COVID-19 Pandemic-Related Perceived Stress, Insomnia, Depression, and Anxiety Among Rural Primary Care Health Workers: A Mediation Analysis.

Introduction

Mental health of health care workers (HCWs) was affected during the COVID-19 pandemic due to direct handling of suspected and confirmed cases. While neurobiological mechanisms that mediate stress, depression, and anxiety are well established, psychological mechanisms are not.

Objective

To assess (1) the prevalence of anxiety, depression, insomnia, and perceived stress among accredited social health activists, multipurpose health workers, auxiliary nurse midwives, and other certified HCWs of rural areas of Telangana, India and (2) the factors that mediate stress with depression and anxiety.

Methods

A total of 300 HCWs from across 10 primary health centers across 5 districts were selected. All participants self-reported their anxiety, depression, sleep problems, and perceived stress related to the pandemic. Sociodemographic and other relevant data pertinent to the context of stress and the pandemic were also obtained. The survey used translated and validated self report instruments and was conducted during August and September 2021.

Results

The mean (SD) scores on the Insomnia Severity Index, 7-item Generalized Anxiety Disorder scale, Pandemic-Related Perceived Stress Scale of COVID-19, and 9-item Patient Health Questionnaire were 5.94 (5.6), 4.21 (4.5), 21.94 (5.8), and 3.89 (4.8), respectively. Age <35 years and family members being COVID-19 positive were significant predictors of depression and anxiety, respectively. Greater number of family members and COVID-19-positive status were significant predictors of insomnia. While the effect of stress on anxiety was indirect through the mediation of insomnia and depression, the effect of stress on depression was direct as well as through the mediation of anxiety.

Conclusion

The study results highlight the importance of measures to address sleep-related issues in individuals who are experiencing psychosocial stressors to prevent the development of depression and anxiety. Prim Care Companion CNS Disord 2025;27(1):24m03723. Author affiliations are listed at the end of this article.