In Italy, Signs of Psychological Distress Among Healthcare Workers Tackling COVID-19

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Posttraumatic stress symptoms and depression were observed in nearly half and a quarter of the sample, respectively.

A substantial proportion of healthcare workers in Italy, particularly young women and frontline workers, have experienced mental health issues during the 2019 novel coronavirus (COVID-19) pandemic, according to a cross-sectional, web-based study published in JAMA Network Open. Posttraumatic stress symptoms (PTSS) and depression were observed in nearly half and a quarter of the sample, respectively.

Rodolfo Rossi, MD, of the department of systems medicine, University of Rome, Italy, and colleagues explored the mental health outcomes in frontline and second-line healthcare workers during the pandemic. All health care workers working in Italy between March 27 and March 31, 2020 were eligible to participate in the survey, which was available as an online questionnaire and spread via social networks using a snowball technique and sponsored advertisements.

The period covered corresponded to the time immediately preceding the peak of the COVID-19 contagion, which was associated with the greatest use of the healthcare system. The mental health outcomes evaluated included PTSS, depression, anxiety, insomnia, and perceived stress, which were analyzed in a multivariable logistic regression model.

Of the 1379 healthcare workers (mean age, 39.0±16.0 years; 77.2% women) who completed the questionnaire, 49.3% experienced PTSS; 24.73% symptoms of depression; 19.80% anxiety; 8.27% insomnia; and 21.90% high perceived stress. Being younger or a woman was associated with all outcomes except insomnia.

Women experienced more PTSS (odds ratio [OR], 2.31; P <.001) and depression (OR, 2.03; P < .001) compared to men. Frontline healthcare workers (OR, 1.37; P =.03) and general practitioners (OR, 1.75; P =.04) were more likely to experience PTSS than other healthcare workers. On the other hand, nurses (OR, 2.03; P =.02) and healthcare assistants (OR, 2.34; P =.04) were more likely to experience severe insomnia. The quarantine, hospitalization, or death of colleagues was also associated with PTSS, symptoms of depression, higher perceived stress, and insomnia, whereas being exposed to the pathogen was associated with symptoms of depression (OR, 1.54; P =.01).

The primary limitation of this study was the inability to determine the sampling error or to make inferences about populations because of the sampling techniques. The researchers called for monitoring healthcare workers and implementing interventions to prevent long-term mental health-related issues.


Rossi R, Socci V, Pacitti F, et al. Mental health outcomes among frontline and second-line health care workers during the coronavirus disease 2019 (COVID-19) pandemic in Italy. JAMA Network Open. 2020;3:e2010185.