A pandemic may have a negative impact on healthcare workers’ (HCW) mental health. In this cross-sectional study, we assess the self-reported prevalence of stress, anxiety, and depression and identify their predictive factors among HCW in Kosovo. The online questionnaire collected data on socio-demographics (sex, age, occupation, education, workplace) and the presence and severity of depression, anxiety, and stress through the 21-item Depression, Anxiety, and Stress Scale (DASS-21) questionnaire. Descriptive statistics, t-test, and linear logistic regression were used to analyze the data. Of the 545 respondents, the majority were male (53.0%), under 60 years of age (94.7%), and married (81.7%). Most of them were physicians (78.2%), while the remaining were nurses, midwives, and other health professionals (22%). Prevalence rates for moderate to extremely high stress, anxiety, and depressive symptoms were 21.9%, 13.0%, and 13.9%, respectively. The nurses reported significantly higher mean scores for depression and anxiety than the physicians (p < 0.05). Being married, having poor health, not exercising, and reporting “burnout” from work significantly predicted higher levels of depressive, anxiety, and stress symptoms among health workers (p < 0.05). Most HCWs (71.6%) reported a mild, moderate, or severe mental health burden, and certain factors predicted higher levels of such burden.

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Background The COVID-19 pandemic has created a very large workload burden on health systems worldwide, Kosovo is no exception to this trend. A pandemic may have a negative impact on health care workers’ (HCWs) mental health. In this cross-sectional study, we assessed the self-reported prevalence of stress, anxiety, and depression and identified their predictive factors among HCWs in Kosovo. Methods Data were collected on sociodemographics (sex, age, occupation, education, workplace) and the presence and severity of depression, anxiety, and stress through the 21-item Depression, Anxiety, and Stress Scale (DASS-21) online questionnaire. Descriptive statistics, t-tests, and linear logistic regression were used to analyze the data. Results Of the 545 respondents, the majority were male (53.0%), under 60 years of age (94.7%), and married (81.7%). Most of them were physicians (78.2%), while the remaining respondents were nurses, midwives, and other health professionals (22%). The prevalence rates for moderate to extremely high levels of stress, anxiety, and depressive symptoms were 21.9%, 13.0%, and 13.9%, respectively. Nurses reported significantly higher mean scores for depression and anxiety than physicians (P &lt; 0.05). Being married, having poor health, not exercising, and reporting ‘burnout’ from work significantly predicted higher levels of depressive, anxiety, and stress symptoms among health workers (P &lt; 0.05). Conclusions HCWs require specific national mental health intervention programs that will, among other effects, help raise awareness of the early recognition of symptoms related to stress, anxiety, depression, and burnout due to workload as well as the importance of regular physical exercise. These programs should be part of the national emergency preparedness, emergency response, and health sector strategy, aiming to build and sustain a resilient health system. Key messages • During COVID-19 pandemic, certain factors predicted higher levels of mental health burden among HCWs. • Addressing these factors require policy recommendations with concrete systemic interventions.

BACKGROUND The efficient response and containment of a pandemic within resource- and movement-constrained contexts may have a negative impact on mental health. Regarding the COVID-19 pandemic, assessing the prevalence of mental health problems and identifying risk and protection factors among health care workers may help design specific programs that will promote the wellbeing of health care workers and sustain health care service delivery. OBJECTIVE This study assessed the self-reported prevalence of stress, anxiety, and depression and identified their risk and protective factors among health care workers registered in the Kosovo Medical and Nursing Chambers. METHODS An online cross-sectional survey collected demographic, work, and health data and clinical characteristics using validated tools (self-reported stress, anxiety, and depression). Descriptive statistics and t test analyses were used to compare the clinical characteristics of physicians, nurses and other professional workers. Correlation coefficients among the observed variables were estimated. Linear logistic regression determined associations between observed variables and the likelihood of self-reported symptoms of moderate stress, anxiety, and depression while controlling for other variables. RESULTS Overall, 19,974 surveys were delivered through the internet to the registered members of Kosovo Medical and Nursing Chambers (100%). Of the 545 respondents, a majority were male (n= 289, 53.0%), under 60 years of age (n=508, 94.7%) and married (n=445, 81.7%). The majority were medical doctors (n=426, 78.2%), while the remaining respondents represented nurses, midwives, and other health professionals (n=118, 22%), and the respondents mainly worked in hospitals (n=144, 26.4%), clinics (n=141, 25.9%), and primary health care facilities (184, 33.8%). In the general sample, the 4-week prevalence rates for moderate to extremely high levels of stress, anxiety, and depressive symptoms were 21.9%, 13.0%, and 13.9%, respectively. The nurses reported significantly higher mean scores for depression and anxiety than the physicians (P<0.05). Being married, having poor health, not exercising, and reporting "burnout" from work significantly predicted higher levels of depressive, anxiety, and stress symptoms among health workers (P<0.05). These study results should be interpreted cautiously since the extent to which the adaptive behavior of health care workers might be misclassified by validated tools during a pandemic is unclear. CONCLUSIONS Assessing the prevalence of stress, anxiety, and depressive symptoms and identifying their risk and protective factors in health care workers may enhance our understanding of COVID-19 mental health needs and define specific programs that may become part of the national emergency preparedness, emergency response and health sector strategies. Cross-sector research collaboration is needed to understand the relationships between mental health changes, working environments, pandemic phases, and containment measures. We demonstrate the importance of the internet to safely and rapidly assess the mental health needs of health care workers and recommend specific programs in the midst of pandemics. CLINICALTRIAL Not applicable