Volume 23, Issue 5 (December & January - Special Issue on COVID-19 2020)                   J Arak Uni Med Sci 2020, 23(5): 724-739 | Back to browse issues page

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Ariapooran S, Amirimanesh M. Depression, Anxiety and Suicidal ideation of Nurses in the Outbreak of COVID-19: The Role of Demographic Variables. J Arak Uni Med Sci 2020; 23 (5) :724-739
URL: http://jams.arakmu.ac.ir/article-1-6427-en.html
1- Depatrment of Psychology, Faculty of Literature and Humanistic, Malayer University, Malayer, Iran. , s.ariapooran@malayeru.ac.ir
2- Depatrment of Psychology, Faculty of Literature and Humanistic, Malayer University, Malayer, Iran.
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1. Introduction
ue to direct contact with patients, nurses have an important role in preventing the spread of COVID-19 [7]. Hence, nurses are highly exposed to stress induced by COVID-19 [8, 9, 10]. In studies conducted outside Iran, the prevalence of psychological problems (depression and anxiety) in nurses during the COVID-19 pandemic has been reported between 10.7 to 42.8% [31, 3233, 34, 35]. In Iran, depression and anxiety during the pandemic have been studied in nurses [36373839], but their suicidal ideation has not been studied. Before the outbreak of COVID-19, it was shown that nurses in ICU, CCU and emergency departments have more occupational stress [4142], and their psychological disorders have been reported more compared to nurses in other wards [4344]. Therefore, the main purpose of this study was to investigate the prevalence of depression, anxiety and suicidal ideation in nurses during the COVID-19 outbreak, and evaluate the role of gender, educational level, marital status and department.
2. Materials and Methods
This is a descriptive-survey study. The study population consists of all nurses in Malayer, Iran in 2020 with a total number of 525 (205 in Shahid Gharazi Hospital, 200 in Imam Hossein Hospital and 120 in Mehr Hospital). Samples were selected using census method. After distributing questionnaires among nurses, 312 were returned completed and their data were used in the analysis. Questionnaires were the short form of Beck Depression Inventory (BDI) with 13 items [45] and acceptable psychometric properties [454647], Beck Anxiety Inventory (BAI) with 21 items [48] and acceptable psychometric properties [4849, 50], and Scale for Suicidal Ideation (SSI) with 19 items and acceptable psychometric properties [5152, 53]. Prevalence of psychological problems was described by using frequency and percentage. To compare the variables based on demographic factors, multivariate Analysis of Covariance (MANCOVA) was used by controling the effects of age and work experience.
3. Results
According to the results, 15.38% of nurses had moderate to severe depression; 46.47% had moderate to severe anxiety, 27.56% had plans for suicide, and 9.94% had active suicidal desire (Tables 1 and 2). 

The results of MANCOVA showed that the mean of depression and anxiety of female nurses were higher than those of male nurses, and there was no significant
difference in suicidal between male and female nurses, although they were higher in females. Depression and suicidal ideation were higher in nurses with a bachelor’s degree than in nurses with a master’s degree or higher, but there was no significant difference in anxiety between the two education groups. Anxiety and suicidal ideation of single nurses were higher than that of married nurses, and no significant difference was observed in depression between single and married nurses. Only anxiety in nurses differed based on their department. According to the results of LSD post hoc test, the mean anxiety of nurses in the emergency department and ICU/CCU were higher than in the pre-hospital emergency department, but there was no significant difference in depression and suicidal ideation between nurses based on department.
4. Discussion and Conclusion
The results of this study related to the prevalence of psychological problems were against the findings of studies conducted before the COVID-19 outbreak [31, 32], but consistent with the findings of studies conducted during the COVID-19 outbreak [3233, 34]. The high prevalence of psychological problems is probably due to the stress caused by the coronavirus. Nurses in the COVID-19 outbreak are more likely to experience deaths of patients and even hospital staff, which can increase their rates of depression, anxiety, and suicidal ideation. Female nurses were more anxious and depressed than men and suicidal ideation was not significantly different between them. This is against the findings of a previous study [28] and consistent with the findings of some previous studies [29, 35, 55]. Women’s vulnerability to stress compared to men [56] can play a role in this difference. Nurses with a bachelor’s degree had more depression and suicidal ideation, which is consistent with the findings of a previous study [28]. The higher incomes of nurses with a master’s degree may play a role in this outcome. The difference in anxiety and suicidal ideation and the lack of difference in depression based on marital status in our study are against the findings of a previous study [28] and consistent with the findings of other study [57]. Married nurses join their families after work and are supported by their spouse and even children; contact with the family makes them less likely to experience anxiety and suicidal thoughts. The nurses of the emergency department and the ICU/CCU were more anxious than the pre-hospital emergency nurses, which is consistent with the findings of some previous studies [4344]. The high level of stress induced by COVID-19 in nurses working in ICU/CCU and emergency department can cause nurses to experience anxiety symptoms. One of the limitations of this study was the use of self-report scales. The use of qualitative methods and interviews in future studies is recommended. Psychologists, counselors, and psychiatrists working in hospitals are highly recommended to pay attention to the symptoms of depression, anxiety, and suicidal ideation in nurses.

Ethical Considerations
Compliance with ethical guidelines

This study was approved by the Ethics Committee of Malayer University (Code: IR.MALAYERU.REC.1399.002). All ethical principles are considered in this article. The participants were informed about the purpose of the research and its implementation stages. They were also assured about the confidentiality of their information and were free to leave the study whenever they wished, and if desired, the research results would be available to them.

This research did not receive any grant from funding agencies in the public, commercial, or non-profit sectors. 

Authors' contributions
Conceptualization: Saeed Ariapooran; Research, editing and finalizatio: Both authors.

Conflicts of interest
The authors declare no conflict of interest.

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Type of Study: Original Atricle | Subject: COVID-19
Received: 2020/08/29 | Accepted: 2020/12/27

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