Levels of stress and resilience related to the COVID‐19 pandemic among academic medical staff in Serbia

The pandemic nature of COVID‐19 and the fear of being in contact with individuals who might be infected have led to significant stress and psychological pressure as well as stigmatization and discrimination worldwide. ¹ , ² , ³ Some of the factors that further affect mental health in this context include poverty, access to health care, unemployment, life experiences, and social support, ⁴ as well as the fact that the virus is an invisible and unfamiliar source of danger. ⁵ In addition to worries about possible physical health consequences, mental health problems, such as a generalized sense of fear, anxiety, and stress, are becoming a widely discussed topic. ⁶ One study found that, during the pandemic, a quarter of Chinese students showed symptoms of increased anxiety. ¹ Another study found that medical staff exhibited greater levels of fear, anxiety, and depression than administrative staff. ⁷ Even though stress reactions to the pandemic are normal and expected, reactions such as concentration problems, irritability, anxiety, insomnia, and interpersonal conflicts are also a common occurence. ⁴ Several studies have evaluated the severity of the fear of COVID‐19, ³ , ⁵ while other studies provide suggestions for improvement of certain protective factors, such as resilience. ⁴

The aim of our study was to assess the potential relation between resilience (ability to cope with difficulties and recover from stress) ⁸ and perceived levels of stress during the pandemic. This is a part of a broader study that evaluated stress, anxiety, depressiveness, and other symptoms in medical workers.

The first COVID‐19 case in Serbia was diagnosed on 6 March 2020, while the state of emergency began on 15 March. The government mandated strict measures of social distancing, institutions and business were temporarily shut down, and preventive quarantine and lockdown were enforced from 18:00 hours until 05:00 hours. This part of the study was conducted online from 20 to 29 April on academic staff and students of medical sciences. The study protocol was approved by the Ethical Committee, Faculty of Medical Sciences, University of Kragujevac, and it conformed to the provisions of the Declaration of Helsinki.

The sample comprised of 420 students (female, 81.7%; M_age = 22.53 ± 3.65 years) and 63 members of staff (female, 50.8%; M_age = 41.70 ± 10.92 years) at the Faculty of Medical Sciences, University of Kragujevac, Serbia. The participants were asked to fill out basic sociodemographic data (age, sex, education, economic and marriage status, somatic/psychological difficulties, family history of mental disorders, smoking, alcohol and drug use); the Brief Resilience Scale (BRS), ⁸ which showed satisfactory psychometric characteristics in our study (α = 0.79); and the 21‐item Depression, Anxiety, and Stress Scale (DASS‐21) to evaluate the perceived levels of stress over the past 2 weeks (α = 0.84). ⁹ Informed consent was obtained from all participants included in the study and their anonymity was preserved.

Mean levels of stress were significantly higher, t(481) = −3.17, P < 0.01, in students (7.67 ± 4.67) than in staff (5.73 ± 4.22), as well as in female participants, t(481) = −3.45, P < 0.001. The levels of stress also increased with lower economic status. The majority of participants (57.3%) had no symptoms of stress, 26.7% had mild or moderate symptoms, while 15.9% had severe symptoms.

The mean difference in BRS score between staff (3.42 ± 0.75) and students (3.17 ± 0.80) was also significant, t(481) = 2.35, P < 0.05. Males reported higher scores on resilience, t(481) = 4.30, P < 0.001. One‐third (33.3%) of participants showed lower levels of resilience, 56.7% showed medium levels, while only 10% showed higher levels. In both study groups, a moderate negative correlation between BRS scores and DASS‐21 Stress scores was found (ρ = − 0.439 for students, and ρ = − 0.339 for staff).

After grouping all participants with stress symptoms (DASS‐21 Stress score ≥ 8), multivariant binary logistic regression showed that older age (odds ratio [OR], 0.96) and better economic status (OR, 0.82) reduced the risk of stress, while being female (OR, 1.77) and having a family history of mental disorders (OR, 2.17) increased the stress. Finally, higher resilience scores reduced the risk of stress (OR, 0.36; see Table 1).

Table 1.

Multivariate binary logistic regression analyses of variables predicting stress symptoms

							95%CI for Exp(B)
		B	SE	d.f.	Sig.	Exp(B)	Lower	Upper
Step 1	Age	−0.041	0.015	1	0.006**	0.959	0.932	0.988
	Sex	0.562	0.274	1	0.040*	1.754	1.025	3.002
	Economic status	−0.217	0.097	1	0.025*	0.805	0.666	0.973
	Family history of mental disorder	0.756	0.298	1	0.011*	2.129	1.187	3.817
	BRS	−1.045	0.146	1	0.000**	0.352	0.264	0.468
	Psychological difficulties	0.904	0.502	1	0.072	2.471	0.923	6.613
	Constant	3.400	0.872	1	0.000	29.973
Step 2	Age	−0.044	0.015	1	0.003**	0.957	0.929	0.986
	Sex	0.568	0.275	1	0.039*	1.766	1.030	3.027
	Economic status	−0.201	0.098	1	0.040*	0.818	0.675	0.991
	Family history of mental disorder	0.775	0.298	1	0.009**	2.171	1.210	3.896
	BRS	−1.024	0.147	1	0.000**	0.359	0.269	0.480
	Constant	3.281	0.878	1	0.000	26.603

^** P < 0.01.

^* P < 0.05.

BRS, Brief Resilience Scale; CI, confidence interval.

Our findings point towards several risk factors (younger, female academic medical workers with family history of mental disorders) for reporting higher levels of stress during the COVID‐19 pandemic. Higher resilience is likely to be a protective factor. Considering the results of other studies in which medical health workers with somatic disorders, female workers, and workers in contact with COVID‐19 patients were at higher risk of insomnia, anxiety, obsessive–compulsive, and depressive symptoms, ¹⁰ we are aiming to present a more detailed analysis of protective factors in our future analyses.

Disclosure statement

There is no conflict of interest and funds were not received for this study.