Occupational Stress, Psychological Distress, Physical Symptoms, and their Interrelationships among Frontline Nurses Treating Patients with COVID-19

Abstract Background: The COVID-19 pandemic has presented mental health challenges to healthcare workers. Because of the urgency of the situation, this study was done to determine the amount of COVID-19-related occupational stress, psychosomatic symptoms, psychological distress, and their correlations among frontline nurses during and after the peak of the outbreak in Japan. Methods: Sixteen frontline nurses, aged 25-52 years, working in a ward with COVID-19 patients participated. Two months after the peak of the first wave of the COVID-19 outbreak in Japan, the COVID-19-related occupational stress scale (COS, questionnaire items: fear of infection, increased workload) and physical symptom scale (PS, questionnaire items: gastrointestinal symptoms, pain, appetite loss, insomnia) were assessed. The degree of general psychological distress was evaluated using the 6-item Kessler Scale (K6). At the same time, the participants were asked to recall their condition during the peak period of the first wave and to rate it using the same scale. Results: The COS, PS, and K6 scores during the peak period were all significantly higher than those two months after the peak. There were positive correlations between K6 and COS scores and between K6 and PS scores during the peak period (rs=.574, P=.020 and rs=.587, P=.017, respectively). However, these correlations were not significant two months after the peak. The correlation analysis including COS and K6 or PS showed that increased workload was positively correlated with K6 and PS scores during the peak period (rs=.869, PConclusions: Among these Japanese nurses working in COVID-19 wards, COVID-19-related occupational stress, psychological distress, and physical symptoms were all decreased after the peak period compared with the peak period. During the peak period, associations were found between COVID-19-related occupational stress and psychological distress and between psychological distress and physical symptoms. Increased workload and insomnia were associated with psychological distress in both the peak and post-peak periods, and increased workload was associated with physical symptoms during the peak period.