Symptoms of anxiety and depression are very common among healthcare workers (HCWs) and could impact the quality of care.
This study aimed to evaluate the prevalence of these disorders in a public health company and their association with work ability and work-related stress.
A cross-sectional study involved 80 HCWs being treated for mental disorders (MD), 55 HCWs who said they suffered from MD but were not being treated, and 824 healthy colleagues. All workers completed the Work Ability Index (WAI), the Siegrist's Effort/Reward Imbalance questionnaire (ERI), the Goldberg's scales of anxiety and depression (GADS), and the Warr's scale of job satisfaction.
Three-quarters of workers with MD suffered from anxiety and/or depression. Workers who declared at the periodic medical examination in the workplace that they were being treated for MD had significantly lower levels of work ability than those of their colleagues who declared good mental health. They also reported greater work stress (high effort, low rewards, high overcommitment) and lower job satisfaction than their healthy colleagues. Symptomatic but untreated workers reported significantly lower work ability, lower satisfaction, and greater occupational stress than their healthy colleagues. In the entire sample, there were many workers with symptoms of anxiety or depression who did not declare these disorders during the examination. Overall, there were 328 suspected cases of anxiety (34.2%) and 334 cases of depression (34.8%). Anxious workers [OR = 8.11, 95% confidence interval (CI) = 3.74–17.58] and depressed workers (OR = 4.49, 95% CI = 2.22–9.10) had an increased risk of being classified as having “poor work ability”.
The negative association between psychological symptoms and work ability even in undiagnosed/untreated workers demonstrates the usefulness of screening for these symptoms in work environments.
Citation: Nicola Magnavita, Igor Meraglia, Matteo Riccò. Anxiety and depression in healthcare workers are associated with work stress and poor work ability[J]. AIMS Public Health, 2024, 11(4): 1223-1246. doi: 10.3934/publichealth.2024063
Symptoms of anxiety and depression are very common among healthcare workers (HCWs) and could impact the quality of care.
This study aimed to evaluate the prevalence of these disorders in a public health company and their association with work ability and work-related stress.
A cross-sectional study involved 80 HCWs being treated for mental disorders (MD), 55 HCWs who said they suffered from MD but were not being treated, and 824 healthy colleagues. All workers completed the Work Ability Index (WAI), the Siegrist's Effort/Reward Imbalance questionnaire (ERI), the Goldberg's scales of anxiety and depression (GADS), and the Warr's scale of job satisfaction.
Three-quarters of workers with MD suffered from anxiety and/or depression. Workers who declared at the periodic medical examination in the workplace that they were being treated for MD had significantly lower levels of work ability than those of their colleagues who declared good mental health. They also reported greater work stress (high effort, low rewards, high overcommitment) and lower job satisfaction than their healthy colleagues. Symptomatic but untreated workers reported significantly lower work ability, lower satisfaction, and greater occupational stress than their healthy colleagues. In the entire sample, there were many workers with symptoms of anxiety or depression who did not declare these disorders during the examination. Overall, there were 328 suspected cases of anxiety (34.2%) and 334 cases of depression (34.8%). Anxious workers [OR = 8.11, 95% confidence interval (CI) = 3.74–17.58] and depressed workers (OR = 4.49, 95% CI = 2.22–9.10) had an increased risk of being classified as having “poor work ability”.
The negative association between psychological symptoms and work ability even in undiagnosed/untreated workers demonstrates the usefulness of screening for these symptoms in work environments.
[1] | Pappa S, Ntella V, Giannakas T, et al. (2020) Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis. Brain Behav Immun 88: 901-907. https://doi.org/10.1016/j.bbi.2020.05.026 |
[2] | Marvaldi M, Mallet J, Dubertret C, et al. (2019) Anxiety, depression, trauma-related, and sleep disorders among healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis. Neurosci Biobehav Rev 126: 252-264. https://doi.org/10.1016/j.neubiorev.2021.03.024 |
[3] | Li Y, Scherer N, Felix L, et al. (2021) Prevalence of depression, anxiety and post-traumatic stress disorder in health care workers during the COVID-19 pandemic: A systematic review and meta-analysis. PLoS One 16: e0246454. https://doi.org/10.1371/journal.pone.0246454 |
[4] | Hill JE, Harris C, Danielle LC, et al. (2022) The prevalence of mental health conditions in healthcare workers during and after a pandemic: Systematic review and meta-analysis. J Adv Nurs 78: 1551-1573. https://doi.org/10.1111/jan.15175 |
[5] | Takada H, Ae R, Ogawa M, et al. (2022) Depression prevention in healthcare workers during the COVID-19 pandemic. Occup Med (Lond) 72: 207-214. https://doi.org/10.1093/occmed/kqab192 |
[6] | Turan O, Demirci NY, Güntülü AK, et al. (2022) Anxiety and depression levels of healthcare workers during Covid-19 pandemic. Afr Health Sci 22: 532-540. https://doi.org/10.4314/ahs.v22i1.62 |
[7] | Weibelzahl S, Reiter J, Duden G (2021) Depression and anxiety in healthcare professionals during the COVID-19 pandemic. Epidemiol Infect 149: e46. https://doi.org/10.1017/S0950268821000303 |
[8] | Shamsan A, Alhajji M, Alabbasi Y, et al. (2022) Level of anxiety and depression among healthcare workers in Saudi Arabia during the COVID-19 pandemic. Peer J 10: e14246. https://doi.org/10.7717/peerj.14246 |
[9] | Smirnova D, Syunyakov T, Pavlichenko A, et al. (2022) Anxiety, depression and suicidality in healthcare workers during the COVID-19 pandemic: The Russian study sample of the COMET-G project. Psychiatr Danub 34: 246-255. |
[10] | Danet Danet A (2021) Psychological impact of COVID-19 pandemic in western frontline healthcare professionals. A systematic review. Med Clin (Barc) 156: 449-458. https://doi.org/10.1016/j.medcli.2020.11.009 |
[11] | Abdulla EK, Velladath SU, Varghese A, et al. (2021) Depression and anxiety associated with COVID-19 pandemic among healthcare professionals in India- A systematic review and meta-analysis. Clin Epidemiol Glob Health 12: 100888. https://doi.org/10.1016/j.cegh.2021.100888 |
[12] | Saragih ID, Tonapa SI, Saragih IS, et al. (2021) Global prevalence of mental health problems among healthcare workers during the Covid-19 pandemic: A systematic review and meta-analysis. Int J Nurs Stud 121: 104002. https://doi.org/10.1016/j.ijnurstu.2021.104002 |
[13] | Aymerich C, Pedruzo B, Pérez JL, et al. (2022) COVID-19 pandemic effects on health worker's mental health: Systematic review and meta-analysis. Eur Psychiatry 65: e10. https://doi.org/10.1192/j.eurpsy.2022.1 |
[14] | Fernandez R, Sikhosana N, Green H, et al. (2021) Anxiety and depression among healthcare workers during the COVID-19 pandemic: A systematic umbrella review of the global evidence. BMJ Open 11: e054528. https://doi.org/10.1136/bmjopen-2021-054528 |
[15] | Vindegaard N, Benros ME (2020) COVID-19 pandemic and mental health consequences: Systematic review of the current evidence. Brain Behav Immun 89: 531-542. https://doi.org/10.1016/j.bbi.2020.05.048 |
[16] | Chen Y, Wang J, Geng Y, et al. (2022) Meta-analysis of the prevalence of anxiety and depression among frontline healthcare workers during the COVID-19 pandemic. Front Public Health 10: 984630. https://doi.org/10.3389/fpubh.2022.984630 |
[17] | Wu T, Jia X, Shi H, et al. (2021) Prevalence of mental health problems during the COVID-19 pandemic: A systematic review and meta-analysis. J Affect Disord 281: 91-98. https://doi.org/10.1016/j.jad.2020.11.117 |
[18] | Salari N, Khazaie H, Hosseinian-Far A, et al. (2020) The prevalence of stress, anxiety and depression within front-line healthcare workers caring for COVID-19 patients: A systematic review and meta-regression. Hum Resour Health 18: 100. https://doi.org/10.1186/s12960-020-00544-1 |
[19] | Tian H, Qiao T, Teng J, et al. (2023) Factors associated with depression among healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis. Psychol Med 15: 1-10. https://doi.org/10.1017/S0033291723002271 |
[20] | Andhavarapu S, Yardi I, Bzhilyanskaya V, et al. (2022) Post-traumatic stress in healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis. Psychiatry Res 317: 114890. https://doi.org/10.1016/j.psychres.2022.114890 |
[21] | Magnavita N, Chirico F, Garbarino S, et al. (2021) SARS/MERS/SARS-CoV-2 outbreaks and burnout syndrome among healthcare workers. An umbrella systematic review. Int J Environ Res Public Health 18: 4361. https://doi.org/10.3390/ijerph18084361 |
[22] | Serrano-Ripoll MJ, Meneses-Echavez JF, Ricci-Cabello I, et al. (2020) Impact of viral epidemic outbreaks on mental health of healthcare workers: A rapid systematic review and meta-analysis. J Affect Disord 277: 347-357. https://doi.org/10.1016/j.jad.2020.08.034 |
[23] | Norhayati MN, Che Yusof R, Azman MY (2021) Prevalence of psychological impacts on healthcare providers during COVID-19 pandemic in Asia. Int J Environ Res Public Health 18: 9157. https://doi.org/10.3390/ijerph18179157 |
[24] | Arora T, Grey I, Östlundh L, et al. (2022) The prevalence of psychological consequences of COVID-19: A systematic review and meta-analysis of observational studies. J Health Psychol 27: 805-824. https://doi.org/10.1177/1359105320966639 |
[25] | Lee BEC, Ling M, Boyd L, et al. (2023) The prevalence of probable mental health disorders among hospital healthcare workers during COVID-19: A systematic review and meta-analysis. J Affect Disord 330: 329-345. https://doi.org/10.1016/j.jad.2023.03.012 |
[26] | Ghahramani S, Kasraei H, Hayati R, et al. (2023) Health care workers' mental health in the face of COVID-19: A systematic review and meta-analysis. Int J Psychiatry Clin Pract 27: 208-217. https://doi.org/10.1080/13651501.2022.2101927 |
[27] | Chirico F, Nucera G, Magnavita N (2020) COVID-19: Protecting healthcare workers is a priority. Infect Control Hosp Epidemiol 41: 1117. https://doi.org/10.1017/ice.2020.148 |
[28] | Chirico F, Nucera G, Magnavita N (2020) Protecting the mental health of healthcare workers during the COVID-19 emergency. Brit J Psych Int 18: E1. https://doi.org/10.1192/bji.2020.39 |
[29] | Cohen C, Pignata S, Bezak E, et al. (2023) Workplace interventions to improve well-being and reduce burnout for nurses, physicians and allied healthcare professionals: A systematic review. BMJ Open 13: e071203. https://doi.org/10.1136/bmjopen-2022-071203 |
[30] | Muller AE, Hafstad EV, Himmels JPW, et al. (2020) The mental health impact of the covid-19 pandemic on healthcare workers, and interventions to help them: A rapid systematic review. Psychiatry Res 293: 113441. https://doi.org/10.1016/j.psychres.2020.113441 |
[31] | Pollock A, Campbell P, Cheyne J, et al. (2020) Interventions to support the resilience and mental health of frontline health and social care professionals during and after a disease outbreak, epidemic or pandemic: A mixed methods systematic review. Cochrane Database Syst Rev 11: CD013779. https://doi.org/10.1002/14651858.CD013779 |
[32] | Yang JM, Ye H, Long Y, et al. (2023) Effects of web-based mindfulness-based interventions on anxiety, depression, and stress among frontline health care workers during the COVID-19 pandemic: Systematic review and meta-analysis. J Med Internet Res 25: e44000. https://doi.org/10.2196/44000 |
[33] | Del Campo MT, Romo PE, de la Hoz RE, et al. (2017) Anxiety and depression predict musculoskeletal disorders in health care workers. Arch Environ Occup Health 72: 39-44. https://doi.org/10.1080/19338244.2016.1154002 |
[34] | Shi L, Li G, Hao J, et al. (2020) Psychological depletion in physicians and nurses exposed to workplace violence: A cross-sectional study using propensity score analysis. Int J Nurs Stud 103: 103493. https://doi.org/10.1016/j.ijnurstu.2019.103493 |
[35] | Magnavita N, Heponiemi T (2011) Workplace violence against nursing students and nurses. An Italian experience. J Nurs Scholarsh 43: 203-210. https://doi.org/10.1111/j.1547-5069.2011.01392.x |
[36] | Magnavita N, Fileni A (2012) Violence against radiologists. II: psychosocial factors. Radiol Med 117: 1034-1043. |
[37] | Li Y, Wang Y, Lv X, et al. (2022) Effects of factors related to shift work on depression and anxiety in nurses. Front Public Health 10: 926988. https://doi.org/10.3389/fpubh.2022.926988 |
[38] | Hoying J, Melnyk BM, Hutson E, et al. (2020) Prevalence and correlates of depression, anxiety, stress, healthy beliefs, and lifestyle behaviors in first-year graduate health sciences students. Worldviews Evid Based Nurs 17: 49-59. https://doi.org/10.1111/wvn.12415 |
[39] | Cirrincione L, Plescia F, Malta G, et al. (2023) Evaluation of correlation between sleep and psychiatric disorders in a population of night shift workers: A pilot study. Int J Environ Res Public Health 20: 3756. https://doi.org/10.3390/ijerph20043756 |
[40] | Weaver MD, Vetter C, Rajaratnam SMW, et al. (2018) Sleep disorders, depression and anxiety are associated with adverse safety outcomes in healthcare workers: A prospective cohort study. J Sleep Res 27: e12722. https://doi.org/10.1111/jsr.12722 |
[41] | Sabanciogullari S, Yilmaz FT, Karabey G (2021) The effect of the clinical nurses' compassion levels on tendency to make medical error: A cross-sectional study. Contemp Nurse 57: 65-79. https://doi.org/10.1080/10376178.2021.1927772 |
[42] | Cocker F, Joss N (2016) Compassion fatigue among healthcare, emergency and community service workers: A systematic review. Int J Environ Res Public Health 13: 618. https://doi.org/10.3390/ijerph13060618 |
[43] | Bailey BC, Cox S, Terris L, et al. (2023) Rural health care worker wellness during COVID-19: Compassion fatigue, compassion satisfaction & utilization of wellness resources. PLoS One 18: e0295020. https://doi.org/10.1371/journal.pone.0295020 |
[44] | Abbaszadeh R, Ahmadi F, Khoobi M, et al. (2024) Contributors to fatigue among nurses working in critical care units: A qualitative study. Nurs Crit Care 2024 . https://doi.org/10.1111/nicc.13091 |
[45] | de Boer J, Lok A, Van't Verlaat E, et al. (2011) Work-related critical incidents in hospital-based health care providers and the risk of post-traumatic stress symptoms, anxiety, and depression: a meta-analysis. Soc Sci Med 73: 316-326. https://doi.org/10.1016/j.socscimed.2011.05.009 |
[46] | Magnavita N, Magnavita G, Fileni A, et al. (2009) Ethical problems in radiology. Medical error and disclosure. Radiol Med 114: 1345-1355. https://doi.org/10.1007/s11547-009-0445-z |
[47] | Fileni A, Magnavita N, Mammi F, et al. (2007) Malpractice stress syndrome in radiologists and radiotherapists. Perceived causes and consequences. Radiol Med 112: 1069-1084. https://doi.org/10.1007/s11547-007-0206-9 |
[48] | Lindwall M, Gerber M, Jonsdottir IH, et al. (2014) The relationships of change in physical activity with change in depression, anxiety, and burnout: A longitudinal study of Swedish healthcare workers. Health Psychol 33: 1309-1318. https://doi.org/10.1037/a0034402 |
[49] | Magnavita N, Fileni A (2014) Association of work-related stress with depression and anxiety in radiologists. Radiol Med 119: 359-366. https://doi.org/10.1007/s11547-013-0355-y |
[50] | Ramírez-Elvira S, Romero-Béjar JL, Suleiman-Martos N, et al. (2021) Prevalence, risk factors and burnout levels in intensive care unit nurses: A systematic review and meta-analysis. Int J Environ Res Public Health 18: 11432. https://doi.org/10.3390/ijerph182111432 |
[51] | Ulfa M, Azuma M, Steiner A (2022) Burnout status of healthcare workers in the world during the peak period of the COVID-19 pandemic. Front Psychol 13: 952783. https://doi.org/10.3389/fpsyg.2022.952783 |
[52] | Jun J, Ojemeni MM, Kalamani R, et al. (2021) Relationship between nurse burnout, patient and organizational outcomes: Systematic review. Int J Nurs Stud 119: 103933. https://doi.org/10.1016/j.ijnurstu.2021.103933 |
[53] | Melnyk BM, Kelly SA, Stephens J, et al. (2020) Interventions to improve mental health, well-being, physical health, and lifestyle behaviors in physicians and nurses: A systematic review. Am J Health Promot 34: 929-941. https://doi.org/10.1177/0890117120920451 |
[54] | Zhang XJ, Song Y, Jiang T, et al. (2020) Interventions to reduce burnout of physicians and nurses: An overview of systematic reviews and meta-analyses. Medicine (Baltimore) 99: e20992. https://doi.org/10.1097/MD.0000000000020992 |
[55] | West CP, Dyrbye LN, Erwin PJ, et al. (2016) Interventions to prevent and reduce physician burnout: A systematic review and meta-analysis. Lancet 388: 2272-2281. https://doi.org/10.1016/S0140-6736(16)31279-X |
[56] | Ghawadra SF, Abdullah KL, Choo WY, et al. (2019) Mindfulness-based stress reduction for psychological distress among nurses: A systematic review. J Clin Nurs 28: 3747-3758. https://doi.org/10.1111/jocn.14987 |
[57] | Gilmartin H, Goyal A, Hamati MC, et al. (2017) Brief mindfulness practices for healthcare providers-A systematic literature review. Am J Med 130: 1219.e1-1219.e17. https://doi.org/10.1016/j.amjmed.2017.05.041 |
[58] | Guillaumie L, Boiral O, Champagne J (2017) A mixed-methods systematic review of the effects of mindfulness on nurses. J Adv Nurs 73: 1017-1034. https://doi.org/10.1111/jan.13176 |
[59] | Tamminga SJ, Emal LM, Boschman JS, et al. (2023) Individual-level interventions for reducing occupational stress in healthcare workers. Cochrane Database Syst Rev 5: CD002892. https://doi.org/10.1002/14651858.CD002892.pub6 |
[60] | Di Nota PM, Bahji A, Groll D, et al. (2021) Proactive psychological programs designed to mitigate posttraumatic stress injuries among at-risk workers: A systematic review and meta-analysis. Syst Rev 10: 126. https://doi.org/10.1186/s13643-021-01677-7 |
[61] | Ward EJ, Fragala MS, Birse CE, et al. (2023) Assessing the impact of a comprehensive mental health program on frontline health service workers. PLoS One 18: e0294414. https://doi.org/10.1371/journal.pone.0294414 |
[62] | Magnavita N, Cicerone M, Cirese V, et al. (2006) Critical aspects of the management of “hazardous” health care workers. Consensus document. Med Lav 97: 715-725. |
[63] | Magnavita N (2006) Management of impaired physicians in Europe. Med Lav 97: 762-773. |
[64] | Magnavita N (2007) The unhealthy physician. J Med Ethics 33: 210-214. https://doi.org/10.1136/jme.2006.017533 |
[65] | Magnavita N, Magnavita G, Bergamaschi A (2010) The impaired radiologist. Radiol Med 115: 826-838. https://doi.org/10.1007/s11547-010-0539-7 |
[66] | Sturesson M, Edlund C, Fjellman-Wiklund A, et al. (2013) Work ability as obscure, complex and unique: Views of Swedish occupational therapists and physicians. Work 45: 117-128. https://doi.org/10.3233/WOR-2012-1416 |
[67] | Ebener M, Hasselhorn HM (2019) Validation of short measures of work ability for research and employee surveys. Int J Environ Res Public Health 16: 3386. https://doi.org/10.3390/ijerph16183386 |
[68] | Tengland PA (2011) The concept of work ability. J Occup Rehabil 21: 275-285. https://doi.org/10.1007/s10926-010-9269-x |
[69] | Abbasi M, Zakerian A, Kolahdouzi M, et al. (2016) Relationship between Work Ability Index and cognitive failure among nurses. Electron Physician 8: 2136-2143. https://doi.org/10.19082/2136 |
[70] | Gracino ME, Dos Santos Tortajada J, de-Castro-Alves MB, et al. (2020) Analysis of physicians work ability, in the city of Maringá, Brazil. Rev Bras Med Trab 16: 417-428. https://doi.org/10.5327/Z1679443520180296 |
[71] | Magnavita N (2023) Workplace health promotion embedded in medical surveillance: The Italian way to total worker health program. Int J Environ Res Public Health 20: 3659. https://doi.org/10.3390/ijerph20043659 |
[72] | Magnavita N (2007) Anxiety and depression at work. the A/D Goldberg Questionnaire. G Ital Med Lav Ergon 29: 670-671. |
[73] | Goldberg D, Bridges K, Duncan-Jones P, et al. (1988) Detecting anxiety and depression in general medical settings. BMJ 297: 897-899. https://doi.org/10.1136/bmj.297.6653.897 |
[74] | Magnavita N (2007) Two tools for health surveillance of job stress: The Karasek job content questionnaire and the Siegrist effort reward imbalance questionnaire. G Ital Med Lav Ergon 29: 667-670. |
[75] | Magnavita N, Garbarino S, Siegrist J (2012) The use of parsimonious questionnaires in occupational health surveillance: Psychometric properties of the short Italian version of the effort/reward imbalance questionnaire. Scientific World J 372852. https://doi.org/10.1100/2012/372852 |
[76] | Siegrist J (1996) Adverse health effects of high-effort/low-reward conditions. J Occup Health Psychol 1: 27-41. https://doi.org/10.1037/1076-8998.1.1.27 |
[77] | Siegrist J, Wege N, Pühlhofer F, et al. (2009) A short generic measure of work stress in the era of globalization: Effort-reward imbalance. Int Arch Occup Environ Health 82: 1005-1013. https://doi.org/10.1007/s00420-008-0384-3 |
[78] | Avanzi L, Perinelli E, Vignoli M, et al. (2020) Unravelling work drive: A comparison between workaholism and overcommitment. Int J Environ Res Public Health 17: 5755. https://doi.org/10.3390/ijerph17165755 |
[79] | Siegrist J, Li J (2016) Associations of extrinsic and intrinsic components of work stress with health: A systematic review of evidence on the effort-reward imbalance model. Int J Environ Res Public Health 13: 432. https://doi.org/10.3390/ijerph13040432 |
[80] | Magnavita N, Fileni A, Magnavita L, et al. (2007) Job satisfaction. Use of the Job Satisfaction Scale (JSS). G Ital Med Lav Ergon 29: 655-657. |
[81] | Warr P, Cook J, Wall T (1979) Scales for the measurement of some work attitudes and aspects of psychological well-being. J Occup Psychol 52: 129-148. https://doi.org/10.1111/j.2044-8325.1979.tb00448.x |
[82] | Converso D, Sottimano I, Garzaro G, et al. (2022) Contribution to validation of the Italian version of work ability personal radar. Med Lav 113: e2022051. https://doi.org/10.23749/mdl.v113i6.13470 |
[83] | Tuomi K, Ilmarinen J, Jahkola A, et al. (1998) Work Ability Index, 2 Eds. revised Edn. Helsinki: Finnish Institute of Occupational Health. |
[84] | Ilmarinen J (2007) The Work Ability Index (WAI). Occup Med 57: 160. https://doi.org/10.1093/occmed/kqm008 |
[85] | Radkiewicz P, Widerszal-Bazyl M (2005) Psychometric properties of Work Ability Index in the light of comparative survey study. Int Congr Ser 1280: 304-309. https://doi.org/10.1016/j. ics.2005.02.089. 23 |
[86] | Abdolalizadeh M, Arastoo AA, Ghsemzadeh R, et al. (2012) The psychometric properties of an Iranian translation of the Work Ability Index (WAI) questionnaire. J Occup Rehabil 22: 401-408. https://doi.org/10.1007/s10926-012-9355-3 |
[87] | Bethge M, Radoschewski FM, Gutenbrunner C (2012) The Work Ability Index as a screening tool to identify the need for rehabilitation: Longitudinal findings from the Second German Sociomedical Panel of Employees. J Rehabil Med 44: 980-987. https://doi.org/10.2340/16501977-1063 |
[88] | Martinez MC, Latorre Mdo R, Fischer FM (2009) Validity and reliability of the Brazilian version of the Work Ability Index questionnaire. Rev Saude Publica 43: 525-532. https://doi.org/10.1590/S0034-89102009005000017 |
[89] | Martus P, Jakob O, Rose U, et al. (2010) A comparative analysis of the Work Ability Index. Occup Med 60: 517-524. https://doi.org/10.1093/occmed/kqq093 |
[90] | Peralta N, Godoi Vasconcelos AG, Härter Griep R, et al. (2012) Validity and reliability of the Work Ability Index in primary care workers in Argentina. Salud Colectiva 8: 163-173. https://doi.org/10.1590/S1851-82652012000200005 |
[91] | Al Maqbali M, Alsayed A, Hughes C, et al. (2024) Stress, anxiety, depression and sleep disturbance among healthcare professional during the COVID-19 pandemic: An umbrella review of 72 meta-analyses. PLoS One 19: e0302597. https://doi.org/10.1371/journal.pone.0302597 |
[92] | Nowrouzi-Kia B, Sithamparanathan G, Nadesar N, et al. (2022) Factors associated with work performance and mental health of healthcare workers during pandemics: A systematic review and meta-analysis. J Public Health (Oxf) 44: 731-739. https://doi.org/10.1093/pubmed/fdab173 |
[93] | Magnavita N, Tripepi G, Di Prinzio RR (2020) Symptoms in health care workers during the COVID-19 epidemic. A cross-sectional survey. Int J Environ Res Public Health 17: 5218. https://doi.org/10.3390/ijerph17145218 |
[94] | Magnavita N, Soave PM, Ricciardi W, et al. (2020) Occupational stress and mental health of anaesthetists during the COVID-19 pandemic. Int J Environ Res Public Health 17: 8245. https://doi.org/10.3390/ijerph17218245 |
[95] | Magnavita N, Soave PM, Antonelli M (2021) Prolonged stress causes depression in frontline workers facing the COVID-19 pandemic-a repeated cross-sectional study in a COVID-19 hub-hospital in central Italy. Int J Environ Res Public Health 18: 7316. https://doi.org/10.3390/ijerph18147316 |
[96] | Magnavita N, Soave PM, Antonelli M (2021) A one-year prospective study of work-related mental health in the intensivists of a COVID-19 hub hospital. Int J Environ Res Public Health 18: 9888. https://doi.org/10.3390/ijerph18189888 |
[97] | Magnavita N, Soave PM, Antonelli M (2022) Treating anti-vax patients, a new occupational stressor—data from the 4th wave of the Prospective Study of Intensivists and COVID-19 (PSIC). Int J Environ Res Public Health 19: 5889. https://doi.org/10.3390/ijerph19105889 |
[98] | Magnavita N, Soave PM, Antonelli M (2022) Teaching safety-resident anaesthetists at the forefront of COVID-19. Ind Health 60: 75-78. https://doi.org/10.2486/indhealth.2021-0054 |
[99] | Petrie K, Milligan-Saville J, Gayed A, et al. (2018) Prevalence of PTSD and common mental disorders amongst ambulance personnel: A systematic review and meta-analysis. Soc Psychiatry Psychiatr Epidemiol 53: 897-909. https://doi.org/10.1007/s00127-018-1539-5 |
[100] | Tung YJ, Lo KKH, Ho RCM, et al. (2018) Prevalence of depression among nursing students: A systematic review and meta-analysis. Nurse Educ Today 63: 119-129. https://doi.org/10.1016/j.nedt.2018.01.009 |
[101] | Pacheco JP, Giacomin HT, Tam WW, et al. (2017) Mental health problems among medical students in Brazil: A systematic review and meta-analysis. Braz J Psychiatry 39: 369-378. https://doi.org/10.1590/1516-4446-2017-2223 |
[102] | Wieclaw J, Agerbo E, Mortensen PB, et al. (2006) Risk of affective and stress related disorders among employees in human service professions. Occup Environ Med 63: 314-319. https://doi.org/10.1136/oem.2004.019398 |
[103] | Maharaj S, Lees T, Lal S (2018) Prevalence and risk factors of depression, anxiety, and stress in a cohort of Australian nurses. Int J Environ Res Public Health 16: 61. https://doi.org/10.3390/ijerph16010061 |
[104] | Al Mawaali Z, Abdelrahman H, Al Qadire M, et al. (2024) Prevalence of anxiety, depression, and sleep disturbance among emergency nurses in Oman. J Emerg Nurs 13: S0099–1767(24)00050–3. https://doi.org/10.1016/j.jen.2024.02.004 |
[105] | Opoku Agyemang S, Ninnoni JP, Enyan NIE (2022) Prevalence and determinants of depression, anxiety and stress among psychiatric nurses in Ghana: A cross-sectional study. BMC Nurs 21: 179. https://doi.org/10.1186/s12912-022-00964-5 |
[106] | Huang CL, Weng SF, Wang JJ, et al. (2015) Risks of treated insomnia, anxiety, and depression in health care-seeking physicians: A nationwide population-based study. Medicine (Baltimore) 94: e1323. https://doi.org/10.1097/MD.0000000000001323 |
[107] | Chirico F, Afolabi AA, Ilesanmi OS, et al. (2021) Prevalence, risk factors and prevention of burnout syndrome among healthcare workers before the COVID-19 pandemic: An umbrella review of systematic reviews and meta-analyses. J Health Soc Sci 6: 465-491. HTTPS://DOI.ORG/10.19204/2021/prvl3 |
[108] | Prga Borojević I, Kincaid IA, Bago M, et al. (2024) The mediating role of depressive, anxiety, and physical symptoms on Work Ability Index in employed women with breast cancer: A prospective study from Croatia. Croat Med J 65: 101-110. https://doi.org/10.3325/cmj.2024.65.101 |
[109] | Magnavita N, Di Prinzio RR, Meraglia I, et al. (2023) Supporting return to work after breast cancer: A mixed method study. Healthcare (Basel) 11: 2343. https://doi.org/10.3390/healthcare11162343 |
[110] | Cordeiro RA, Fischer FM, Shinjo SK (2023) Work situation, work ability and expectation of returning to work in patients with systemic autoimmune myopathies. Rheumatology (Oxford) 62: 785-793. https://doi.org/10.1093/rheumatology/keac389 |
[111] | Knekt P, Lindfors O, Laaksonen MA, et al. (2008) Helsinki psychotherapy study group. Effectiveness of short-term and long-term psychotherapy on work ability and functional capacity--a randomized clinical trial on depressive and anxiety disorders. J Affect Disord 107: 95-106. https://doi.org/10.1016/j.jad.2007.08.005 |
[112] | Riedl D, Labek K, Gstrein I, et al. (2023) Large improvement of mental health during in outpatient short-term group psychotherapy treatment-a naturalistic pre-/post-observational study. Neuropsychiatr 37: 57-64. https://doi.org/10.1007/s40211-022-00449-6 |
[113] | Guidi S, Bagnara S, Fichera GP (2012) The HSE indicator tool, psychological distress and work ability. Occup Med (Lond) 62: 203-209. https://doi.org/10.1093/occmed/kqs021 |
[114] | Walker EJ, Jackson CA, Egan HH, et al. (2015) Workability and mental wellbeing among therapeutic prison officers. Occup Med (Lond) 65: 549-551. https://doi.org/10.1093/occmed/kqv084 |
[115] | Westermann C, Nienhaus A, Treszl A (2019) Quality of life and work ability among healthcare personnel with chronic viral hepatitis. Evaluation of the inpatient rehabilitation program of the Wartenberg clinic. Int J Environ Res Public Health 16: 3874. https://doi.org/10.3390/ijerph16203874 |
[116] | Lerner D, Adler DA, Chang H, et al. (2004) The clinical and occupational correlates of work productivity loss among employed patients with depression. J Occup Environ Med 46: S46-S55. https://doi.org/10.1097/01.jom.0000126684.82825.0a |
[117] | Lerner D, Henke RM (2008) What does research tell us about depression, job performance, and work productivity?. J Occup Environ Med 50: 401-410. https://doi.org/10.1097/JOM.0b013e31816bae50 |
[118] | McKnight PE, Kashdan TB (2009) The importance of functional impairment to mental health outcomes: A case for reassessing our goals in depression treatment research. Clin Psychol Rev 29: 243-259. https://doi.org/10.1016/j.cpr.2009.01.005 |
[119] | Gartner FR, Nieuwenhuijsen K, van Dijk FJ, et al. (2010) The impact of common mental disorders on the work functioning of nurses and allied health professionals: A systematic review. Int J Nurs Stud 47: 1047-1061. https://doi.org/10.1016/j.ijnurstu.2010.03.013 |
[120] | Noben C, Smit F, Nieuwenhuijsen K, et al. (2014) Comparative cost-effectiveness of two interventions to promote work functioning by targeting mental health complaints among nurses: Pragmatic cluster randomised trial. Int J Nurs Stud 51: 1321-1331. https://doi.org/10.1016/j.ijnurstu.2014.01.017 |
[121] | Noben C, Evers S, Nieuwenhuijsen K, et al. (2015) Protecting and promoting mental health of nurses in the hospital setting: Is it cost-effective from an employer's perspective?. Int J Occup Med Environ Health 28: 891-900. https://doi.org/10.13075/ijomeh.1896.00465 |
[122] | Magnavita N, Meraglia I, Viti G, et al. (2024) The Work Ability Index (WAI) in the healthcare sector: A cross-sectional/retrospective assessment of the questionnaire. Int J Environ Res Public Health 21: 349. https://doi.org/10.3390/ijerph21030349 |
[123] | Magnavita N, Meraglia I, Chiorri C (2024) Emotional and work-related factors in the self-assessment of work ability among italian healthcare workers. Healthcare 12: 1731. https://doi.org/10.3390/healthcare12171731 |
[124] | Kaewboonchoo O, Ratanasiripong P (2015) Psychometric properties of the Thai version of the work ability index (Thai WAI). J Occup Health 57: 371-377. https://doi.org/10.1539/joh.14-0173-OA |
[125] | Smrekar M, Franko A, Petrak O, et al. (2020) Validation of the croatian version of Work Ability Index (WAI) in population of nurses on transformed item-specific scores. Zdr Varst 59: 57-64. https://doi.org/10.2478/sjph-2020-0008 |
[126] | González-Domínguez ME, Fernández-García E, Paloma-Castro O, et al. (2024) Work Ability Index: Psychometric testing in aeronautical industry workers. Saf Health Work 15: 80-86. https://doi.org/10.1016/j.shaw.2023.12.001 |