Psychosociological Issues in Human Resource Management

9(2), 2021, pp. 105–118, ISSN 2332-399X, eISSN 2377-0716

Cognitive, Emotional, and Behavioral Disorders

in Medical Staff Treating COVID-19 Patients

Aurel Pera
aurelpera@yahoo.com
University of Craiova, Romania
(corresponding author)
Raluca-Ștefania Balica
ralu.balica@yahoo.com
University of Craiova, Romania

ABSTRACT. Despite the relevance of cognitive, emotional, and behavioral dis-

orders in medical staff treating COVID-19 patients, only limited research has been
conducted on this topic. Using and replicating data from APIC, BMA, Nursing
Times, Rek et al. (2020), and UGMH, we performed analyses and made estimates
regarding whether severe stress, extreme anxiety, and acute depression among
COVID-19 primary care providers are elevated, possibly leading to personal and
professional burnout. Psychological distress, illness fears, burnout syndrome, stress-
related psychiatric disorders, emotional anxiety, clinically significant depression,
and moral injury are prevalent among COVID-19 frontline respiratory and intensive
care physicians and nurses. The results of a study based on data collected from 5,600
respondents provide support for our research model. Descriptive statistics of com-
piled data from the completed surveys were calculated when appropriate.
JEL codes: H51; H75; I12; I18; D91

Keywords: COVID-19; cognition; emotion; behavior; anxiety; depression

How to cite: Pera, A., and Balica, R.-Ș. (2021). “Cognitive, Emotional, and Behavioral
Disorders in Medical Staff Treating COVID-19 Patients,” Psychosociological Issues in
Human Resource Management 9(2): 105–118. doi: 10.22381/pihrm9220218.

Received 23 April 2021 • Received in revised form 13 November 2021

Accepted 15 November 2021 • Available online 25 November 2021

105
1. Introduction
COVID-19 frontline medical staff exposed to an increased risk of adverse
mental health outcomes (e.g., trauma-related symptoms) may need specific
training, psychological support, and long-term treatment. (Rossi et al., 2020)
Frontline healthcare staff may have mixed feelings between their respon-
sibility to attend to patients and their necessity to protect themselves and
their family and friends from COVID-19. (Kinman et al., 2020) Healthcare
workers managing massive volumes of patients treated for COVID-19 ex-
perience considerable psychosocial burdens, especially medical staff who
supply care in facilities where exposure to deeply disturbing situations is
heightened. (Benham et al., 2020)

2. Conceptual Framework and Literature Review

Healthcare professionals should be able to protect themselves and their loved
ones against the risk of COVID-19 transmission. (Korkmaz et al., 2020)
Nurses enduring COVID-19-related stress and unsatisfactory relationship
quality with the loved ones tend to develop depression and anxiety symp-
toms (Lăzăroiu et al., 2017a, b; Lăzăroiu and Adams, 2020), in addition to
stress-related psychiatric disorders. (Zheng et al., 2021) COVID-19 fear
thoroughly mediates the link between perceived risk and professional resil-
ience among healthcare personnel. (Yıldırım et al., 2020) Severe stress, ex-
treme anxiety, and acute depression among COVID-19 primary care providers
are elevated, possibly decreasing their productivity, impeding the pandemic-
related measures, and supplying less adequate treatment procedures for con-
firmed patients. (Salari et al., 2020) Working hours on a weekly basis do not
influence the prevalence of anxiety and depression in COVID-19 primary
care providers, but the subjective feeling of excessive workload does. (Chen
et al., 2021) Access to suitable personal protective equipment assists
COVID-19 frontline medical staff in feeling physically safe. (Shreffler et al.,
2020) Being in a dilemma whether a family member is infected with COVID-
19 is related to elevated levels of anxiety. (Firew et al., 2020)

3. Methodology and Empirical Analysis

Using and replicating data from APIC, BMA, Nursing Times, Rek et al.
(2020), and UGMH, we performed analyses and made estimates regarding
whether severe stress, extreme anxiety, and acute depression among COVID-
19 primary care providers are elevated, possibly leading to personal and pro-
fessional burnout. The results of a study based on data collected from 5,600
respondents provide support for our research model. Descriptive statistics of
compiled data from the completed surveys were calculated when appropriate.
106
4. Study Design, Survey Methods, and Materials
The interviews were conducted online and data were weighted by five vari-
ables (age, race/ethnicity, gender, education, and geographic region) so that
each European country’s sample composition reliably and accurately reflects
the demographic profile of the adult population according to the most recent
census data.

Data sources: APIC, BMA, Nursing Times, Rek et al. (2020), and UGMH.
Study participants: 5,600 individuals provided an informed e-consent.

Multivariate analyses, and not univariate associations with outcomes, are

more likely to factor out confounding covariates and more precisely deter-
mine the relative significance of individual variables. All data were inter-
rogated by employing graphical and numeric exploratory data analysis
methods. Results are estimates and commonly are dissimilar within a narrow
range around the actual value. The data was weighted in a multistep process
that accounts for multiple stages of sampling and nonresponse that occur at
different points in the survey process.

Test data was populated and analyzed in SPSS to ensure the logic and ran-
domizations were working as intended before launching the survey. To ensure
high-quality data, data quality checks were performed to identify any respon-
dents showing clear patterns of satisficing (e.g., checking for high rates of
leaving questions blank). Sampling errors and test of statistical significance
take into account the effect of weighting. Question wording and practical dif-
ficulties in conducting surveys can introduce error or bias into the findings
of opinion polls. The sample weighting was accomplished using an iterative
proportional fitting process that simultaneously balanced the distributions of
all variables. Stratified sampling methods were used and weights were
trimmed not to exceed 3. Average margins of error, at the 95% confidence
level, are +/-2%. The design effect for the survey was 1.3. For tabulation
purposes, percentage points are rounded to the nearest whole number. The cu-
mulative response rate accounting for non-response to the recruitment surveys
and attrition is 2.5%.

Confirmatory factor analysis was employed to test for the reliability and
validity of measurement instruments. The precision of the online polls was
measured using a Bayesian credibility interval. Addressing a significant
knowledge gap in the literature, the research has complied with stringent
methodology, reporting, and data analysis requirements.
Flow diagram of study procedures

107
5. Statistical Analysis
Independent t-tests for continuous variables or chi-square tests for cate-
gorical variables were employed. This survey employs statistical weighting
procedures to clarify deviations in the survey sample from known population
features, which is instrumental in correcting for differential survey partici-
pation and random variation in samples. Descriptive analyses (mean and
standard deviations for continuous variables and counts and percentages for
categorical variables) were used. Descriptive statistical analysis and multi-
variate inferential tests were undertaken for the survey responses and for
the purpose of variable reduction in regression modeling.

To ensure reliability and accuracy of data, participants undergo a rigorous

verification process and incoming data goes through a sequence of steps and
multiple quality checks. Mean and standard deviation, t-test, exploratory
factor analysis, and data normality were inspected using SPSS. Descriptive
and inferential statistics provide a summary of the responses and comparisons
among subgroups. AMOS-SEM analyzed the full measurement model and
structural model. The break-off rate among individuals who logged onto the
survey and completed at least one item is 0.2%.

An Internet-based survey software program was utilized for the delivery and
collection of responses. Behavioral datasets have been collected, entered into
a spreadsheet, and cutting-edge computational techniques and empirical
strategies have been harnessed for analysis. Panel research represents a swift
method for gathering data recurrently, drawing a sample from a pre-recruited
set of respondents. Groundbreaking computing systems and databases enable
data gathering and processing, extracting meaning through robust deploy-
ment. Non-response bias and common method bias, composite reliability,
and construct validity were assessed.
Flow diagram of statistical parameters and reproducibility

6. Results and Discussion

Escalated COVID-19 anxiety is typically identifiable in female nurses,
medical staff holding contracted job status, and married healthcare workers.
(Labrague and De Los Santos, 2020a) Relevant factors in personal and
professional burnout are health issues and close contact during COVID-19
diagnosis, treatment, and care. (Duarte et al., 2020) Primary care providers
caring for COVID-19 patients are exposed to negative mental health effects.
(Lasalvia et al., 2021a) COVID-19-related anxiety is extensive in the nursing
staff, possibly resulting in decreased psychological well-being and dimin-
ished work performance. (Labrague and de los Santos, 2020b) (Tables 1–6)
108
Table 1 The impact of COVID-19 on mental health and
psychosocial well-being (%, relevance)
The impact of the COVID-19 pandemic on mental health is complex, 95
diverse and wide ranging, affecting all parts of societies and populations.
Those with existing poor mental health are facing a number of risks 92
including increased rates of mental ill health and disruption to treatment,
medications and the lifeline of support services.
COVID-19 has had a huge impact on mental health services 90
and caused disruption to care and treatment.
Demand for face-to-face mental health services has reportedly significantly 88
decreased due to fear of infection, especially among older people.
Playing a crucial role in fighting the outbreak and saving lives, frontline 87
workers are under exceptional stress and while deaths of health workers
are rising, the mental ill health rates are rising faster still.
Frontline healthcare workers are at particularly high risk of mental ill health, 87
including suicide attempts, the risk of burnout and stigmatization.
Dedicated teams providing mental health support for health workers should 85
include the introduction of personal screening for stress and mental health
illness involving an assessment of occupational exposure to COVID-19,
prior history of stress and mental health conditions, new personal and family
stressors arising since the pandemic onset, and current presenting problems
including increased use of alcohol or drugs.
People who test positive for COVID-19 have to cope with fear, anxiety 85
and uncertainty about their condition, as well as physical discomfort and
separation from loved ones.
For those who have loved ones affected by COVID-19 they face 86
worry and separation. People who experience the death of a family
member often do not have the opportunity to be present in their last
moments, or to hold funerals which can have a profound effect on
grieving and impact mental health.
Some COVID-19 patients may experience stigma, discrimination 86
and intimidation, possibly leading to them to hide the illness to avoid
such discrimination, preventing them from seeking health care, and
discouraging them from adopting healthy behaviors, all of which
undermining efforts to control the pandemic while increasing levels
of fear and depression for those patients and their families.
The elderly are at high risk of mental ill health due to 85
the anticipated long periods of social distancing and
the accompanying isolation and loneliness.
There may be a worsening of cognitive decline in older populations, who 86
may be one of the last groups for whom lockdown measures are lifted.
Social isolation, reduced physical activity and reduced cognitive stimulation 85
all increase the risk of cognitive decline and dementia, and for some there is
an inability to understand and follow public health advice.
In humanitarian settings affected by conflict and natural disaster, 83
the mental health challenges are huge but often overlooked.
The current pandemic is adding an extraordinary level of stress to already 84
109
vulnerable populations due to insecurity of housing and food,
combined with feelings of helplessness and despair.
COVID-19 may further exacerbate existing mental health conditions, 85
trigger new conditions, and limit the access of those with pre-existing
conditions to the already scarce mental health services they had.
Fear, loneliness, sadness and anxiety are common as people are afraid of 84
infection, dying, losing family members, losing their income or livelihoods,
being socially isolated and separated from loved ones.
For those in psychiatric institutions and care homes the necessary 84
infection prevention and control measures must be provided to stop
the spread of COVID-19 while giving care for those affected by
COVID-19, without discrimination.
Emergency mental health and psychosocial support should be 84
scaled up especially for those most at risk of mental ill health
during the pandemic including health care workers.
Mental health services and support needs to be incorporated in all 83
aspects of the response including conducting national public health
campaigns that promote mental health and psychosocial wellbeing, that
explain COVID-19 and signpost mental health services, while address
misinformation, stigma and discrimination for all citizens.
Sources: UGMH; our survey among 5,600 individuals conducted October 2020.

Table 2 Over the last two weeks, have you had adequate supplies
of the following PPE? (%, yes)
FFP3 masks/respirators (for AGP areas) 36
Fluid-Repellent facemasks 33
Aprons 31
Long sleeved disposable gowns 30
Gloves 27
Eye protection 27
Sources: BMA; our survey among 5,600 individuals conducted October 2020.

Certain sociodemographic and professional determinants are instrumental in

COVID-19 medical professionals’ emotional burden. (Gorini et al., 2020) To
reduce the risk of burnout syndrome throughout the COVID-19 crisis, hos-
pital administrations should take in auxiliary healthcare providers to relieve
frontline medical staff from non-clinical assignments, and limit immoderate
workload by making arrangements for breaks, decrease work time in subin-
tensive and intensive care units, and supply specific psychosocial support.
(Lasalvia et al., 2021b) The COVID-19 outbreak places frontline medical
professionals at risk of elevated cognitive, emotional, and behavioral dis-
orders. (Wilson et al., 2020) Sleep quality, age, optimistic emotional state,
and life satisfaction can optimize psychological resilience of COVID-19
medical workforce (Bozdağ and Ergün, 2020) who have reduced stress level,
while fearing of getting contaminated or bearing the brunt of wearing per-
sonal protective equipment for long hours. (Wang et al., 2020)
110
Table 3 “Because of the COVID-19 pandemic, over the past 14 days
I have felt stressed or burdened a lot by…” Select all that apply. (%)
living in a small accommodation. 10
being in quarantine. 21
childcare. 41
taking over school lessons. 9
the curfew. 22
being in home office. 17
customer service. 24
worries about my health. 74
worries of not being able to get medical care. 76
worries about being sick with COVID-19 when I noticed 82
first signs of symptoms such as fever, dry cough, breathing
problems, sore throat, loss of smell/taste, headache or diarrhea.
increased conflicts with people close to me. 32
financial worries. 17
uncertainties regarding my job, training place, studies or school. 21
concerns for my own personal safety. 27
concerns for the integrity of family members or friends. 66
fears of what the future will bring, or that I won’t be able 65
to cope with everything.
thoughts that it would be better to be dead. 2
Sources: Rek et al. (2020); our survey among 5,600 individuals conducted October 2020.

Table 4 Please indicate your current situation of the following supplies (%)
Have plenty Have Running Almost out
sufficient a bit low
amount
For personal
protective equipment
Respirators 21 58 19 2
Masks 32 59 7 2
Face shields 34 58 6 2
Goggles 35 57 6 2
Gloves 49 38 11 2
Isolation gowns 41 46 10 3
Cloth gowns 46 43 6 5
For cleaning and
other supplies
Hand sanitizer 48 43 7 2
Hand soap 53 42 3 2
Cleaning/Disinfection 40 45 12 3
products
Injection supplies 59 36 3 2
Sources: APIC; our survey among 5,600 individuals conducted October 2020.

111
Table 5 How does the work you are doing now compare with before
the start of the COVID-19 outbreak? Select all that apply. (%)
My work has not changed. 2
My work has changed a little. 7
My work has changed significantly. 40
My work has completely changed. 63
I am working in my usual setting. 29
I have returned to practice to help address the COVID-19 outbreak. 12
I was a student nurse and have graduated early to help address 7
the COVID-19 outbreak.
I am working in a new setting but with a similar 16
patient group and scope of practice.
I am working in a new setting with a different 27
patient group and scope of practice.
I am working specifically with COVID-19 patients 38
who do not require intensive care.
I am working specifically with COVID-19 patients 26
who are receiving intensive care.
Sources: Nursing Times; our survey among 5,600 individuals conducted October 2020.

Table 6 How do you currently perceive the risk of the COVID-19 pandemic?
“I am worried that…” (%, yes)
I have no means of control over the COVID-19 pandemic. 46
I will infect myself with COVID-19. 39
people close to me are infected with COVID-19. 29
I will infect other people with COVID-19. 28
the consequences of the COVID-19 pandemic 66
will greatly affect me personally.
in case of infection with COVID-19 the consequences 37
for my health will be severe.
I will die of COVID-19. 12
people close to me will die of COVID-19. 29
Sources: Rek et al. (2020); our survey among 5,600 individuals conducted October 2020.

Nurses are exposed to heterogeneous psychosocial stressors as a result of

unexpected risks during the COVID-19 crisis. (Kackin et al., 2020) Wearing
protective clothes and equipment for long hours limit COVID-19 frontline
healthcare professionals’ mobility, leading to body temperature increase, con-
stant sweating, and oxygen deficiency. (Galehdar et al., 2020) Instability and
unpredictability in relation to excessive workload, unusual working situations,
intense ineffectiveness as regards COVID-19 transmission, and lack of infor-
mation (Lăzăroiu et al., 2021; Lyons and Lăzăroiu, 2020) are typically expe-
rienced by frontline medical workers. (He et al., 2020) Nurses are persistently
feeling uneasy concerning their inability to care for patients, their own health
safety and that of their coworkers. (Jia et al., 2020)

112
7. Conclusions, Implications, Limitations,
and Further Research Directions

Severe stress, extreme anxiety, and acute depression among COVID-19

primary care providers are elevated, possibly leading to personal and pro-
fessional burnout. Psychological distress, illness fears, burnout syndrome,
stress-related psychiatric disorders, emotional anxiety, clinically significant
depression, and moral injury are prevalent among COVID-19 frontline res-
piratory and intensive care physicians and nurses. When enduring COVID-
19 related stressors, nurses are susceptible to developing negative emotions
(e.g., extreme anxiety, acute depression, and somatization symptoms) and
stress-related behaviors (e.g., obsessive hand washing). (Zhang et al., 2020)
This article focuses only on cognitive, emotional, and behavioral disorders in
medical staff treating COVID-19 patients. Limitations of this research also
include a convenient sample, small sample size, and cross-sectional data col-
lection, thus limiting generalizability. Certain variables were dichotomized
because of small cell sizes throughout the analysis. The sample size and
the richness of the cohort study dataset enable the control for numerous
potential confounders in the multivariable analysis, and provide novel data
on the topic. More data gathered either cross-sectionally or longitudinally
that utilize larger study populations are required to check and support
the conclusions drawn in this study. Further research should consider emo-
tional fatigue, elevated anxiety symptoms, and sustained psychological dis-
tress in frontline medical staff and nurses working with COVID-19 patients.

Aurel Pera, https://orcid.org/0000-0001-5279-6360

Raluca-Ștefania Balica, https://orcid.org/0000-0003-4169-5892

Research method
Cross-sectional design employing self-report questionnaires.

Data analysis
The gathered data were entered into a spreadsheet and analyzed. The ana-
lytical procedures included heterogeneous descriptive statistics for all em-
ployed variables in the tables.

Software information
To process and inspect the collected data, IBM SPSS 24 and AMOS 20 tools
were used.

Survey result aggregation

Responses were classified into categorical variables for quantitative analysis.
113
Data and materials availability
All research mentioned has been published and datasets used and inspected
during the current study are available from respective outlets. All raw, results,
and key source data supporting the conclusions, statistics, models, and codes
generated or used, together with the details of the study design and the proce-
dures for information analysis, are provided with this article. Note: The pub-
lisher is not responsible for the content or functionality of any supporting in-
formation supplied by the authors. Any queries (other than missing content)
should be directed to the corresponding author for the article. Other modeling
input assumptions are available on reasonable request.

Compliance with ethical standards

Ethical approval
All procedures performed in studies involving human participants were in
accordance with the ethical standards of the institutional and/or national
research committee and with the 1964 Helsinki declaration and its later
amendments or comparable ethical standards.
Informed consent
The ethical consequences of this research have been carefully considered.
Best practices have been respected so as to inform the participants and
protect the data and integrity of the interviewees whose participation was
voluntary and who were given a plain language document with information
as regards the research. The data have been processed in a way that ensures
appropriate security of personal data against unauthorized or unlawful proc-
essing, accidental loss, destruction or damage, employing appropriate tech-
nical or organizational measures. All the information provided by the inter-
viewees has been anonymized for confidentiality reasons. Study participants
were informed clearly about their freedom to opt out of the study at any point
of time without providing justification for doing so. If a participant began a
survey without completing it, that was withdrawal of consent and the data
was not used. To prevent missing data, all fields in the survey were required.
Any survey which did not reach greater than 50% completion was removed
from subsequent analysis to ensure quality. Throughout the research process,
the total survey quality approach, designed to minimize error at each stage as
thus the validity of survey research would be diminished, was followed. At
each step in the survey research process, best practices and quality controls
were followed to minimize the impact of additional sources of error as regards
specification, frame, non-response, measurement, and processing. Only par-
ticipants with non-missing and non-duplicated responses were included in
the analyses. Individuals who completed the survey in a too short period of
time, thus answering rapidly with little thought, were removed from the ana-
lytical sample.
114
Animal studies statement verification
This article does not require animal studies verification.

Code availability
This project has employed statistical analytical techniques standard in all
statistical packages.

Funding information
This paper was supported by Grant GE-1654647 from the Wearable Internet
of Things Healthcare Systems Research Unit, Montreal, Canada. The funder
had no role in study design, data collection analysis, and interpretation,
decision to submit the manuscript for publication, or the preparation and
writing of this paper.

Author contributions
All authors listed have made a substantial, direct and intellectual contribution
to the work, and approved it for publication. The authors take full respon-
sibility for the accuracy and the integrity of the data analysis.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any
commercial or financial relationships that could be construed as a potential
conflict of interest.

Disclosure by the editors of record

The editors declare no conflict of interest in the review and publication
decision regarding this article.

Transparency statement
The authors affirm that the manuscript represents an honest, accurate, and
transparent account of the research being reported, that no relevant aspects
of the study have been left out, and that any inconsistencies from the research
as planned (and, if significant, registered) have been clarified. The study
questionnaires were carried out in an inclusive manner.

Publisher’s note
Addleton Academic Publishers remains neutral with regard to jurisdictional
claims in published maps and institutional affiliations.

Acknowledgments
We thank the three anonymous reviewers for their support, helpful sugges-
tions, and critique of this manuscript.

115
 REFERENCES

Benham, T., Hart, A., Bortolin, M., Court, M., Groves, J., Kraus, A., et al. (2020).
“Preparing for the Second Surge: Preventing Posttraumatic Stress Disorder and
Building Resilience for Health Care Workers in the Face of COVID-19,”
Disaster Medicine and Public Health Preparedness. doi: 10.1017/dmp.2020.371.
Bozdağ, F., and Ergün, N. (2020). “Psychological Resilience of Healthcare Profes-
sionals during COVID-19 Pandemic,” Psychological Reports. doi: 10.1177/0033
294120965477.
Chen, J., Liu, X., Wang, D., Jin, Y., He, M., Ma, Y., et al. (2021). “Risk Factors for
Depression and Anxiety in Healthcare Workers Deployed during the COVID-19
Outbreak in China,” Social Psychiatry and Psychiatric Epidemiology 56: 47–55.
doi: 10.1007/s00127-020-01954-1.
Duarte, I., Teixeira, A., Castro, L., Marina, S., Ribeiro, C., Jácome, C., et al. (2020).
“Burnout among Portuguese Healthcare Workers during the COVID-19 Pan-
demic,” BMC Public Health 20: 1885. doi: 10.1186/s12889-020-09980-z.
Firew, T., Sano, E. D., Lee, J. W., Flores, S., Lang, K., Salman, K., et al. (2020).
“Protecting the Front Line: A Cross-Sectional Survey Analysis of the Occupa-
tional Factors Contributing to Healthcare Workers’ Infection and Psychological
Distress during the COVID-19 Pandemic in the USA,” BMJ Open 10: e042752.
doi: 10.1136/bmjopen-2020-042752.
Galehdar, N., Toulabi, T., Kamran, A., and Heydari, H. (2020). “Exploring Nurses’
Perception of Taking Care of Patients with Coronavirus Disease (COVID‐19): A
Qualitative Study,” Nursing Open 8: 171–179. doi: 10.1002/nop2.616.
Gorini, A., Fiabane, E., Sommaruga, M., Barbieri, S., Sottotetti, F., La Rovere, M.
T., et al. (2020). “Mental Health and Risk Perception among Italian Healthcare
Workers during the Second Month of the Covid-19 Pandemic,” Archives of
Psychiatric Nursing 34(6): 537–544. doi: 10.1016/j.apnu.2020.10.007.
He, Q., Li, T., Su, Y., and Luan, Y. (2020). “Instructive Messages and Lessons From
Chinese Countermarching Nurses of Caring for COVID-19 Patients: A Qualita-
tive Study,” Journal of Transcultural Nursing. doi: 10.1177/1043659620950447.
Jia, Y., Chen, O., Xiao, Z., Xiao, J., Bian, J., and Jia, H. (2020). “Nurses’ Ethical
Challenges Caring for People with COVID-19: A Qualitative Study,” Nursing
Ethics. doi: 10.1177/0969733020944453.
Kackin, O., Ciydem, E., Aci, O. S., and Kutlu, F. Y. (2020). “Experiences and
Psychosocial Problems of Nurses Caring for Patients Diagnosed with COVID-19
in Turkey: A Qualitative Study,” International Journal of Social Psychiatry. doi:
10.1177/0020764020942788.
Kinman, G., Teoh, K., and Harriss, A. (2020). “Supporting the Well-Being of
Healthcare Workers during and after COVID-19,” Occupational Medicine 70(5):
294–296. doi: 10.1093/occmed/kqaa096.
Korkmaz, S., Kazgan, A., Çekiç, S., Tartar, A. S., Balcı, H. N., and Atmaca, M.
(2020). “The Anxiety Levels, Quality of Sleep and Life and Problem-Solving
Skills in Healthcare Workers Employed in COVID-19 Services,” Journal of
Clinical Neuroscience 80: 131–136. doi: 10.1016/j.jocn.2020.07.073.
Labrague, L. J., and De Los Santos, J. A. A. (2020a). “Prevalence and Predictors of
Coronaphobia among Frontline Hospital and Public Health Nurses,” Public
Health Nursing. doi: 10.1111/phn.12841.
116
Labrague, L. J., and de los Santos, J. A. (2020b). “COVID‐19 Anxiety among Front‐
Line Nurses: Predictive Role of Organisational Support, Personal Resilience and
Social Support,” Journal of Nursing Management 28: 1653–1661. doi: 10.1111/
jonm.13121.
Lasalvia, A., Bonetto, C., Porru, S., Carta, A., Tardivo, S., Bovo C., et al. (2021a).
“Psychological Impact of COVID-19 Pandemic on Healthcare Workers in a
Highly Burdened Area of North-East Italy,” Epidemiology and Psychiatric
Sciences 30(e1): 1–13. doi: 10.1017/S2045796020001158.
Lasalvia, A., Amaddeo, F., Porru, S., Carta, A., Tardivo, S., Bovo, C., et al. (2021b).
“Levels of Burn-Out among Healthcare Workers during the COVID-19 Pan-
demic and Their Associated Factors: A Cross-Sectional Study in a Tertiary
Hospital of a Highly Burdened Area of North-East Italy,” BMJ Open 11:
e045127. doi: 10.1136/bmjopen-2020-045127.
Lăzăroiu, G., Pera, A., Ştefănescu-Mihăilă, R. O., Bratu, S., and Mircică, N. (2017a).
“The Cognitive Information Effect of Televised News,” Frontiers in Psychology
8: 1165. doi: 10.3389/fpsyg.2017.01165.
Lăzăroiu, G., Pera, A., Ștefănescu-Mihăilă, R. O., Mircică, N., and Neguriță, O.
(2017b). “Can Neuroscience Assist Us in Constructing Better Patterns of Economic
Decision-Making?,” Frontiers in Behavioral Neuroscience 11: 188. doi: 10.3389/
fnbeh.2017.00188.
Lăzăroiu, G., and Adams, C. (2020). “Viral Panic and Contagious Fear in Scary
Times: The Proliferation of COVID-19 Misinformation and Fake News,” Analysis
and Metaphysics 19: 80–86. doi: 10.22381/AM1920209.
Lăzăroiu, G., Mihăilă, R., and Braniște, L. (2021). “The Language of Misinformation
Literacy: COVID-19 Vaccine Hesitancy Attitudes, Behaviors, and Perceptions,”
Linguistic and Philosophical Investigations 20: 85–94. doi: 10.22381/LPI2020217.
Lyons, N., and Lăzăroiu, G. (2020). “Addressing the COVID-19 Crisis by Har-
nessing Internet of Things Sensors and Machine Learning Algorithms in Data-
driven Smart Sustainable Cities,” Geopolitics, History, and International Relations
12(2): 65–71. doi: 10.22381/GHIR12220209.
Rossi, R., Socci, V., Pacitti, F., Mensi, S., Di Marco, A., Siracusano, A., et al.
(2020). “Mental Health Outcomes among Healthcare Workers and the General
Population during the COVID-19 in Italy,” Frontiers in Psychology 11: 608986.
doi: 10.3389/fpsyg.2020.608986.
Salari, N., Khazaie, H., Hosseinian-Far, A., Khaledi-Paveh, B., Kazeminia, M.,
Mohammadi, M., et al. (2020). “The Prevalence of Stress, Anxiety and De-
pression within Front-Line Healthcare Workers Caring for COVID-19 Patients:
A Systematic Review and Meta-Regression,” Human Resources for Health 18:
100. doi: 10.1186/s12960-020-00544-1.
Shreffler, J., Petrey, J., and Huecker, M. (2020). “The Impact of COVID-19 on
Healthcare Worker Wellness: A Scoping Review,” The Western Journal of
Emergency Medicine 21(5): 1059–1066. doi: 10.5811/westjem.2020.7.48684.
Wang, H., Liu, Y., Hu, K., Zhang, M., Du, M., Huang, H., et al. (2020). “Healthcare
Workers’ Stress when Caring for COVID-19 Patients: An Altruistic Perspective,”
Nursing Ethics 27(7): 1490–1500. doi: 10.1177/0969733020934146.
Wilson, W., Raj, J. P., Rao, S., Ghiya, M., Nedungalaparambil, N. M., Mundra, H., et
al. (2020). “Prevalence and Predictors of Stress, Anxiety, and Depression among
Healthcare Workers Managing COVID-19 Pandemic in India: A Nationwide
117
 Observational Study,” Indian Journal of Psychological Medicine 42(4): 353–
358. doi: 10.1177/0253717620933992.
Yıldırım, M., Arslan, G., and Özaslan, A. (2020). “Perceived Risk and Mental Health
Problems among Healthcare Professionals during COVID-19 Pandemic: Exploring
the Mediating Effects of Resilience and Coronavirus Fear,” International
Journal of Mental Health and Addiction. doi: 10.1007/s11469-020-00424-8.
Zhang, Y., Wei, L., Li, H., Pan, Y., Wang, J., Li, Q., et al. (2020). “The Psycho-
logical Change Process of Frontline Nurses Caring for Patients with COVID-19
during Its Outbreak,” Issues in Mental Health Nursing 41(6): 525–530. doi:
10.1080/01612840.2020.1752865.
Zheng, R., Zhou, Y., Fu, Y., Xiang, Q., Cheng, F., Chen, H., et al. (2021). “Prevalence
and Associated Factors of Depression and Anxiety among Nurses during the
Outbreak of COVID-19 in China: A Cross-Sectional Study,” International
Journal of Nursing Studies 114: 103809. doi: 10.1016/j.ijnurstu.2020.103809.

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