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.