**Julian Maciaszek 1, Marta Ciulkowicz 1, Blazej Misiak 2, Dorota Szczesniak 1,\*, Dorota Luc 3, Tomasz Wieczorek 1, Karolina Fila-Witecka 1, Pawel Gawlowski <sup>4</sup> and Joanna Rymaszewska <sup>1</sup>**


Received: 11 July 2020; Accepted: 3 August 2020; Published: 5 August 2020

**Abstract:** Background: The study aimed to compare psychopathological expressions during the COVID-19 (novel coronavirus disease 2019) pandemic, as declared on March 11th 2020 by the World Health Organization, with respect to which institutional variables might distinguish the impact of COVID-19 in medical and non-medical professionals. Methods: A cross-sectional study was performed nationwide between 16th March and the 26th April 2020 in Poland. A total of 2039 respondents representing all healthcare providers (59.8%) as well as other professionals filled in the sociodemographic section, the General Health Questionnaire-28 and the author's questionnaire with questions related to exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, the availability of protective measures, quarantine, change of working hours and place of employment during the pandemic, as well as feelings associated with the state of the pandemic. Results: Medical professionals more often presented with relevant psychopathological symptoms (GHQ-28 (General Health Questionnaire-28) total score >24) than the non-medical group (60.8% vs. 48.0%, respectively) such as anxiety, insomnia and somatic symptoms even after adjustment for potential confounding factors. Male sex, older age and appropriate protective equipment were associated with significantly lower GHQ-28 total scores in medical professionals, whereas among non-medical professionals, male sex was associated with significantly lower GHQ-28 total scores. Conclusions: Somatic and anxiety symptoms as well as insomnia are more prevalent among medical staff than workers in other professions. Targeting the determinants of these differences should be included in interventions aimed at restoring psychological well-being in this specific population. Apparently, there are present gender differences in psychological responses that are independent of profession.

**Keywords:** SARS-CoV-2; psychiatry; infectious disease; healthcare personnel; psychopathological symptoms

#### **1. Introduction**

The novel coronavirus disease 2019 (COVID-19) was identified in Wuhan, China, in December 2019 and attributed to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Subsequently, a rapid transmission of COVID-19 occurred across China and affected other countries. Although epidemics of infectious diseases have always had their place in history, this time, globalization has facilitated the spread of SARS-CoV-2, causing a pandemic, which was announced on March 11, 2020, by the World Health Organization (WHO). In addition, the WHO has estimated the COVID-19 mortality rate to be 3.4% [1]. Epidemiological studies have provided further evidence that the mortality rate increases with age and is associated with comorbid physical health impairments, especially those related to the cardiovascular system. Although the pandemic has largely changed research priorities, specific treatments and vaccines are not available yet [2]. Consequently, the COVID-19 outbreak has emerged as a global medical, social and economic threat.

Apart from the direct consequences of COVID-19, it has been identified that the pandemic might have a great impact on mental health through various mechanisms. Firstly, it has been found that SARS-CoV-2 can impact the central nervous system, leading to acute psychiatric manifestations [3]. Secondly, social isolation and quarantine may trigger a number of maladaptive responses manifesting as post-traumatic stress symptoms, anxiety, fear, anger and confusion [4]. There is also evidence that quarantine conditions might have long-term effects on mental health [5]. It has been shown that individuals affected by the pandemic are struggling with the fear of uncertainty, death, loss of job, drastic changes of lifestyle, stigmatization, isolation, separation from family and beloved persons, disruption of the usual routine of life and grief [6]. The impact of the COVID-19 pandemic is also largely associated with the ongoing economic crisis, the loss of jobs and reduced revenues [7].

The severe psychological and physical impact on medical staff in terms of mental health outcomes has already been identified during previous epidemics [8–10]. Emerging evidence also indicates that medical staff might be particularly vulnerable to the negative effects of the COVID-19 pandemic [11]. Indeed, medical professionals standing on the front lines have direct contact with patients suspected of being infected. Consequently, many medical professionals became infected and some of them died [12]. In light of the growing mortality related to SARS-CoV-2 infection, long working time, a high level of uncertainty in the management of infected patients, healthcare workers are reporting increasing levels of anxiety associated with numerous clinical activities and present with symptoms of depression [13]. Although it has been observed that psychopathological expressions among medical professionals may differ from those observed in the general population, studies in this field have been performed with small samples and there is still a lack of nationwide studies [14]. In addition, several mechanisms underlying the specificity of psychopathological expressions among medical professionals need to be taken into consideration. These include various individual factors (e.g., age, sex and the presence of children) and institutional factors (e.g., the length of service, changes to working time and the availability of personal protective equipment).

Taking into account the limitations of previous studies and a number of research gaps, we aimed to compare psychopathological expressions during the COVID-19 pandemic in medical and non-medical professionals on the basis of a nationwide survey. Furthermore, we tested the hypothesis that there are various individual and institutional determinants of these responses that might distinguish the impact of COVID-19 on the psychological responses among two groups of professionals.
