality factors, lower self-esteem,
unpleasant emotions in the workplace, and the absence of a hobby were associated with higher
odds of depressive symptoms. Regarding generalised anxiety symptoms, younger age, female
gender, longer work experience, work in general practice and the State Emergency Medical
Service, and working more hours were associated with higher odds of having clinically
significant anxiety symptoms. Lower self-esteem and unpleasant emotions in the workplace
were also associated with higher odds of generalised anxiety symptoms.
An increase in the prevalence of clinically significant depressive and generalised
anxiety symptoms was observed with Covid-19 infection incidence rates. The increase in
prevalence compared to baseline was evident six months after the first state of emergency
(p < 0.001). During the data collection period, the prevalence of depressive and generalised
anxiety symptoms did not return to baseline levels. The 19-month cumulative incidence of
clinically significant depressive symptomsin the sample was 48.0 %. The 19-month cumulative
incidence of clinically significant generalised anxiety symptoms was 43.0 %.
Older age was associated with a lower risk of developing depressive symptoms.
Participants with a postgraduate education had a 30.0 % lower risk of developing depressive
symptoms. Working in general practice was associated with an 89 % increased risk while
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working in Stomatology was associated with a 43.0 % reduced risk compared to working in
a hospital or State Emergency Medical Service. Male participants had a 25 % lower risk of
developing depressive symptoms than females. Those with low self-esteem had an 82 % higher
risk of developing clinically significant depressive symptoms than those with high self-esteem
and a 61.0 % higher risk than those with medium self-esteem. Participants who experienced
more positive emotions in the workplace had a 28.0 % lower risk of developing depressive
symptoms than those who did not. Respondents who experienced anger and distress at work
had a 29.0 % higher risk of developing depressive symptoms.
The risk of developing generalised anxiety symptoms was associated with sex and
workplace. Males had a 33.0 % lower risk of developing generalised anxiety symptoms
compared to females. Working in general practice was associated with a 93.0 % increased risk
of generalised anxiety symptoms while working in Stomatology was associated with a 55.0 %
reduced risk compared to working in a Hospital or State Emergency Medical Service.
Respondents with low self-esteem had a 75.0 % higher risk of developing clinically significant
generalised anxiety symptoms than those with high self-esteem, and a 44.0 % higher risk than
those with medium self-esteem. Respondents who experienced anger and distress at work had
a 40.0 % higher risk of developing clinically significant generalised anxiety symptoms.
Conclusions. The prevalence of clinically significant symptoms of depression and
generalised anxiety among healthcare workers at the beginning of the first Covid-19 state of
emergency in Latvia is high and has been increasing over time. The incidence of clinically
significant symptoms of depression and generalised anxiety among healthcare workers during
the Covid-19 pandemic is high and is associated with changes in the spread of Covid-19
infection.
Low self-esteem, unpleasant emotions experienced in the work environment, younger
age, female gender, working in a general practice setting, and working more than 40 hours per
week are identified as risk factors for clinically significant symptoms of depression and
generalised anxiety among the health care workers during the Covid-19 pandemic in Latvia.