Indian Journal of Critical Care Medicine
Volume 25 | Issue 5 | Year 2021

Impact of COVID-19 on Psychological and Emotional Well-being of Healthcare Workers

Pradip K Bhattacharya1, Jay Prakash2

1 Department of Critical Care Medicine, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India

2 Department of Critical Care Medicine, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India

Corresponding Author: Pradip K Bhattacharya, Department of Critical Care Medicine, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India, Phone: +91 9131660754, e-mail: drpradipkb@gmail.com

How to cite this article: Bhattacharya PK, Prakash J. Impact of COVID-19 on Psychological and Emotional Well-being of Healthcare Workers. Indian J Crit Care Med 2021;25(5):479–481.

Source of support: Nil

Conflict of interest: None


Background: Coronavirus disease-2019 (COVID-19) in the last few months has disrupted the healthcare system globally. The objective of this study is to assess the impact of the COVID-19 pandemic on the psychological and emotional well-being of healthcare workers (HCWs).

Materials and methods: We conducted an online, cross-sectional, multinational survey, assessing anxiety [using Generalized Anxiety Disorder (GAD) Scale: GAD-2 and GAD-7], depression (using Center for Epidemiologic Studies Depression Scale), and insomnia (using Insomnia Severity Index Scale), among HCWs across India, the Middle East, and North America. We used univariate and bivariate logistic regression to identify risk factors for psychological distress.

Results: The prevalence of clinically significant anxiety, depression, and insomnia was 41.4%, 48.0%, and 31.3%, respectively. On bivariate logistic regression, lack of social or emotional support to HCWs was independently associated with anxiety [odds ratio (OR), 3.81 (2.84–3.90)], depression [OR, 6.29 (4.50–8.79)], and insomnia [OR, 3.79 (2.81–5.110]. Female gender and self-COVID-19 were independent risk factors for anxiety [OR, 3.71 (1.53–9.03) and 1.71 (1.23–2.38)] and depression [OR, 1.72 (1.27–2.31) and 1.62 (1.14–2.30)], respectively. Frontliners were independently associated with insomnia [OR, 1.68 (1.23–2.29)].

Conclusion: COVID-19 pandemic has a high prevalence of anxiety, depression, and insomnia among HCWs. Female gender, frontliners, self-COVID-19, and absence of social or emotional support are the independent risk factors for psychological distress.

Keywords: Anxiety, Depression, Healthcare workers, Insomnia, Psychological distress.

Indian Journal of Critical Care Medicine (2021): 10.5005/jp-journals-10071-23833


In the context of the global disruption in socioeconomic conditions and the death of more than 2.8 million people worldwide to date, healthcare workers (HCWs) are the first line of defense to combat this disease. The psychological consequences such as depression, anxiety, stress, and health workers′ perceptions of coronavirus disease-2019 (COVID-19) based on environmental factors, professional strength, and societal stigmatization weaken and incapacitate health workers, who are at greater risk because of poor working conditions.

The author has done an extensive multinational survey on the psychological impact of COVID-19 among HCWs of different backgrounds. Stress-related anxiety, depression, and insomnia have been captured through various feedback questionnaires and finally identify risk factors for psychological distress through respective scaling.1 The study concluded that the prevalence of anxiety (41.4%), depression (48%), and insomnia (68.7%) was high among HCWs in this survey, and similar findings were reported from other surveys.24 Moreover, younger adults (<40 years), female gender, lack of emotional support, professional role as a frontline HCW had a significantly higher prevalence of psychological symptoms. Female gender, frontline workers, self-illness with COVID-19, and absence of social or emotional support are the independent risk factors associated with psychological distress among HCWs.

Stress doesn’t come from what’s going on in your life. It comes from your thoughts about what’s going on in your life.”

Andrew J. Bernstein

We human beings are curious by nature. We strive to predict, understand, and control our lives, and when stress increases, this leads to significant discomfort. An inability to cope with the stress affects our mental health. Most humans suffer from stress in their day-to-day lives, primarily related to family and relationships, profession, disease, health and fitness, and many more in this competitive world. However, the current pandemic is unique because it impacted billions of people on an immense scale in a short period.

For HCWs, it is a dual stress situation. On the one hand, care of infected people with full responsibility and a hard struggle to protect and keep themselves noninfected and healthy.

It is probably the first time that such a daunting situation arose, which created a high uncertainty level among human beings. Although not visible, it is the HCWs who got the closest feeling of all those uncertainties. Some truly relevant uncertainties among HCWs were how long one could stay safe! There is no definite treatment! Whether we will recover or not if we get infected! For females, how to save their kids and other family members.

It did not give time to adaptation; encroachment was fast. It exhausted healthcare resources. Many deaths happened because of the nonavailability of resources and treatment. HCWs are forced to work long hours while under extreme stress in these conditions. When treating sick people, they run the risk of being infected. On the other hand, they, like other people, are subjected to a significant amount of false news and misinformation, all of which contribute to their anxiety.5

Completely cutoff from family support because of repeated rotation duties and quarantines and fear of spread to near and dear. Prolonged wearing of personal protective equipment (PPE), negative messages from social media, failure to discriminate between myths and facts were other precipitating factors.

In this pandemic, many things happened for the first time, like complete lockdown of the country, social distancing, cremation of near and dear under administrative control, full restrictions on rituals for lost family members. Claustrophobic PPEs, lengthy quarantines, no clue of any treatment, and no clue of any protective vaccine are the first time where the entire world was confused.

Sleep disturbance and poor sleep quality impacted a large number of medical workers, which is unsurprising. Sleep quality and social support were related to anxiety, stress, and self-efficacy as mediating variables. Anxiety levels had a negative impact on sleep quality.6

Insomnia leads to comorbid mental disorders, particularly depression and anxiety. Persistent insomnia may represent a risk factor and an early symptom for bipolar, depressive, and anxiety disorders.7 Nondepressed people with insomnia have a doubled risk of developing depression than people with no sleep difficulties.8 On the other side, risk factors for developing insomnia could be both depression and anxiety. Depression, anxiety, and insomnia are part of a vicious cycle with two more components to understand: anxiety sensitivity and the other: intolerance of uncertainty (IU). Anxiety sensitivity is conceptualized as an amplification factor that exacerbates anxiety, panic, and other forms of distress.9

IU has been defined as “A dispositional characteristic that results from a set of negative beliefs about uncertainty and its implications and involves the tendency to react negatively on an emotional, cognitive, and behavioral level to uncertain situations and events.”10

Screening tools used in this study were the “Generalised Anxiety Disorder (GAD) scale” for anxiety, “Center for Epidemiologic Studies Depression scale” for depression, and “Insomnia Severity Index (ISI) scale” for insomnia. ISI is limited to DSM-IV criteria (the predominant complaint is difficulty initiating or maintaining sleep, or nonrestorative sleep, for at least 1 month) for an insomnia disorder and assesses symptom severity but fails to measure sleep disturbances frequency and quality. It was proposed that anxiety and depression remained interlinked, and the therapeutic relationship may be a critical factor in understanding the early impact shown and that future studies should focus on direct measures of the relationship.

Cognitive theories of psychopathology maintain that IU and anxiety sensitivity confer a higher risk of developing anxiety and depression.11

Prevailing IU among HCWs was much higher than presumed, creating its impact maximally on sleep disturbance followed by depression and anxiety, as has been finally observed in the form of percentage outcome in this study.

IU was strongly associated with anxiety sensitivity, influencing insomnia via depression and anxiety. On the contrary, anxiety and depression may also have a direct impact on insomnia severity. In one of the studies published recently, the author has demonstrated through a mediation model that how prospective anxiety and inhibitory anxiety, which are reflections of IU and depression anxiety and stress which are reflections of anxiety sensitivity, come into play between fear of COVID-19 and positivity. The concluding remark is IU, depression, anxiety, and stress had a mediating role in the relationship between the fear of COVID-19 and positivity.12 The gender difference in fear of COVID-19 was consistent with the finding that the coronavirus pandemic causes more psychological effects in females12,13 and findings of previous studies on mental health in women.14 Gender is one of the nominal variables that determine the health and disease status of individuals.

Following general tips can apply to HCWs especially frontline junior doctors, to help them develop better control of the situation:

Ideally, avoiding such stress disorders among HCWs requires frequent screening with some preset questionnaires followed by proper counseling and assurance from trained psychologists regularly. Frequent change of HCWs can be one modality, but it is practically impossible due to their limited numbers in healthcare organizations and ample patient coverage.

Prolonged duty hours can be avoided. Shifts of shorter duration, followed by a reasonable relaxation period, are one method to reduce the total contact period of HCWs. From time to time, acknowledgment and encouragement by the hospital administration will help boost the morale of HCWs. Additional incentives will always help and encourage their work performances. To avoid loneliness in the quarantine area, good provision of entertainment facilities should be there. Provision of choice food and beverages for HCWs after duty hours and the quarantine zone can become a good mood changer. After all, the final attempt should be to develop a good culture and team spirit; good communication and relationships with seniors and team members will never allow these psychological problems to develop among HCWs.

The current article suggests that COVID-19 has badly ruled the psychology and emotions of HCWs and let them suffer from insomnia, anxiety, and depression. Here, the HCWs need to understand that uncertainty about the future need not rule their lives. It is always better to focus on life in the present and spend less time worrying about what might come in future. It is always better to believe in known expectations or no expectations rather than unknown expectations.


Pradip K Bhattacharya © https://orcid.org/0000-0002-0219-385X

Jay Prakash © https://orcid.org/0000-0002-5290-3848


1. Bharat G Jagiasi, Gunjan Chanchalani, Prashant Nasa, Seema Tekwani. Impact of COVID-19 Pandemic on the Emotional Well-being of Healthcare Workers: A Multinational Cross-sectional Survey. Indian J Crit Care Med 2021;25(5):499–506.

2. Maunder R, Hunter J, Vincent L, Bennett J, Peladeau N, Leszcz M, et al. The immediate psychological and occupational impact of the 2003 SARS outbreak in a teaching hospital. CMAJ 2003;168(10):1245–1251.

3. Lai J, Ma S, Wang Y, Cai Z, Hu J, Wei N, et al. Factors associated with mental health outcomes among health care workers exposed to coronavirus disease 2019. JAMA Netw Open 2020;3(3):e203976. DOI: 10.1001/jamanetworkopen.2020.3976.

4. Que J, Shi L, Deng J, Liu J, Zhang L, Wu S, et al. Psychological impact of the COVID-19 pandemic on healthcare workers: a cross-sectional study in China. Gen Psychiatr 2020;33(3):e100259. DOI: 10.1136/gpsych-2020-100259.

5. Schwartz J, King CC, Yen MY. Protecting healthcare workers during the coronavirus disease 2019 (COVID-19) outbreak: lessons from Taiwan’s severe acute respiratory syndrome response. Clin Infect Dis 2020;71(15):858–860. DOI: 10.1093/cid/ciaa255.

6. Xiao H, Zhang Y, Kong D, Li S, Yang N. The effects of social support on sleep quality of medical staff treating patients with coronavirus disease 2019 (COVID-19) in January and February 2020 in China. Med Sci Monit 2020;26:e923549. DOI: 10.12659/MSM.923549.

7. Taylor DJ, Lichstein KL, Durrence HH. Insomnia as a health risk factor. Behav Sleep Med 2003;1(4):227–247. DOI: 10.1207/S15402010BSM0104_5.

8. Baglioni C, Battagliese G, Feige B, Spiegelhalder K, Nissen C, Voderholzer U, et al. Insomnia as a predictor of depression: a meta-analytic evaluation of longitudinal epidemiological studies. J Affect Disord 2011;135(1-3):10–19. DOI: 10.1016/j.jad.2011.01.011.

9. Reiss S, Peterson RA, Gursky DM, McNally RJ. Anxiety sensitivity, anxiety frequency and the prediction of fearfulness. Behav Res Ther 1986;24(1):1–8. DOI: 10.1016/0005-7967(86)90143-9.

10. Buhr K, Dugas MJ. The role of fear of anxiety and intolerance of uncertainty in worry: an experimental manipulation. Behav Res Ther 2009;47(3):215–223. DOI: 10.1016/j.brat.2008.12.004.

11. Hong RY, Cheung MW-L. The structure of cognitive vulnerabilities to depression and anxiety: evidence for a common core etiologic process based on a meta-analytic review. Clin Psychol Sci 2015;3(6):892–912. DOI: 10.1177/2167702614553789.

12. Bakioğlu F, Korkmaz O, Ercan H. Fear of COVID-19 and positivity: mediating role of intolerance of uncertainty, depression, anxiety, and stress. Int J Ment Health Addict 2020;2020:1–14. DOI: 10.1007/s11469-020-00331-y.

13. Wang C, Pan R, Wan X, Tan Y, Xu L, Ho CS, et al. Immediate psychological responses and associated factors during the initial stage of the 2019 coronavirus disease (COVID-19) epidemic among the general population in China. Int J Environ Res Public Health 2020;17(5):1729. DOI: 10.3390/ijerph17051729.

14. Lim GY, Tam WW, Lu Y, Ho CS, Zhang MW, Ho RC. Prevalence of depression in the community from 30 countries between 1994 and 2014. Sci Rep 2018;8(1):2861. DOI: 10.1038/s41598-018-21243-x.

© The Author(s). 2021 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted use, distribution, and non-commercial reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.