To the best of our knowledge, this is the first and only study conducted so far in the Eastern Black Sea Region of Turkey that examined the relationships among depression, anxiety, stress, PTSD, compassion satisfaction, burnout and STS of HCWs during the COVID-19 pandemic.
In connection with our first study aim concerning the psychological health status of the HCWs during the COVID-19 period, appreciable percentages reported mild or higher levels of depression, anxiety and stress; almost half of them evidenced PTSD symptoms, and worrying levels of burnout and STS were reported. Previous studies of other Turkish HCWs showed similar high results for depression, anxiety and stress (Elbay et al., 2020; Çalışkan and Dost, 2020; Şahin et al., 2020); as well as in other countries of the world (Abdulla et al., 2021; Lai et al., 2020; Kang et al., 2020; Pappa et al.,2021) and for compassion satisfaction, burnout and STS (Ruiz-Fernandez et al., 2020; Wong et. al., 2021). Although it seems contradictory that both job satisfaction and burnout and STS levels were high at the same time; this showed that the moral satisfaction of helping patients increased the compassion satisfaction of HCWs. As a matter of fact, Dosil et al. (2020) also stated that although professionals are aware of the stress level associated with their job, their high level of compassion satisfaction is due to the fact that they provide significant rewards that somehow outweigh the stress and reduce fatigue. The PTSD levels of HCWs in the literature were quite different from each other like 29% in Norway (Johnson et al., 2020), 40% in Spain (Dosil et al., 2020), 71% in China (Lai et al., 2020) and 76% in Turkey (Şahin et al., 2020). Therefore, it can be concluded the PTSD levels of HCWs in studies conducted during the COVID-19 pandemic period vary from country to country, according to the resources they have or the strength of their health system.
Our second aim was to determine whether the psychological health of particular groups of HCWs were notably affected adversely during the pandemic period. We found that nurses had higher depression, anxiety, stress, PTSD and burnout scores than other occupations. Important sociodemographic risk factors were being woman, younger age, fewer years of health care experience and lower levels of formal education. Not surprisingly, HCWs working in high-risk departments such as the COVID-19 outpatient clinic / service / intensive care units, reported lower levels of compassion satisfaction and higher levels of burnout and STS. Power (2020) stated that during the COVID-19 epidemic, the domestic burden including child care, increased among women and this negatively affected their psychological health. Many studies were consistent with the results of being a nurse was related with more psychological disorders (Lai et al., 2020; Song et al., 2020; Şahin et al., 2020; Wong et al., 2021). This may be that nurses contacted patients more frequently than other HCWs (Chutiyami et al., 2022); higher level of financial concerns than doctors (Cai et al., 2020); increased workload, reassignment to other roles or duties, threat of infection, disappointments with the death of patients they care for during the COVID-19 pandemic (Al Maqbali et al., 2021). Previous studies supported that depression, anxiety or stress levels were higher in young HCWs (Huang et al., 2020a; Liang et al., 2020; Rossi et al., 2020; Salman et al., 2020). When the 18–25 age group in the study is examined, it was seen that 71% of the group consists of nurses and this group had the highest depression and anxiety level among the occupational groups. Therefore, it can be concluded that depression and anxiety levels were higher in young nurses, which is consistent with the literature (Guo et al., 2020; Roberts et al., 2021). In our study HCWs who worked less years, had higher burnout scores. In many studies, less experienced HCWs had a higher risk of depression, anxiety and stress (Nadeem et al., 2021; Roberts et al., 2021) and PTSD (Leng et al., 2021; Song et al., 2020). According to Song et al (2020), it is because of longer working time generally means more clinical experience when faced with an epidemic/pandemic, which had the effect of reducing PTSD levels by aiding a stronger self-control skill.
In terms of COVID-19 related factors in the univariate analysis, HCWs working in high-risk departments such as the COVID-19 outpatient clinic / service / intensive care unit, showed higher compassion fatigue, burnout and STS, which were consistent with many studies about higher burnout (Dobson et al., 2021; Ruiz-Fernandez et al., 2020) and higher compassion satisfaction (Buselli et al., 2021) for the frontline HCWs. Despite the emotional and psychological exhaustion, frontline HCWs experience a high level of professional satisfaction from helping others, and this acts as a protector against compassion fatigue and burnout (Cummings et al., 2018). Within the scope of COVID-19-related factors, the levels of depression, anxiety, stress, and PTSD were significantly higher in HCWs who continued to provide healthcare services as COVID-19 contacts and were afraid of infecting their relatives/friends with COVID-19. This result was supported with the literature that the infection / hospitalization / quarantine / death of colleagues (Rossi et al., 2021; Leng, 2021) and the concern that the person living with the HCWs could be infected (Luceno-Moreno et al., 2020) were risk factors for the PTSD level of HCWs. One of the final results showed that HCWs who have considered resigning from their work had higher depression, anxiety, stress, PTSD, compassion satisfaction, burnout and STS. This result was supported in the literature, mostly doctors who thought to resign had higher depression and anxiety (Kurt et al., 2020), PTSD (Pan et al., 2021), burnout and STS (Wong et al., 2021). This situation brings a decrease in the number of health manpower and causes serious damage to the health system on a macro scale.
Our third aim was to examine how depression, anxiety and stress were related to PTSD and the how depression, anxiety, stress and PTSD levels were related to aspects of professional quality of life during the COVID-19 pandemic. Consistent with the literature (Bahadirli and Sagaltici, 2021; Carmassi et al., 2022; Li et al., 2020; Su et al. 2021) we found that self-reported higher levels of depression, anxiety and stress were associated with more PTSD symptoms. The findings concerning the three components of professional quality of life were complex, but generally consistent with findings from other research across a range of work domains (Çankaya and Dikmen, 2020; Ghio et al. 2021; Chen et al. 2020; Carmassi et al. 2022). Depression and anxiety were associated with compassion satisfaction, similar to findings reported by Ruiz-Fernandez et al. (2020). Higher levels of depression, anxiety, stress and PTSD level were associated with higher levels of burnout; and STS was associated with only PTSD.
Limitations should be noted. First, it was a cross-sectional study, relationships between variables are correlational, and thus the findings do not permit any inferences about causal relationships. Second, no pre-COVID baseline data was available for comparison: the findings apply only at a single point in time. Longitudinal studies would be invaluable in terms of understanding how the psychological health status of HCWs changes with the nature of the kinds of disease-related work pressures they experience. Third, participants were recruited from a large public hospital in Giresun, Turkey and may not be representative of HCWs’ COVID-related experiences in other hospitals, in other regions of Turkey.