Abstract
The COVID-19 pandemic has exposed healthcare staff to mental distress. Given the importance of applying effective strategies to cope with stress caused by COVID-19, this study aimed to assess the stress-coping strategies of Iranian healthcare providers. This cross-sectional study was performed through a web-based survey. Data collection was done online using a demographic data questionnaire and the short form of Endler and Parker’s coping inventory. The mean scores of task-oriented strategies (27.06 ± 5.13) were higher than avoidance-oriented (19.42 ± 5.77) and emotion-oriented strategies (18.45 ± 5.76), and the healthcare workers mainly used task-oriented styles to cope with COVID-19-related stress. There was a significant difference between the score of task-oriented strategy in terms of age groups (P < 0.001), work experience (P = 0.018), level of education (P < 0.001), having children (P = 0.002), and type of hospital (P = 0.028). The score of task-oriented strategies was lower in employees who were in the age group of 20–30 years and had less than 10 years of work experience, and it was higher in employees who had children, worked in private hospitals, and had a master's degree or higher. The score of emotion-oriented strategies in the age group of 51–60 years was significantly lower than other age groups (P < 0.01) and was significantly higher in employees with a bachelor's degree than those with a master's degree or higher (P = 0.017). There was no significant difference between the scores of avoidance-oriented strategies and any socio-demographic variables. According to the findings of this study, young and less experienced employees were more inclined to utilize emotion-oriented coping styles. Therefore, considering appropriate training programs for these employees to apply effective coping strategies is extremely important.
Keywords: COVID-19, Health personnel, Social adjustment, SARS-CoV-2
1. Introduction
Healthcare workers are on the front lines of the fight against COVID-19. The long-term prevalence and mortality rate of COVID-19 has exposed healthcare personnel to mental disorders such as stress, anxiety, depression, burnout, post-traumatic disorders (PTSD), and insomnia [[1], [2], [3]].
The COVID-19 outbreak in Iran happened quickly and the country's hospitals were not prepared to deal with the disease. At the beginning of the epidemic, Iran's healthcare workers were under a lot of stress due to the unknown disease and its treatment, lack of medical equipment and personal protection, overcrowding of patients, high workload, and fear of transmitting the disease to their families [[4], [5], [6]].
New perspectives on stress, emphasize the role of personal mental resources in dealing with stressors; the more appropriate the methods that are used in the face of stress, the less the damage that will be caused. The stress response is useful when it prevents the occurrence and persistence of stressful events and restlessness in the person, and this is possible by using appropriate coping skills [7]. Lazarus and Folkman consider coping to be a cognitive and behavioral ability to cope with stress [8]. Endler and Parker suggest that there are three mechanisms of coping with stress; These mechanisms include task or problem-oriented coping or an active approach to solving the problem, emotion-oriented coping, or concentrating on emotional reactions to the problem, and avoidance-oriented coping, or escape from the situation or problem, which manifests itself in the form of turning to the community and another person or turning to and engaging in a new activity [9]. According to Endler and Parker’s coping model, emotion-oriented and avoidance-oriented strategies are identified as maladaptive strategies, and task-oriented styles as adaptive styles to cope with stressors [10].
Evidence has shown that coping styles with stress affect people's quality of life. The use of ineffective coping strategies leads to physical and psychological problems [11]. Coping styles also help people in the community to overcome the crisis with minimal material and spiritual costs [12].
People deal with stress differently. By knowing what makes healthcare workers more vulnerable to COVID-19-induced stress and how to deal with such a situation, more targeted and effective counseling programs can be designed.
This study is an attempt to understand the factors associated with coping strategies in healthcare workers. This study aimed to assess the stress-coping strategies of Iranian healthcare providers during the COVID-19 outbreak in Iran.
2. Material and methods
2.1. Study design and participants
This cross-sectional study was conducted on healthcare personnel working in Iranian hospitals providing services to patients with COVID-19. This study was performed through a web-based survey from April to June 2020. The inclusion criteria were all healthcare personnel, including physicians, nurses, and paramedics working in Iranian hospitals, who provided medical services to COVID-19 patients at the time of the study. The samples were excluded from the study if they did not answer the questionnaires completely, were inactive during the outbreak of COVID-19, or engaged in non-medical work.
The online questionnaire was created through Google Form and its electronic address was sent to healthcare personnel via social networking apps such as WhatsApp or Telegram. A total of 552 staff completed the questionnaires.
2.2. Data collection tool
Data collection was done online using a demographic data questionnaire and the short form of Endler and Parker’s coping inventory for stressful situations (CISS). The questions of the demographic information questionnaire included age, gender, level of education, marital status, having children, suffering from an illness, type of job, type of hospital or health center, work history, and income level.
The short form of the CISS has 21 items and evaluates behavioral strategies preferred by people in stressful situations in three respects under the theoretical infrastructure: task-oriented, emotion-oriented, and avoidance-oriented coping styles [13]. This questionnaire is a self-report tool and subjects should indicate on a five-point Likert scale (from never = 1 to always = 5) how much they use each of the presented strategies and the dominant style of each person is determined according to the scores in each of the coping styles. Cronbach's alpha coefficients have been reported for each subscale of task-oriented coping 0.78–0.87, emotion-oriented coping 0.78–0.87, and avoidance coping 0.7–0.8 [14]. The CISS has been translated and validated in Persian [[15], [16], [17]]. In this study, we use the Persian version of the CISS.
2.3. Statistical analysis
Statistical analysis was done by SPSS version 23. Descriptive statistical methods such as determining the mean, standard deviation, and frequency were used to describe the demographic variables and the scores of coping styles. Statistical tests, including Mann-Whitney and Kruskal-Wallis tests, were used to compare the mean scores of coping styles based on demographic variables.
2.4. Ethical considerations
This study has ethical approval from the Ethics Committee of Saveh University of Medical Sciences (Code: IR.SAVEHUMS.REC.1399.008). The participants consented to complete the questionnaires and their information was analyzed and reported confidentially and anonymously. All procedures were performed under relevant guidelines.
3. Results
The average age of the samples was 32.75 ± 7.50 years and they had a mean of 9.68 ± 7.21 years of work experience. The socio-demographic information of the samples is presented in Table 1.
Table 1.
Socio-demographic characteristics of the participants.
| Variables | Category | N (%) |
|---|---|---|
| Gender | Female | 418 (76.8) |
| Male | 126 (23.2) | |
| Age category | 20–30 | 177 (33.1) |
| 31–40 | 202 (37.8) | |
| 41–50 | 136 (25.4) | |
| 51–60 | 20 (3.7) | |
| Marital status | Single | 149 (27.4) |
| Married | 395 (72.6) | |
| Having children | Yes | 309 (56.9) |
| No | 234 (43.1) | |
| Career type | Nurse | 242 (43.8) |
| Physician | 90 (16.6) | |
| other | 194 (39.6) | |
| Level of education | Undergraduate | 60 (11) |
| Bachelor | 377 (69.3) | |
| MA and above | 107 (19.7) | |
| Working years | 1–10 | 275 (49.8) |
| 11–20 | 181 (33.8) | |
| 21–30 | 74 (13.8) | |
| >30 | 5 | |
| Type of hospital | Public | 411 (76.3) |
| Private | 38 (7.1) | |
| Semi-private | 90 (16.7) | |
| Income level (million IRRa) | 10–30 | 146 (26.8) |
| 31–60 | 357 (65.5) | |
| 61–80 | 35 (6.4) | |
| 81–100 | 7 (1.3) |
At the time of the study, one million IRR was equivalent to 5.06 USD.
The mean scores of task-oriented strategies (27.06 ± 5.13) were higher than avoidance-oriented (19.42 ± 5.77) and emotion-oriented strategies (18.45 ± 5.76), and the healthcare workers mostly used task-oriented strategies to cope with COVID-19-related stress (Table 2).
Table 2.
Coping styles’ score by participants’ characteristics.
| Variables | Task-oriented Mean ± SD | Emotion-oriented Mean ± SD | Avoidance-oriented Mean ± SD | |
|---|---|---|---|---|
| Gender | Female | 27.02 ± 5.2 | 18.46 ± 5.49 | 19.74 ± 5.57 |
| Male | 27.23 ± 4.84 | 18.37 ± 6.46 | 18.52 ± 6.30 | |
| P-valuea | 0.55 | 0.6 | 0.15 | |
| Age category | 20–30 | 25.78 ± 4.97 | 18.3 ± 4.88 | 20.24 ± 5.52 |
| 31–40 | 27.21 ± 5.21 | 19.06 ± 5.59 | 19.47 ± 5.54 | |
| 41–50 | 28.45 ± 4.6 | 18.39 ± 6.7 | 18.84 ± 6.27 | |
| 51–60 | 27.15 ± 6.76 | 13.68 ± 4.65 | 17.75 ± 5.72 | |
| P-valueb | 0.000c | 0.001c | 0.13 | |
| Marital status | single | 26.4 ± 6.07 | 17.73 ± 5.62 | 19.66 ± 6.20 |
| Married | 27.28 ± 4.66 | 18.71 ± 5.75 | 19.32 ± 5.59 | |
| P-valuea | 0.14 | 0.14 | 0.49 | |
| Having children | yes | 27.60 ± 4.89 | 18.88 ± 6.08 | 19.17 ± 5.91 |
| No | 26.30 ± 5.32 | 17.76 ± 5.17 | 19.74 ± 5.65 | |
| P-valuea | 0.002c | 0.051 | 0.27 | |
| Career type | Physician | 27.01 ± 5.33 | 18.37 ± 5.93 | 19.42 ± 6.11 |
| Nurse | 27.03 ± 5.07 | 18.37 ± 5.54 | 19.68 ± 5.75 | |
| Other | 27.06 ± 5.07 | 18.47 ± 5.89 | 19.15 ± 5.72 | |
| P-valueb | 0.91 | 0.98 | 0.52 | |
| Level of education | Undergraduate | 26.92 ± 5.17 | 18.78 ± 7.31 | 18.35 ± 6.56 |
| Bachelor | 26.54 ± 5.11 | 18.78 ± 5.30 | 19.85 ± 5.58 | |
| MA and above | 28.66 ± 4.84 | 16.96 ± 6 | 18.5 ± 5.92 | |
| P-valueb | 0.000c | 0.02c | 0.08c | |
| Work experience (years) | 1–10 | 26.58 ± 4.99 | 18.6 ± 5.34 | 19.81 ± 5.55 |
| 11–20 | 27.26 ± 5.15 | 18.63 ± 6.36 | 19.18 ± 5.98 | |
| 21–30 | 28.08 ± 5.17 | 17.32 ± 5.52 | 18.29 ± 6.08 | |
| >30 | 30.6 ± 2.3 | 16.8 ± 5.54 | 19.6 ± 5.85 | |
| P-valueb | 0.018c | 0.31 | 0.25 | |
| Type of hospital | Public | 26.84 ± 5.28 | 18.14 ± 5.85 | 19.58 ± 5.87 |
| Private | 29.05 ± 4.44 | 18.16 ± 5.47 | 18.63 ± 4.93 | |
| Semi-private | 27.15 ± 4.4 | 19.49 ± 5.25 | 18.71 ± 5.69 | |
| P-valueb | 0.028c | 0.14 | 0.18 | |
| Income level (million IRR) | 10–30 | 26.46 ± 5.83 | 18.94 ± 5.74 | 19.57 ± 6.04 |
| 31–60 | 27.22 ± 4.78 | 18.34 ± 5.7 | 19.46 ± 5.65 | |
| 61–80 | 27.28 ± 5.95 | 17.18 ± 6.41 | 18.75 ± 6.16 | |
| 81–100 | 26.66 ± 2.33 | 15.33 ± 1.63 | 16.66 ± 5.53 | |
| P-valueb | 0.55 | 0.14 | 0.8 | |
| In total | 27.06 ± 5.13 | 18.45 ± 5.76 | 19.42 ± 5.77 |
U-Mann-Whitney test.
Kruskal-Wallis test.
Significant level.
There was a statistically significant difference between the scores of task-oriented strategies in terms of age groups (P < 0.001), work experience (P = 0.018), level of education (P < 0.001), having children (P = 0.002), and type of hospital (P = 0.028) (Table 2). The mean scores of task-oriented strategies in the age group of 20–30 years were significantly lower than the age group of 31–40 (P = 0.043) and 41–50 years (P < 0.001). Employees who had between 1 and 10 years of work experience used task-oriented strategies significantly less than employees with over 30 years of experience (P = 0.05). In terms of education level, the mean scores of task-oriented strategies in employees with a master's degree or a higher level were significantly more than employees with a bachelor's degree (P < 0.001). The mean scores of task-oriented style in participants who had children were significantly higher than those who did not have children (P = 0.002). Employees working in private hospitals used task-oriented strategies significantly more than employees working in public hospitals (P = 0.017).
There was a statistically significant difference between the scores of emotion-oriented strategies in terms of age groups (P = 0.001), and level of education (P = 0.02) (Table 2). The mean scores of emotion-oriented coping strategies in the age group of 51–60 years were significantly lower than other age groups (P < 0.01). The scores of emotion-oriented strategies in employees with a bachelor's degree were significantly more than in employees with a master's degree or higher education (P = 0.017).
There was no significant difference between the scores of avoidance-oriented strategies and any of the socio-demographic variables (Table 2).
4. Discussion
In this study, we investigated the coping strategies of healthcare workers during the COVID-19 outbreak. The results of the present study showed that health workers mostly used task-oriented strategies to deal with stress and anxiety caused by COVID-19. Consistent with this finding, the results of other studies show that healthcare workers were more likely to use task-oriented strategies such as learning about COVID-19 and its transmission and prevention, following infection control protocols, personal protection measures, and maintaining social distance [[18], [19], [20], [21]]. On the contrary, some studies have reported that healthcare workers were more concerned with emotion and avoidance strategies such as limiting media exposure, limited sharing of COVID details, denial, religious confrontation, and seeking social support for coping with the stress of the COVID epidemic [[22], [23], [24]].
This study was conducted between the first and second waves of the COVID-19 epidemic in Iran. At this time, Iran's Ministry of Health and Medical Education (MoHME) and the Corona National Anti-Virus Headquarters (CNAVH) took more precautionary measures to prevent the disease and the number of daily COVID-19 patients decreased compared to the first wave. The country's hospitals were equipped and the health personnel were more prepared to take care of the disease than in the first wave [25].
Having effective coping strategies is important for stressful situations, as it may prevent experiences that lead to stress-related psychiatric disorders [26]. The use of positive and problem-based coping mechanisms is associated with lower levels of stress, psychological distress, anxiety, and depression, while the use of negative coping strategies is related to psychological distress and weak mental health [22,27,28].
There was a statistically significant difference between the scores of task-oriented and emotion-oriented strategies in terms of age groups. Younger employees were less likely to use task-oriented strategies than other employees. Conversely, older employees were less likely to use emotion-oriented strategies. Consistent with these findings, the results of a study showed that the use of task-oriented coping strategies in age groups over 55 years was significantly higher than in younger employees [29]. Older people may be better at emotional regulation than younger people, they respond to a crisis with less anger, and they are better able to adapt their coping strategies to a changing environment [30].
In terms of education level, employees with a bachelor's degree were more emotion-oriented and less task-oriented than employees with a master's degree or higher level. Previous research shows that the level of education is related to individuals’ coping strategies. These studies have reported a significant positive correlation between education level and the use of task-based strategies, [31,32]. Higher education may be associated with better mental performance, which can be effective in counteracting stress [29].
In this study, less experienced employees used task-oriented strategies significantly less than employees with high experience. Since there is a positive relationship between employees' age and work experience, the significance of using task-oriented strategies in employees with higher work experience can be justified by age-related findings. Less experienced employees have more stress in epidemics, because they have less knowledge, and skills, and are less able to self-regulate and adapt [33].
Based on the results, employees who had children were more task-oriented. Similarly, the results of a study showed that the use of ineffective coping strategies such as mental disengagement through the use of alcohol, sedatives, drugs, and overeating is more common in single and childless people. While these strategies are ineffective and can even lead to increased anxiety [34].
In this study, the employees of private hospitals used task-oriented strategies more than in public sectors. Healthcare workers in public hospitals have faced large numbers of patient and staff shortages during the COVID-19 outbreak. Due to the lack of staff, healthcare workers experience additional physical, mental, and environmental stimuli that lead to increased psychological burden and less use of effective coping strategies [35].
This research had some limitations. Given the risk of Coronavirus transmission and the dispersion of health centers, data was collected online, which may lead to less participation of the samples compared to the face-to-face approach. The disparity in the number of participants in terms of gender, type of occupation, and hospital category may limit the generalizability of the data. Various factors can affect the coping style; in this study, we only examined some demographic variables. Evaluation of other related characteristics such as personality type, workload, etc., is needed to fully understand coping strategies in healthcare workers.
5. Conclusion
Based on the findings, Iranian healthcare staff were more likely to use task-oriented coping strategies to deal with COVID-19-related stress. Given the adverse effects of COVID-19-related stress and anxiety on mental health, it is essential to use effective coping strategies such as task-oriented strategies to prevent mental disorders in healthcare workers. Based on the results of this study, it is useful to consider appropriate training programs for younger and less experienced employees to better adapt to stress caused by COVID-19.
Author contribution statement
Maryam Saeedi: Conceived and designed the experiments; Analyzed and interpreted the data; Wrote the paper.
Sahar Taleb: Performed the experiments; Contributed reagents, materials, analysis tools or data; Wrote the paper.
Zahra Abedini: Contributed reagents, materials, analysis tools or data; Wrote the paper.
Data availability statement
The data that has been used is confidential.
Declaration of competing interest
The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
Footnotes
Supplementary data to this article can be found online at https://doi.org/10.1016/j.heliyon.2023.e17178.
Appendix A. Supplementary data
The following is the Supplementary data to this article:
References
- 1.Asmundson G.J., Taylor S. How health anxiety influences responses to viral outbreaks like COVID-19: what all decision-makers, health authorities, and health care professionals need to know. J. Anxiety Disord. 2020;71 doi: 10.1016/j.janxdis.2020.102211. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Chinvararak C., Kerdcharoen N., Pruttithavorn W., Polruamngern N., Asawaroekwisoot T., Munsukpol W., et al. Mental health among healthcare workers during COVID-19 pandemic in Thailand. PLoS One. 2022;17(5) doi: 10.1371/journal.pone.0268704. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Hajebi A., Abbasinejad M., Zafar M., Hajebi A., Taremian F. Mental health, burnout, and job stressors among healthcare workers during the COVID-19 pandemic in Iran: a cross-sectional survey. Front. Psychiatr. 2022;13 doi: 10.3389/fpsyt.2022.891430. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Jahanmehr N., siamiaghdam A., Daneshkohan A. Covid-19 in Iran: a qualitative study of the experiences of health care workers. J. Sch. Publ. Health Inst. Publ. Health Res. 2022;20(1):97–110. [Google Scholar]
- 5.Saeedi M., Yazdi S., Bahador R.C. Predictors of COVID-19-related health anxiety among health care workers: a cross-sectional study. BMC Psychol. 2022;10(1):170. doi: 10.1186/s40359-022-00880-y. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6.Sirati Nir M., Karimi L., Khalili R. The perceived stress level of health care and non-health care in exposed to COVID-19 pandemic. Iran. J. Psychiatry Clin. Psychol. 2020;26(3):294–305. doi: 10.32598/ijpcp.26.3405.1. [DOI] [Google Scholar]
- 7.Mohammadinia N., Rezaei M., Heydarikhayat N., Sharifipoor H., Darban F. Assessing stressors and coping styles in medical sciences students. QJ Nurs. Manage. 2012;1(1):9–16. [Google Scholar]
- 8.Kronenberg L.M., Goossens P.J., van Busschbach J., van Achterberg T., van den Brink W. Coping styles in substance use disorder (SUD) patients with and without co-occurring attention deficit/hyperactivity disorder (ADHD) or autism spectrum disorder (ASD) BMC Psychiatr. 2015;15(1):159. doi: 10.1186/s12888-015-0530-x. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 9.Endler N.S., Parker J. Multi-Health Systems. Inc; Toronto, Canada: 1990. Coping Inventory for Stressful Situations (CISS) [Google Scholar]
- 10.Marquez-Arrico J.E., Benaiges I., Adan A. Strategies to cope with treatment in substance use disorder male patients with and without schizophrenia. Psychiatr. Res. 2015;228(3):752–759. doi: 10.1016/j.psychres.2015.05.028. [DOI] [PubMed] [Google Scholar]
- 11.Santarnecchi E., Sprugnoli G., Tatti E., Mencarelli L., Neri F., Momi D., et al. Brain functional connectivity correlates of coping styles. Cognit. Affect Behav. Neurosci. 2018;18(3):495–508. doi: 10.3758/s13415-018-0583-7. [DOI] [PubMed] [Google Scholar]
- 12.Cerami C., Santi G.C., Galandra C., Dodich A., Cappa S.F., Vecchi T., et al. Covid-19 outbreak in Italy: are we ready for the psychosocial and the economic crisis? Baseline findings from the PsyCovid study. Front. Psychiatr. 2020;11:556. doi: 10.3389/fpsyt.2020.00556. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 13.Parker J., Endler N. Multi-Health Systems; North Tonawanda, NY: 1990. Coping Inventory for Stressful Situations (CISS) [Google Scholar]
- 14.Endler N., Parker J. Multi-Health System; NY: 1999. Coping Inventory for Stressful Situations Manual North Tonawanda. [Google Scholar]
- 15.Bazzazian S., Besharat M., Ehsan H.B., Rajab A. The moderating role of coping strategies in relationship between illness perception, quality of life and HbA1c in patients with type I diabetes. Iranian J. Endocrinol. Metabol. 2010;12(3):213–309. [Google Scholar]
- 16.Piri L., Shararay M. The relationship between identity style, assertive and coping styles with mental pressure. J. Psychol. Stud. 2005;1(2):39–54. [Google Scholar]
- 17.Shokri O., Taghilou S., Geravand F., Paezi M., Molaei M., abd Elahpour M., et al. Factor structure and psychometric properties of the farsi version of the coping inventory for stressful situations (CISS) Adv. Cognitive Sci. 2009;10(3):22–33. [Google Scholar]
- 18.Cai H., Tu B., Ma J., Chen L., Fu L., Jiang Y., et al. Psychological impact and coping strategies of frontline medical staff in Hunan between January and March 2020 during the outbreak of coronavirus disease 2019 (COVID-19) in Hubei, China. Med. Sci. Mon. Int. Med. J. Exp. Clin. Res.: Int. Med. J. Exper. Clinical Res. 2020;26 doi: 10.12659/MSM.924171. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 19.Chen H., Sun L., Du Z., Zhao L., Wang L. A cross‐sectional study of mental health status and self‐psychological adjustment in nurses who supported Wuhan for fighting against the COVID‐19. J. Clin. Nurs. 2020;29(21-22):4161–4170. doi: 10.1111/jocn.15444. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 20.Zhang Y., Wang C., Pan W., Zheng J., Gao J., Huang X., et al. Stress, burnout, and coping strategies of frontline nurses during the COVID-19 epidemic in Wuhan and Shanghai, China. Front. Psychiatr. 2020:1154. doi: 10.3389/fpsyt.2020.565520. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 21.Windarwati H.D., Ati N.A.L., Paraswati M.D., Ilmy S.K., Supianto A.A., Rizzal A.F., et al. Stressor, coping mechanism, and motivation among health care workers in dealing with stress due to the COVID-19 pandemic in Indonesia. Asian J. Psychiatr. 2021;56 doi: 10.1016/j.ajp.2020.102470. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 22.Babore A., Lombardi L., Viceconti M.L., Pignataro S., Marino V., Crudele M., et al. Psychological effects of the COVID-2019 pandemic: perceived stress and coping strategies among healthcare professionals. Psychiatr. Res. 2020;293 doi: 10.1016/j.psychres.2020.113366. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 23.Munawar K., Choudhry F.R. Exploring stress coping strategies of frontline emergency health workers dealing Covid-19 in Pakistan: a qualitative inquiry. Am. J. Infect. Control. 2021;49(3):286–292. doi: 10.1016/j.ajic.2020.06.214. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 24.Tahara M., Mashizume Y., Takahashi K. Coping mechanisms: exploring strategies utilized by Japanese healthcare workers to reduce stress and improve mental health during the covid-19 pandemic. Int. J. Environ. Res. Publ. Health. 2021;18(1):131. doi: 10.3390/ijerph18010131. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 25.Nojomi M., Moradi-Lakeh M., Pourmalek F. COVID-19 in Iran: what was done and what should be done. Med. J. Islam. Repub. Iran. 2021;35:97. doi: 10.47176/mjiri.35.97. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 26.Mahmoud J.S.R., Staten R.T., Hall L.A., Lennie T.A. The relationship among young adult college students’ depression, anxiety, stress, demographics, life satisfaction, and coping styles. Issues Ment. Health Nurs. 2012;33(3):149–156. doi: 10.3109/01612840.2011.632708. [DOI] [PubMed] [Google Scholar]
- 27.Labrague L.J. Psychological resilience, coping behaviours and social support among health care workers during the COVID‐19 pandemic: a systematic review of quantitative studies. J. Nurs. Manag. 2021;29(7):1893–1905. doi: 10.1111/jonm.13336. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 28.Nie A., Su X., Zhang S., Guan W., Li J. Psychological impact of COVID‐19 outbreak on frontline nurses: a cross‐sectional survey study. J. Clin. Nurs. 2020;29(21-22):4217–4226. doi: 10.1111/jocn.15454. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 29.Prentice C., Zeidan S., Wang X. Personality, trait EI and coping with COVID 19 measures. Int. J. Disaster Risk Reduc. 2020;51 doi: 10.1016/j.ijdrr.2020.101789. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 30.Yeung D.Y.-L., Fung H.H. Age differences in coping and emotional responses toward SARS: a longitudinal study of Hong Kong Chinese. Aging Ment. Health. 2007;11(5):579–587. doi: 10.1080/13607860601086355. [DOI] [PubMed] [Google Scholar]
- 31.Barr M., Raphael B., Taylor M., Stevens G., Jorm L., Giffin M., et al. Pandemic influenza in Australia: using telephone surveys to measure perceptions of threat and willingness to comply. BMC Infect. Dis. 2008;8(1):1–14. doi: 10.1186/1471-2334-8-117. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 32.Ferreira R.J., Buttell F., Cannon C. COVID-19: immediate predictors of individual resilience. Sustainability. 2020;12(16):6495. [Google Scholar]
- 33.Chigwedere O.C., Sadath A., Kabir Z., Arensman E. The impact of epidemics and pandemics on the mental health of healthcare workers: a systematic review. Int. J. Environ. Res. Publ. Health. 2021;18(13):6695. doi: 10.3390/ijerph18136695. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 34.Savitsky B., Findling Y., Ereli A., Hendel T. Anxiety and coping strategies among nursing students during the covid-19 pandemic. Nurse Educ. Pract. 2020;46 doi: 10.1016/j.nepr.2020.102809. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 35.Chai J. Countermeasures to reduce psychological stress of nurses in SARS ward. J. Peking Univ. (Heal. Sci.) S. 2003;1:156. [Google Scholar]
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
Data Availability Statement
The data that has been used is confidential.