Document Type : Original Article


1 Industrial Diseases Research Center, Center of Excellence for Occupational Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran

2 Center for Healthcare Data Modeling, Departments of Biostatistics and Epidemiology, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran

3 Environmental Science and Technology Research Center, Department of Environmental Health Engineering, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran


Background and aims: The prevalence of the coronavirus disease 2019 (COVID-19) was associated with many psychological consequences among personnel of hospitals. The aim of this study was to investigate the relationship between COVID-19 anxiety and depression, stress, and anxiety among administrative staff and nurses.
Methods: This is a cross-sectional study that was conducted in January 2022. All 100 nurses and administrative staff of a hospital participated in this study. Demographic information questionnaires, Corona Disease Anxiety Scale, and Depression Anxiety Stress Scale (DASS-21) were employed to collect data. Statistical analysis was performed using SPSS software version 24.
Results: The mean ± standard deviation age of participants was 33.53 ± 6.73 years. The median (interquartile range) disease anxiety in nurses and administrative staff was equal to 7 (4.25) and 10 (8), respectively. Further, COVID-19 anxiety was significantly higher in administrative staff (P = 0.001); moreover, a significant relationship was found between the history of COVID-19 disease and disease anxiety (P = 0.04). Nurses reported higher stress than administrative staff (P = 0.02), and no significant relationship was found between COVID-19 anxiety and components of DASS (P > 0.05).
Conclusion: In this study, COVID-19 anxiety was significantly higher in administrative staff. Therefore, during the COVID-19 pandemic, it is necessary to pay attention to all jobs. Nurses reported higher stress and depression. Therefore, it is suggested that the necessary psychological measures be taken to improve their psychological states. Increasing the number of nurses, improving working conditions, reducing workload, and training can be effective in improving the mental health of nurses.


1.The Novel Coronavirus Pneumonia Emergency Response Epidemiology Team. The epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID-19) - China, 2020. China CDC Wkly. 2020;2(8):113-22. 
2.Bo HX, Li W, Yang Y, Wang Y, Zhang Q, Cheung T, et al. Posttraumatic stress symptoms and attitude toward crisis mental health services among clinically stable patients with COVID-19 in China. Psychol Med. 2021;51(6):1052-3. doi: 10.1017/s0033291720000999. 
3.Delam H, Eidi A, Soufi O, Bazrafshan MR. Anxiety status of Instagram users during coronavirus disease in Iran in 2020: a cross-sectional study. Int J Epidemiol Res. 2021;8(3):105-8. doi: 10.34172/ijer.2021.20. 
4.Morrissette M. School closures and social anxiety during the COVID-19 pandemic. J Am Acad Child Adolesc Psychiatry. 2021;60(1):6-7. doi: 10.1016/j.jaac.2020.08.436. 
5.Clemente-Suárez VJ, Martínez-González MB, Benitez- Agudelo JC, Navarro-Jiménez E, Beltran-Velasco AI, Ruisoto P, et al. The impact of the COVID-19 pandemic on mental disorders. A critical review. Int J Environ Res Public Health. 2021;18(19):10041. doi: 10.3390/ijerph181910041. 
6.Yaribeygi H, Panahi Y, Sahraei H, Johnston TP, Sahebkar A. The impact of stress on body function: A review. EXCLI J. 2017;16:1057-72. doi: 10.17179/excli2017-480. 
7.Fallah Madvari R, Zare Sakhvidi MJ, Kargar-Shouroki F, Sefidkar R, Babaee F, Bagheshahi M, et al. Investigating corona disease anxiety in nurses and its relationship with cognitive flexibility: a case study. Arch Occup Health. 2022;6(2):1243- 9. doi: 10.18502/aoh.v6i2.9488. 
8.Gerami Nejad N, Hosseini M, Mousavi Mirzaei S, Ghorbani Moghaddam Z. Association between resilience and professional quality of life among nurses working in intensive care units. Iran Journal of Nursing. 2019;31(116):49-60. doi: 10.29252/ijn.31.116.49. [Persian]. 
9.An Y, Yang Y, Wang A, Li Y, Zhang Q, Cheung T, et al. Prevalence of depression and its impact on quality of life among frontline nurses in emergency departments during the COVID-19 outbreak. J Affect Disord. 2020;276:312-5. doi: 10.1016/j.jad.2020.06.047. 
10.Jaafarpour M, Khani A, Mahamodian MR. Evaluation of the quality of nursing work life and its association with job burnout in Isfahan University of Medical Sciences. Int J Epidemiol Res. 2015;2(1):30-9. 
11.Jackson D, Bradbury-Jones C, Baptiste D, Gelling L, Morin K, Neville S, et al. Life in the pandemic: some reflections on nursing in the context of COVID-19. J Clin Nurs. 2020;29(13- 14):2041-3. doi: 10.1111/jocn.15257. 
12.Huang L, Lei W, Xu F, Liu H, Yu L. Emotional responses and coping strategies in nurses and nursing students during Covid-19 outbreak: a comparative study. PLoS One. 2020;15(8):e0237303. doi: 10.1371/journal.pone.0237303. 
13.Al Maqbali M, Al Sinani M, Al-Lenjawi B. Prevalence of stress, depression, anxiety and sleep disturbance among nurses during the COVID-19 pandemic: a systematic review and meta-analysis. J Psychosom Res. 2021;141:110343. doi: 10.1016/j.jpsychores.2020.110343. 
14.Nemati M, Ebrahimi B, Nemati F. Assessment of Iranian nurses’ knowledge and anxiety toward COVID-19 during the current outbreak in Iran. Arch Clin Infect Dis. 2020;15(COVID- 19):e102848. doi: 10.5812/archcid.102848. 
15.Restauri N, Sheridan AD. Burnout and posttraumatic stress disorder in the coronavirus disease 2019 (COVID-19) pandemic: intersection, impact, and interventions. J Am Coll Radiol. 2020;17(7):921-6. doi: 10.1016/j.jacr.2020.05.021. 
16.Mo Y, Deng L, Zhang L, Lang Q, Liao C, Wang N, et al. Work stress among Chinese nurses to support Wuhan in fighting against COVID-19 epidemic. J Nurs Manag. 2020;28(5):1002- 9. doi: 10.1111/jonm.13014. 
17.Simonetti V, Durante A, Ambrosca R, Arcadi P, Graziano G, Pucciarelli G, et al. Anxiety, sleep disorders and self-efficacy among nurses during COVID-19 pandemic: a large cross-sectional study. J Clin Nurs. 2021;30(9-10):1360-71. doi: 10.1111/jocn.15685. 
18.Kim SK, Kim JH, Jeon SS, Hong SM. Relationship between sleep quality and dizziness. PLoS One. 2018;13(3):e0192705. doi: 10.1371/journal.pone.0192705. 
19.Tu ZH, He JW, Zhou N. Sleep quality and mood symptoms in conscripted frontline nurse in Wuhan, China during COVID-19 outbreak: a cross-sectional study. Medicine (Baltimore). 2020;99(26):e20769. doi: 10.1097/md.0000000000020769. 
20.Azizi M, Kamali M, Moosazadeh M, Aarabi M, Ghasemian R, Hasannezhad Reskati M, et al. Assessing mental health status among Iranian healthcare workers in times of the COVID-19 pandemic: a web-based cross-sectional study. Brain Behav. 2021;11(8):e2304. doi: 10.1002/brb3.2304. 
21.Behnoush AH, Ahmadi N, Mozafar M, Mirghaderi SP, Jafari Azad A, Kazemzadeh Houjaghan A, et al. Anxiety, depression, and their contributing factors among nurses infected with COVID-19 in Iran: a cross-sectional study. Iran Red Crescent Med J. 2022;24(2):e1519 doi: 10.32592/ ircmj.2022.24.2.1519. 
22.Mohamadzadeh Tabrizi Z, Mohammadzadeh F, Davarinia Motlagh Quchan A, Bahri N. COVID-19 anxiety and quality of life among Iranian nurses. BMC Nurs. 2022;21(1):27. doi: 10.1186/s12912-021-00800-2. 
23.Kang L, Li Y, Hu S, Chen M, Yang C, Yang BX, et al. The mental health of medical workers in Wuhan, China dealing with the 2019 novel coronavirus. Lancet Psychiatry. 2020;7(3):e14. doi: 10.1016/s2215-0366(20)30047-x. 
24.Alipour A, Ghadami A, Alipour Z, Abdollahzadeh H. Preliminary validation of the Corona Disease Anxiety Scale (CDAS) in the Iranian sample. Quarterly Journal of Health Psychology. 2020;8(32):163-75. doi: 10.30473/ hpj.2020.52023.4756. [Persian]. 
25.Lovibond SH, Lovibond PF. Manual for the Depression Anxiety Stress Scales. Psychology Foundation of Australia; 1996. 
26.Teo YC, Hj Yusuf A, Alice Lim WP, Ghazali NB, Abd Rahman H, Lin N, et al. Validation of DASS-21 among nursing and midwifery students in Brunei. J Public Health. 2019;27(3):387- 91. doi: 10.1007/s10389-018-0947-z. 
27.Yohannes AM, Dryden S, Hanania NA. Validity and responsiveness of the Depression Anxiety Stress Scales-21 (DASS-21) in COPD. Chest. 2019;155(6):1166-77. doi: 10.1016/j.chest.2018.12.010. 
28.Sahebi A, Asghari MJ, Salari RS. Validation of Depression Anxiety and Stress Scale (DASS-21) for an Iranian population. J Iran Psychol. 2005;1(4). 
29.Liu CY, Yang YZ, Zhang XM, Xu X, Dou QL, Zhang WW, et al. The prevalence and influencing factors in anxiety in medical workers fighting COVID-19 in China: a cross-sectional survey. Epidemiol Infect. 2020;148:e98. doi: 10.1017/ s0950268820001107. 
30.Lai J, Ma S, Wang Y, Cai Z, Hu J, Wei N, et al. Factors associated with mental health outcomes among health care workers exposed to coronavirus disease 2019. JAMA Netw Open. 2020;3(3):e203976. doi: 10.1001/ jamanetworkopen.2020.3976. 
31.Irandoost SF, Yoosefi Lebni J, Safari H, Khorami F, Ahmadi S, Soofizad G, et al. Explaining the challenges and adaptation strategies of nurses in caring for patients with COVID-19: a qualitative study in Iran. BMC Nurs. 2022;21(1):170. doi: 10.1186/s12912-022-00937-8. 
32.Wong TW, Yau JK, Chan CL, Kwong RS, Ho SM, Lau CC, et al. The psychological impact of severe acute respiratory syndrome outbreak on healthcare workers in emergency departments and how they cope. Eur J Emerg Med. 2005;12(1):13-8. doi: 10.1097/00063110-200502000-00005. 
33.Aghili SM, Rahat Ramroudi A. Prediction of post-traumatic stress disorder based on perceived anxiety caused by coronavirus in nurses. EBNESINA. 2021;23(2):4-13. [Persian]. 
34.Eyni S, Ebadi M, Hashemi Z. Corona anxiety in nurses: the predictive role of perceived social support and sense of coherence. Iran J Psychiatry Clin Psychol. 2020;26(3):320-31. doi: 10.32598/ijpcp.26.3436.1. [Persian]. 
35.Cai Z, Cui Q, Liu Z, Li J, Gong X, Liu J, et al. Nurses endured high risks of psychological problems under the epidemic of COVID-19 in a longitudinal study in Wuhan China. J Psychiatr Res. 2020;131:132-7. doi: 10.1016/j.jpsychires.2020.09.007. 
36.Sasaki N, Kuroda R, Tsuno K, Kawakami N. The deterioration of mental health among healthcare workers during the COVID-19 outbreak: a population-based cohort study of workers in Japan. Scand J Work Environ Health. 2020;46(6):639-44. doi: 10.5271/sjweh.3922. 
37.Pinho L, Correia T, Sampaio F, Sequeira C, Teixeira L, Lopes M, et al. The use of mental health promotion strategies by nurses to reduce anxiety, stress, and depression during the COVID-19 outbreak: a prospective cohort study. Environ Res. 2021;195:110828. doi: 10.1016/j.envres.2021.110828. 
38.Silwal M, Koirala D, Koirala S, Lamichhane A. Depression, anxiety and stress among nurses during corona lockdown in a selected teaching hospital, Kaski, Nepal. J Health Allied Sci. 2020;10(2):82-7. doi: 10.37107/jhas.210. 
39.Sarboozi Hosein Abadi T, Askari M, Miri K, Namazi Nia M. Depression, stress and anxiety of nurses in COVID-19 pandemic in Nohe-Dey Hospital in Torbat-e-Heydariyeh city, Iran. J Mil Med. 2020;22(6):526-33. doi: 10.30491/ jmm.22.6.526. [Persian].
40.Leung GM, Ho LM, Chan SK, Ho SY, Bacon-Shone J, Choy RY, et al. Longitudinal assessment of community psychobehavioral responses during and after the 2003 outbreak of severe acute respiratory syndrome in Hong Kong. Clin Infect Dis. 2005;40(12):1713-20. doi: 10.1086/429923. 
41.Mirzaei Dahka S, Maroufizadeh S, Pouralizadeh M, Zahedsefat T, Ghanbarpoor Ganjari M, Parsasalkisari E, et al. Mental health and resilience among nurses in the COVID-19 pandemic: a web-based cross-sectional study. Iran J Psychiatry. 2022;17(1):35-43. doi: 10.18502/ijps.v17i1.8047. 
42.Cooper AL, Brown JA, Rees CS, Leslie GD. Nurse resilience: a concept analysis. Int J Ment Health Nurs. 2020;29(4):553-75. doi: 10.1111/inm.12721. 
43.Mealer M, Jones J, Meek P. Factors affecting resilience and development of posttraumatic stress disorder in critical care nurses. Am J Crit Care. 2017;26(3):184-92. doi: 10.4037/ ajcc2017798. 
44.Kentish-Barnes N, Chaize M, Seegers V, Legriel S, Cariou A, Jaber S, et al. Complicated grief after death of a relative in the intensive care unit. Eur Respir J. 2015;45(5):1341-52. doi: 10.1183/09031936.00160014. 
45.Bahmani A. Investigating the effect of work shifts in coronary conditions on burnout of employees with the mediating role of coronary stress. Quarterly Journal of Nursing Management. 2020;9(4):20-6. [Persian]. 
46.Shechter A, Diaz F, Moise N, Anstey DE, Ye S, Agarwal S, et al. Psychological distress, coping behaviors, and preferences for support among New York healthcare workers during the COVID-19 pandemic. Gen Hosp Psychiatry. 2020;66:1-8. doi: 10.1016/j.genhosppsych.2020.06.007. 
47.World Health Organization (WHO). Mental Health and Psychosocial Considerations During the COVID-19 Outbreak, 18 March 2020. WHO; 2020. 
48.Tahara M, Mashizume Y, Takahashi K. Coping mechanisms: exploring strategies utilized by Japanese healthcare workers to reduce stress and improve mental health during the COVID-19 pandemic. Int J Environ Res Public Health. 2020;18(1):131. doi: 10.3390/ijerph18010131.