Introduction

The SARS-CoV-2 virus, which is the source of COVID-19, was first identified in Wuhan, China, in 2019. However, due to the virus’s high capacity for transmission, 6 months later, the disease was largely widespread¹. In May 2020, the World Health Organization (2020) called attention to the mental health impact of the global novel coronavirus (COVID-19) outbreak that continues to spread in many parts of the world². The pandemic, in which we have been suffering since 2020 due to the SARS-CoV-2 coronavirus disease (COVID-19), has left its mark on our lives and changed our behaviors, perceptions, and environment³. According to the World Health Organization (WHO), as of August 15, 2022, 588,757,628 confirmed cases and 6,433,749 deaths have been reported globally⁴. Recent large-scale research has demonstrated that diverse public health initiatives are momentarily related to improved COVID-19 pandemic control⁵. However, the potential psychological and mental health effects of the COVID-19 pandemic should also be regarded carefully in addition to physical health⁶. Mental health gets considerably fewer employees for planning and resources, despite earlier research suggesting that the psychological effects of a catastrophic disaster had a wider and longer effect on people compared to physical injuries⁶. Therefore, the aim of this research is to reveal the anxiety status of healthcare workers during the COVID-19 pandemic.

Materials and methods

In this study, the survey method was preferred at the point of data collection. The questionnaires were delivered to the participants. "Epidemic disease Anxiety Scale" and "Vocational Satisfaction Scale" were applied face-to-face to the nurses who accepted to participate in our study, between January 2022 and June 2022. In the questionnaire, there are statements that reveal the level of pandemic disease anxiety and professional satisfaction, as well as descriptive personal characteristics of the participants.

The "Epidemic Disease Anxiety Scale" was developed by Sayar et al. and consists of a total of 18 statements. The statements in the scale were structured as a 5-point Likert scale, ranging from "1: Not at all suitable for me to 5: Completely suitable for me." The scale is "epidemic," (1, 2, 3, 4, 5, 6, and 7^th statements); "economic" (phrases 8 and 9); "quarantine" (phrases 10, 11, 12, and 13); and "social life" (14, 15, 16, 17, and 18 statements)⁷. The expressions in the first dimension include the anxiety of the person about the epidemic diseases and the reflections of this anxiety in life. The second dimension, the economic dimension, expresses the economic concerns experienced by the person during the epidemic period. The third dimension, quarantine, expresses the anxiety of the person arising from the inability to maintain his usual social life and the uncertainty he experiences when he cannot go out during the epidemic period. The social life dimension refers to the concerns regarding the provision of vital needs in the event of an epidemic and the difficulties that may be experienced in social areas accordingly. The highest score that can be obtained from the entire scale is 90 and the lowest score is 18. A high score indicates that it is associated with high epidemic disease anxiety.

If the total score obtained from the scale is in the range of 18-32, "no anxiety," in the range of 33-46 "low anxious," in the range of 47-61 "moderately anxious," in the range of 62-75 "highly anxious," and in the range of 76-90 "very highly anxious." As a result of the reliability analysis of the scale, the internal consistency coefficient was determined as 0.90⁷. In our study, the internal consistency coefficient (Cronbach’s alpha) was determined as 0.96.

There are a total of 20 statements in the "Vocational Satisfaction Scale" developed by Kuzgun et al. in 1999 (8). For these statements, the participants were allowed to answer between always (5), often (4), sometimes (3), rarely (2), and never (1). The minimum score that can be obtained from the scale is 20, and the maximum score is 100. When the scores obtained are high, it is considered that the individual’s professional satisfaction is high. Items 4, 9, 10, 11, 14, and 19 are negative items and scored in reverse. As a result of the factor analysis of the scale, eligibility for qualifications (1, 2, 3, 4, 6, 8, 9, 10, 14, 15, 17, 18, and 19) and willingness to improve (5, 7, 11, 12, 13, 16, and 20) have been determined to consist of two sub-dimensions. As a result of the reliability analysis of the scale, the internal consistency coefficient was determined as 0.90⁸. In this study, the internal consistency coefficient was determined as 0.94.

Exploratory factor analysis was first applied for scale construct validity. The relationship between criterion validity and the sub-dimensions of the scale was examined by calculating the correlation coefficient of the Pearson product of moments. The reliability coefficient of the scale was determined by the Cronbach alpha value. SPSS 26.0 statistical program was used to calculate the exploratory factor analysis, the Cronbach alpha internal consistency coefficient, and the correlation coefficient of the Pearson product of moments.

Results

All of the participants in our study were nurses. In this study, which included 395 nurses, the mean age was 33.4 years (standard error mean = 2.6). It is seen that 62.8% of the nurses are female and 37.2% are male. About 58% of them are married and 42% are single and 35.4% of them had deaths from COVID-19 in their family or close environment. It was determined that 23.5% had 0-4 years, 36.7% had 5-9 years, 31.6% had 10-14 years, 8.1% had 15 years, or more professional experience (Table 1).

It was determined that 17% of the nurses did not have an epidemic disease anxiety. However, 33.4% of the nurses were less anxious; 32.4% of them were moderately anxious; 13.2% of them were highly anxious; and finally, 4.1% of them were found to have a very high level of anxiety (Table 2).

To see if there is any difference between job satisfaction and epidemic anxiety in terms of if there are people who died from COVID-19 in the family or close environment, an independent t-test was performed. Results of the independent t-test indicated that there was no significant difference between job satisfaction (p = 0.08) and eligibility for qualifications (p = 0.13). It has been determined that there is a significant difference between the score of desire to improve in the profession (p = 0.04), outbreak score (p = 0.02), and epidemic anxiety total score (p = 0.02) (Table 3).

To see if there is any difference between job satisfaction and epidemic anxiety in terms of professional working time, one-way ANOVA was performed. Results of one-way ANOVA indicated that there was no significant difference between job satisfaction (F = 0.864, p = 0.06) and epidemic anxiety (F = 0.142, p = 0.18) and professional working time.

To see if there is any difference between job satisfaction and epidemic anxiety and in terms of marital status and gender, an independent t-test was performed. Results of the independent t-test indicated that there was no significant difference between job satisfaction (t = −0.791, p = 0.12) and epidemic anxiety (t = −0.477, p = 0.09) and marital status. There was no significant difference between job satisfaction (t = 0.286, p = 0.08) and epidemic anxiety (t = 1.312, p = 0.06) in terms of gender.

Correlation analysis was applied to determine the relationship between occupational satisfaction and epidemic anxiety level. Occupational satisfaction and epidemic anxiety level (r = −0.560, p = 0.005), epidemic (r = 0.525, p = 0.01), economic (r = −0.473, p = 0.001), quarantine (r = −0.503, p = 0.003), and social life (r = −0.507, p = 0.003) were found to be negatively correlated. Conformity to qualifications and epidemic disease anxiety level (r = −0.600, p = 0.001), epidemic (r = 0.550, p = 0.004), economic (r = −0.505, p = 0.001), quarantine (r = −0.545, p = 0.001), and social life (r = −0.555, p = 0.004) were found to be negatively correlated. Epidemic anxiety level with the desire to develop (r = −0.406, p = 0.001), epidemic (r = 0.407, p = 0.001), economic (r = −0.347, p = 0.006), quarantine (r = −0.354, p = 0.001), and social life (r = −0.344, p <.005) were found to be negatively correlated (Table 4).

Discussion

With the current workload created by the virus around the world, HCWs have a high risk of infection during the diagnosis, treatment, and care of COVID-19 patients⁹,¹⁰. Professional satisfaction, it involves the satisfaction of the employee with the job, which takes place when the requirements of the profession and the demands of the employee overlap¹¹. Low professional satisfaction may result in nurses not being cared for, not having a sense of belonging, not seeing themselves as a part of the team, and not being rewarded, which may negatively affect their performance¹²,¹³.

Zhang et al. conducted a survey in 2020 with 1357 nurses from 10 hospitals in China, the country where the COVID-19 disease first emerged¹⁴. Nearly half of the participants (46%) were nurses. Most sharing (36%) had more than 9 years of work experience¹⁴. In another cross-sectional research involving 261, (72% female) frontline nurses from the Philippines were included in the study. The mean age was 30 years, and the mean year in the nursing profession was 8.32 years¹⁵. The present study was conducted among 395 nurses. The average age of the participants was 33 years, the average work experience was 8.6 years, and 62% of them were female.

Several studies have shown a high prevalence of post-traumatic stress disorder symptoms, anxiety, fear, depression, and frustration in emergency professionals involved in the 2002-2004 SARS epidemic¹⁶. The most common symptoms included recurrent and intrusive thoughts about events experienced during patient care, difficulties falling asleep, memory and concentration, hypervigilance and hyperarousal, outbursts of anger, loss of motivation to work, mood dysregulations, avoidant behaviors toward activities and workplaces, alcohol or drug abuse, numbness, isolation, and psychological detachment¹⁶. The COVID-19 pandemic and the difficulties it brings with it, such as the workload intensity, worsening of working conditions, increase in working hours, and intensity of night shifts, also reduce the satisfaction of healthcare workers with their profession¹⁷. In a study conducted in China, the presence of psychopathology was evaluated in 1257 health workers exposed to COVID-19. A sizeable proportion of participants reported symptoms of depression (50%), anxiety (45%), insomnia (34%), and distress (72%). Nurses, women, frontline healthcare workers, and those working in Wuhan showed higher severity on all measures of mental health symptoms than other healthcare workers¹⁸. In a study by Pérez-Cano et al., 630 participants completed a questionnaire with an average age of 26.77 and 10.30 standard deviation. According to the survey, depression, and anxiety affected more than 40% of the participants, while stress affected < 30%. Of the subjects who experienced anxiety, 18.6% also had moderate-to-very severe depression or stress¹³. In our study, anxiety was detected in 83% of the participants and the total epidemic anxiety score was 47.7 (see: range for moderate anxiety: 47-61). We found a negative correlation between total epidemic anxiety score and total job satisfaction score (p = 0.05, r = −0.560).

According to Taylor and Asmundson, some health anxiety is a helpful reaction to physical disorders. Anxiety levels that are considered normal ensure that the appropriate steps are taken to either avoid or treat sickness. Health anxiety, however, may become an issue if it is persistent, overwhelming, or much bigger than the seriousness of the threat to one’s health¹⁹. Compared to others who had no such experience, health-care personnel who were quarantined and worked in SARS units or had family or friends who had the disease experienced much higher levels of anxiety, depression, frustration, terror, and post-traumatic stress²⁰. In our study, we also tested to see if there is any difference between job satisfaction and epidemic anxiety in terms of if there are people who died from COVID-19 in the family or close environment. Our study indicated that there was no significant difference between job satisfaction and eligibility for qualifications. It has been determined that there is a significant difference between the score of desire to improve in the profession, outbreak score, and epidemic anxiety total score. Accordingly, we found higher levels of epidemic anxiety scores in health-care personnel that had family or friends who had the disease experienced compared to others who had no such experience.

Doctors in Germany reported significant levels of depressive and anxious symptoms²¹, and medical and nursing professionals in Hong Kong were found to be susceptible to burnout, anxiety, and mental tiredness²². In addition, health-care professionals from other disciplines, such as surgeons and anesthesiologists, are also affected psychologically by the crisis. These professionals include frontline respiratory and intensive care doctors and nurses. Sadly, there have also been instances of suicides as a result of the mounting psychological pressure and a great fear of death that health-care professionals are experiencing; this is especially concerning considering the fact that doctors already have a higher suicide risk than the general population²³.

Conclusions

This study found that during the COVID-19 pandemic, there was a significant frequency of moderate anxiety among health-care personnel. The need for appropriate support is crucial. More research on the measures that are most successful in reducing these risks would help the response.