Psychological impact of the COVID-19 pandemic on primary care workers: a cross-sectional study

Enric Aragonès; Isabel del Cura-González; Lucía Hernández-Rivas; Elena Polentinos-Castro; Maria Isabel Fernández-San-Martín; Juan A López-Rodríguez; Josep M Molina-Aragonés; Franco Amigo; Itxaso Alayo; Philippe Mortier; Montse Ferrer; Víctor Pérez-Solà; Gemma Vilagut; Jordi Alonso; the MINDCOVID-19 research group

doi:10.3399/BJGP.2021.0691

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In the context of the COVID-19 pandemic, a psychological impact on healthcare workers has been described, although studies in non-hospital settings are scarce. This study found that a high proportion of primary care workers (43.7%) had a current mental disorder. Female sex, having a history of previous mental disorders, greater work exposure to patients with COVID-19, having children or dependents, and certain professional positions were associated with greater risk. Personal resilience was shown to be a protective factor. Preventive and support interventions for the mental health of primary care workers are required.

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Table 1.

Sociodemographic and occupational characteristics, COVID-19 exposure, infection status, and lifetime mental disorders in primary healthcare workers

Characteristic	Total (n = 2928),^a n (%)	Male (n = 506),^a n (%)	Female (n = 2422),^a n (%)	P-value^b
Age, years	2928	506	2422	<0.001
18–29	207 (7.1)	27 (5.3)	180 (7.4)	—
30–49	1185 (40.5)	166 (32.8)	1019 (42.1)	—
≥50	1536 (52.5)	313 (61.9)	1223 (50.5)	—

Marital status^c	2923	505	2418	0.025
Single, divorced/separated, or widowed	1166 (39.9)	179 (35.4)	987 (40.8)	—
Married	1757 (60.1)	326 (64.6)	1431 (59.2)	—

Children in care^c	2840	493	2347	0.068
Aged ≤12 years	752 (26.5)	110 (22.3)	642 (27.4)	—
Aged >12 years	516 (18.2)	93 (18.9)	423 (18.0)	—
None	1572 (55.4)	290 (58.8)	1282 (54.6)	—

Caring for older person or person with disabilities	2464	420	2044	0.003
Yes	336 (13.6)	38 (9.0)	298 (14.6)
No	2128 (86.4)	382 (91.0)	1746 (85.4)

Profession	2892	500	2392	<0.001
Physician	1384 (47.9)	298 (59.6)	1086 (45.4)	—
Nurse or auxiliary nurse	863 (29.8)	85 (17.0)	778 (32.5)	—
Administrative staff	322 (11.1)	54 (10.8)	268 (11.2)	—
Other staff involved in patient care	228 (7.9)	34 (6.8)	194 (8.1)	—
Other staff not involved in patient care	95 (3.3)	29 (5.8)	66 (2.8)	—

Frequency of direct exposure to patients with COVID-19	2846	496	2350	0.015
All/most of the time	1357 (47.7)	238 (48.0)	1119 (47.6)	—
Some of the time	1041 (36.6)	161 (32.5)	880 (37.4)	—
A little/none of the time	448 (15.7)	97 (19.6)	351 (14.9)	—

Close one infected with COVID-19	2926	506	2420	0.502
No	542 (18.5)	103 (20.4)	439 (18.1)	—
Close one infected, not family member	1721 (58.8)	292 (57.7)	1429 (59.0)	—
Family member infected	663 (22.7)	111 (21.9)	552 (22.8)	—

COVID-19 infection status	2923	505	2418	0.053
Admission to hospital	39 (1.3)	12 (2.4)	27 (1.1)	—
Test positive/diagnosed	548 (18.7)	101 (20.0)	447 (18.5)	—
None	2336 (79.9)	392 (77.6)	1944 (80.4)	—

Resilience score, CD-RISC-10, median (IQR)^c	29.0 (25.0–33.0)	30.0 (26.0–35.0)	29.0 (24.0–33.0)	<0.001

Lifetime mental disorders before COVID-19 outbreak	2895	501	2394	0.070
Yes	1203 (41.6)	190 (37.9)	1013 (42.3)
No	1692 (58.4)	311 (62.1)	1381 (57.7)

↵a Unless stated otherwise.
↵b Mann–Whitney U-test for continuous variables and χ²-test for categorical variables.
↵c Total, n = 2744; males, n = 485; and females, n = 2259. CD-RISC-10 = 10-item Connor–Davidson Resilience Scale. Close one = partner, children, parents, other relatives, or close friends. IQR = interquartile range.

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Table 2.

Prevalence of positive screening for any current mental disorder according to the characteristics of primary care workers, disaggregated by sex

Characteristic	Total (n = 1278) n (%)^a	P-value for χ²	Male (n = 171) n (%)^a	P-value for χ²	Female (n = 1107) n (%)^a	P-value for χ²
Age, years		<0.001		0.003		<0.001
18–29	99 (47.8)	—	7 (25.9)	—	92 (51.1)	—
30–49	586 (49.5)	—	73 (44.0)	—	513 (50.3)	—
≥50	593 (38.6)	—	91 (29.1)	—	502 (41.0)	—

Marital status		0.04		0.085		0.18
Single, divorced/separated, or widow/er	537 (46.1)	—	69 (38.5)	—	468 (47.4)	—
Married	740 (42.1)	—	101 (31.0)	—	639 (44.7)	—

Children in care		0.02		0.628		0.03
Aged ≤12 years	362 (48.1)	—	40 (36.4)	—	322 (50.2)	—
Aged >12 years	222 (43.0)	—	28 (30.1)	—	194 (45.9)	—
None	659 (41.9)	—	100 (34.5)	—	559 (43.6)	—

Caring for older person or person with disabilities		0.003		0.62		0.009
Yes	170 (50.6)	—	13 (34.2)	—	157 (52.7)	—
No	894 (42.0)	—	116 (30.4)	—	778 (44.6)	—

Profession		<0.001		0.005		<0.001
Physician	544 (39.3)	—	84 (28.2)	—	460 (42.4)	—
Nurse or auxiliary nurse	403 (46.7)	—	34 (40.0)	—	369 (47.4)	—
Administrative staff	179 (55.6)	—	27 (50.0)	—	152 (56.7)	—
Other staff involved in patient care	90 (39.5)	—	11 (32.4)	—	79 (40.7)	—
Other staff NOT involving patient care	47 (49.5)	—	14 (48.3)	—	33 (50.0)	—

Frequency of direct exposure to patients with COVID-19		<0.001		0.33		<0.001
All/most of the time	665 (49.0)	—	88 (37.0)	—	577 (51.6)	—
Some of the time	436 (41.9)	—	48 (29.8)	—	388 (44.1)	—
A little/none of the time	145 (32.4)	—	33 (34.0)	—	112 (31.9)	—

Close one infected with COVID-19		0.35		0.47		0.12
No	241 (44.5)	—	30 (29.1)	—	211 (48.1)	—
Close one infected, not family member	763 (44.3)	—	100 (34.2)	—	663 (46.4)	—
Family member infected	273 (41.2)	—	41 (36.9)	—	232 (42.0)	—

COVID-19 infection status		0.06		0.18		0.14
Admission to hospital	24 (61.5)	—	7 (58.3)	—	17 (63.0)	—
Positive test/diagnosis	246 (44.9)	—	35 (34.7)	—	211 (47.2)	—
None	1007 (43.1)	—	129 (32.9)	—	878 (45.2)	—

Lifetime mental disorders before COVID-19 outbreak		<0.001		<0.001		<0.001
Yes	712 (59.2)	—	93 (48.9)	—	619 (61.1)	—
No	558 (33.0)	—	77 (24.8)	—	481 (34.8)	—

↵a Percentages calculated from responders for each cell in Table 1. Close one = partner, children, parents, other relatives, or close friends.

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Table 3.

Associations of sociodemographic and job characteristics, and lifetime mental health disorders with resilience in primary healthcare workers

Characteristic	Resilience score, CD-RISC-10

	Under 25th percentile (n = 660), n (%)	Over 25th percentile (n = 2084), n (%)	P-value^a
Sex			0.003
Male	91 (18.8)	394 (81.2)	—
Female	569 (25.2)	1690 (74.8)	—

Age, years			0.23
18–29	49 (25.8)	141 (74.2)	—
30–49	285 (25.5)	834 (74.5)	—
≥50	326 (22.7)	1109 (77.3)	—

Marital status			0.99
Single, divorced/separated or widowed	262 (24.1)	826 (75.9)	—
Married	398 (24.1)	1254 (75.9)	—

Children in care			0.298
Aged ≤12 years	167 (22.9)	563 (77.1)	—
Aged >12 years	111 (22.3)	387 (77.7)	—
None	382 (25.2)	1134 (74.8)	—

Caring for older person or person with disabilities			0.57
Yes	74 (22.9)	249 (77.1)	—
No	502 (24.4)	1559 (75.6)	—

Profession			0.008
Physician	313 (23.7)	1008 (76.3)	—
Nurse or auxiliary nurse	206 (25.4)	604 (74.6)	—
Administrative staff	87 (29.0)	213 (71.0)	—
Other profession involved in patient care	36 (16.4)	183 (83.6)	—
Other staff NOT involved in patient care	16 (18.0)	73 (82.0)	—

Frequency of direct exposure to patients with COVID-19
All/most of the time	298 (22.8)	1007 (77.2)	0.34
Some of the time	253 (25.4)	743 (74.6)	—
A little/none of the time	109 (24.8)	331 (75.2)	—

Close one infected with COVID-19			0.05
No	142 (28.0)	366 (72.0)
Close one infected, not family member	365 (22.6)	1249 (77.4)
Family member infected	153 (24.7)	467 (75.3)

COVID-19 infection status			0.10
Admission to hospital	11 (31.4)	24 (68.6)	—
Test positive/diagnosed	138 (27.1)	371 (72.9)	—
None	509 (23.2)	1686 (76.8)	—

Lifetime mental disorders before COVID-19 outbreak			<0.001
Yes	370 (32.6)	764 (67.4)	—
No	285 (18.0)	1296 (82.0)	—

↵a Mann–Whitney U-test for continuous variables and χ²-test for categorical variables. CD-RISC-10 = 10-item Connor–Davidson Resilience Scale. Close one = partner, children, parents, other relatives, or close friends. IQR = interquartile range.

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Table 4.

Multivariate associations between primary care workers’ characteristics and lifetime mental disorders, stratified by sex^a

Characteristic	Total (n = 2355), OR (95% CI)	P-value	Male (n = 408), OR (95% CI)	P-value	Female (n = 1947), OR (95% CI)	P-value
Sex
Male	Reference	—	NA	—	NA	—
Female	1.61 (1.25 to 2.06)	<0.001	NA	—	NA	—

Age, years
18–29	1.12 (0.75 to 1.66)	0.588	0.34 (0.09 to 1.35)	0.124	1.34 (0.87 to 2.05)	0.180
30–49	1.50 (1.19 to 1.88)	0.001	1.30 (0.72 to 2.33)	0.387	1.53 (1.19 to 1.97)	0.001
≥50	Reference	—	Reference	—	Reference	—

Children in care
None	Reference	—	Reference	—	Reference	—
Aged ≤12 years	1.18 (0.91 to 1.51)	0.209	1.19 (0.63 to 2.23)	0.597	1.21 (0.92 to 1.60)	0.176
Aged >12 years	1.31 (1.03 to 1.67)	0.026	1.11 (0.60 to 2.03)	0.746	1.35 (1.04 to 1.76)	0.025

Caring for older person or person with disabilities	1.54 (1.18 to 2.00)	0.001	1.38 (0.62 to 3.06)	0.428	1.59 (1.20 to 2.11)	0.001

Profession
Physician	Reference	—	Reference	—	Reference	—
Nurse or auxiliary nurse	1.34 (1.09 to 1.65)	0.006	1.49 (0.81 to 2.75)	0.204	1.33 (1.06 to 1.66)	0.012
Administrative staff	2.24 (1.66 to 3.03)	<0.001	1.69 (0.82 to 3.49)	0.157	2.39 (1.70 to 3.35)	<0.001
Other staff involved in patient care	1.08 (0.76 to 1.54)	0.660	1.18 (0.47 to 3.01)	0.723	1.09 (0.74 to 1.59)	0.668
Other staff not involved in patient care	2.22 (1.30 to 3.81)	0.004	2.24 (0.76 to 6.58)	0.142	2.09 (1.12 to 3.88)	0.020

Frequency of direct exposure to patients with COVID-19
A little/none of the time	Reference	—	Reference	—	Reference	—
Some of the time	1.88 (1.40 to 2.52)	<0.001	1.15 (0.56 to 2.37)	0.712	2.06 (1.49 to 2.84)	<0.001
All/most of the time	2.63 (1.98 to 3.51)	<0.001	1.61 (0.80 to 3.22)	0.183	2.90 (2.11 to 3.99)	<0.001

Resilience score, CD-RISC-10	0.93 (0.92 to 0.95)	<0.001	0.91 (0.88 to 0.95)	<0.001	0.94 (0.92 to 0.95)	<0.001

Any lifetime mental disorder	2.58 (2.15 to 3.10)	<0.001	2.57 (1.60 to 4.12)	<0.001	2.59 (2.12 to 3.16)	<0.001

↵a Exponentiated coefficients, adjusted by month of survey. Total model: pseudo-R² 0.1174; AIC 2874.2; BIC 2966.4; and AUC 0.72. Male model: pseudo-R² 0.1304; AIC 467.2; BIC 527.4; and AUC 0.74. Female model: pseudo-R² 0.1090; AIC 2422.4; BIC 2506.0; and AUC 0.71. AIC = Akaike Information Criterion. AUC = area under the curve. BIC = Bayesian Information Criterion. CD-RISC-10 = 10-item Connor–Davidson Resilience Scale. NA = Not applicable. OR = odds ratio.

Supplementary Data

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