4. DISCUSSION
This study assessed the extent of anxiety about the viral epidemic and
relevant work-related stress of 500 healthcare professionals working as
family physicians in Turkey, and determined that a significant number of
the participants (40.6%) were suffering anxiety about the viral
epidemic. When the subgroup of 50 participants was assessed for the
second time after the COVID-19 vaccination, it appeared that there was a
significant decline in physicians’ anxiety about the viral epidemic, but
with no significant change in their scores of work-related stress
associated with the viral epidemic. The increasing responsibilities of
family physicians in the management of the pandemic may be regarded as
the main reason for this.
On the other hand, there are many studies examining the psychological
effects of the pandemic. In the early days of the pandemic in China, 927
medical health workers, i.e., nurses and doctors, and 1255 non-medical
health workers were evaluated in terms of their mental status and
relevant symptoms in a study concluding that insomnia, anxiety,
depression and obsessive-compulsive disorders presented by the group of
medical health workers proved significantly more common than those
presented by nonmedical health workers.8
Another study conducted by Huang et al. with healthcare professionals
who were involved in the treatment of COVID-19 at the beginning of the
pandemic reported that clinical anxiety symptoms increased in 23% of
the participants without a statistically significant difference in terms
of age, marital status, department, title, educational background, and
professional status.9 In our study, in a similar
manner, no statistical significance was observed between the variables
of age, marital status, having a child, and the scores of anxiety about
the viral epidemic and of work-related stress associated with the viral
epidemic, whereas work-related stress scores appeared to be
significantly higher in family physicians with chronic diseases.
Moreover, a study conducted in Spain with 1228 healthcare professionals
who had contact with patients with the COVID-19 reported that the rate
of having a possible anxiety disorder was 58.6%, while the rate of
having a serious anxiety disorder was 20.7%.10 It was
unfortunately not possible to rate the anxiety levels with the scale
used in our study.
In a study conducted with the nurses in Korea using the SAVE-9 scale,
the participants were divided into two groups as depressed and
non-depressed, as a result of which the SAVE-9 scale scores turned out
to be significantly higher in the group with depression, both in the
subgroup of anxiety assessment and subgroup of the work-related stress
assessment.11 In our study conducted with family
physicians in Turkey by using the SAVE-9 scale, we determined that a
significant part of the participants (40.6%) were in a state of anxiety
about the viral epidemic.
The assessment of work-related stress scores in our study showed that
the stress scores were significantly higher in the physicians who
followed up patients infected with COVID-19 in the FHC. In addition to
the cross-sectional assessment of anxiety about the viral epidemic and
work-related stress associated with the viral epidemic, our study also
examined the effect of COVID-19 vaccinations on these conditions in the
subgroup, which is the strength of our study. Moreover, in the
literature, no study was found to have explored the changes in mental
status after COVID-19 vaccinations, which is another strength of our
study.
The scientific world has been racing against time since the beginning of
the pandemic, bringing along some drawbacks by nature. The scale we used
in our study has already been translated into different multiple
languages, including Turkish. 7,12,13 However, a
validity and reliability study for Turkish has not been published yet,
which is one of the limitations of our study.
In a study evaluating anxiety and depression associated with the
COVID-19 pandemic in Iran, the prevalence of anxiety symptoms in the
group infected with COVID-19 was found to be higher than in the
non-infected group.14 In our study, while work-related
stress scores were found to be significantly higher in the group
infected with the COVID-19 virus compared to the non-infected group, no
statistical significance was found in the scores of the anxiety about
the viral epidemic.
A study of 393 participants with resident physicians and those
continuing their minor studies reported that 55% of the participants
had been working in COVID-19-related units, and that the stress and
burnout scores were significantly higher in physicians working in such
units than those who were not.15 Similarly, in our
study, pandemic-related stress scores were found to be statistically
significantly higher in the group of participants who were actively
working in relation to the COVID-19. In addition, the formerly mentioned
study concluded that the state of being stressed was higher in female
participants. Likewise, in our study, the scores of anxiety about the
viral epidemic and work-related stress were found to be significantly
higher in female physicians than in male physicians.
When it came to the COVID-19-related departments where the participants
were working, the pandemic-related stress scores appeared to be the
highest among the physicians working in the COVID-19 ICUs, which may be
related to the fact that they are one of the work spaces that most
clearly demonstrates the life-threatening risk of the pandemic to human
life.
A study conducted with 197 physicians and nurses working in units
related to the COVID-19 reported that 33% of the participants presented
symptoms of anxiety ranging from severe to very severe, while 27.9% of
them presented symptoms of stress ranging from severe to very severe,
and that the nurses’ scores of anxiety and stress were reported to be
significantly higher than those of the physicians in the
study.16 Likewise, in another study conducted with
healthcare workers by Karadem et al., it was reported that being a nurse
may be associated with the fear of COVID‐19.17
In our study, the evaluation according to the title revealed that the
scores of anxiety about the viral epidemic in family medicine academics
were found to be significantly lower than those of the other groups. The
group with the highest work-related stress scores turned out to be the
non-tenured family physicians.
A study assessing the extent of the COVID-19 induced anxiety and stress
of 1106 physicians in Israel drew attention to the fact that the fear of
being infected and the worry of transmitting an infection to family
members were among the factors most strongly associated with the state
of anxiety. Financial concerns, on the other hand, were found to be
unrelated to anxiety.18
In our study, when the pandemic-related stress scores were assessed, the
question with the highest score was about the concern that family or
friends might be infected from the participant. However, there was a
negative correlation between the income levels and the stress scores,
such that the scores of anxiety about the viral epidemic and of
work-related stress found to be significantly high, even at the highest
levels, in the group considering their income levels as inadequate. The
regression analysis of the results in our study showed that the total
score decreased with the increasing income level, a situation that
supports the fact that financial concerns are effective in the presence
of stress in our country.
Although circumstances such as working in the COVID-19-related units or
inadequate income have increasing effects on stress, it is believed that
COVID-19 vaccinations will help reduce the stress of millions of people
around the world.19 In our study, the evaluation of
the subgroup after the COVID-19 vaccination clearly indicated a
significant decline in the participants’ reconsidering their profession,
which had emerged as a result of the fear of deterioration in their
health due to the virus, and the concern of getting infected as well as
infecting the relatives.
Family physicians, who take on important duties and responsibilities in
the management of the pandemic, clearly experience anxiety about the
viral epidemic. Although vaccinations have started to relieve anxiety in
family physicians to a certain extent, the lack of a significant
reduction in work-related stress even after vaccination may be related
to the length of the pandemic, increased work areas, and the
continuation of the intense workload. Sharing the increasing
responsibilities of family physicians with their colleagues specialized
in other departments may contribute to reducing work-related stress.