Prevalence of Depression and Generalised Anxiety Symptoms, Prevalence Changes and Associated Factors in Population of Healthcare Workers during Covid-19 Pandemic in Latvia. Summary of the Doctoral Thesis
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Date
2025
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Rīga Stradiņš University
Abstract
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. 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 symptoms in 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 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.
Description
The Doctoral Thesis was developed at RSU Department of Psychosomatic Medicine and Psychotherapy, Latvia Defence: at the public session of the Promotion Council of Clinical medicine on 31 March 2025 at 15.00 in the Hippocrates Lecture Theatre, 16 Dzirciema Street, Rīga Stradiņš University and remotely via online platform Zoom.
Keywords
Summary of the Doctoral Thesis, depression, anxiety, self-esteem, healthcare workers, physicians, nurses, Covid-19
Citation
Valaine, L. 2025. Prevalence of Depression and Generalised Anxiety Symptoms, Prevalence Changes and Associated Factors in Population of Healthcare Workers during Covid-19 Pandemic in Latvia: Summary of the Doctoral Thesis: Sub-Sector – Other Clinical Medicines (Psychotherapy). Rīga: Rīga Stradiņš University. https://doi.org/10.25143/prom-rsu_2025-03_dts