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. 2021 Feb 5;16(2):e0246602. doi: 10.1371/journal.pone.0246602

Table 3. Socio-ecological factors associated with mental health outcomes using multivariable models.

  Probable MD Probable GAD Probable PTSD Probable AUD
  adjOR (95% CI) p-value adjOR (95% CI) p-value adjOR (95% CI) p-value adjOR (95% CI) p-value
Individual-level factors
    Age (years) 1.01 (0.98–1.03) 0.584 0.97 (0.95–0.99)* 0.012 1.00 (0.98–1.02) 0.723 0.98 (0.97–1.00)* 0.015
    Gender
        Male 1.00 [Reference] 0.886 1.00 [Reference] 0.542 1.00 [Reference] 0.002 1.00 [Reference] 0.076
        Female 0.96 (0.57–1.63) 1.18 (0.70–2.00) 2.05 (1.30–3.23)** 1.32 (0.97–1.80)
    Hispanic ethnicity
        Yes 1.12 (0.48–2.61) 0.794 0.95 (0.40–2.22) 0.897 1.55 (0.78–3.07) 0.213 0.61 (0.34–1.07) 0.085
        No 1.00 [Reference] 1.00 [Reference] 1.00 [Reference] 1.00 [Reference]
    Race
        White 1.00 [Reference]   1.00 [Reference]   1.00 [Reference]   1.00 [Reference]  
        Black or African American 0.92 (0.35–2.37) 0.858 0.23 (0.07–0.74)* 0.014 1.12 (0.52–2.42) 0.770 0.50 (0.26–0.94)* 0.033
        Asian 1.26 (0.66–2.40) 0.484 0.78 (0.41–1.50) 0.458 0.68 (0.39–1.20) 0.179 0.36 (0.23–0.55)*** <0.001
        Other 2.75 (0.86–8.78) 0.088 0.19 (0.02–1.87) 0.156 0.49 (0.12–1.96) 0.314 0.69 (0.29–1.63) 0.397
    Marital status
        Married 1.00 [Reference]   1.00 [Reference]   1.00 [Reference]   1.00 [Reference]  
        Single 1.10 (0.67–1.79) 0.704 0.94 (0.58–1.53) 0.803 0.83 (0.55–1.24) 0.356 1.12 (0.82–1.54) 0.488
        Divorced or widowed 1.23 (0.58–2.61) 0.590 1.17 (0.52–2.64) 0.704 0.79 (0.40–1.54) 0.484 1.50 (0.89–2.52) 0.130
    Pre-pandemic psychiatric illness
        Yes 2.49 (1.63–3.79)*** <0.001 2.30 (1.52–3.50)*** <0.001 1.88 (1.31–2.69)** 0.001 1.26 (0.93–1.70) 0.140
        No 1.00 [Reference] 1.00 [Reference] 1.00 [Reference] 1.00 [Reference]
    Region
        Northeast 1.21 (0.79–2.09) 0.499 1.78 (1.01–3.14)* 0.046 1.54 (0.98–2.42) 0.064 1.36 (0.97–1.90) 0.072
        South 1.65 (0.72–3.78) 0.234 2.91 (1.25–6.80)* 0.013 1.58 (0.79–3.16) 0.194 1.71 (1.02–2.87)* 0.043
        Midwest 1.00 [Reference]   1.00 [Reference]   1.00 [Reference]   1.00 [Reference]  
        West 1.23 (0.58–2.57) 0.592 1.36 (0.65–2.88) 0.417 1.20 (0.64–2.26) 0.564 1.40 (0.88–2.24) 0.161
    COVID-19 status
        Tested, positive 1.22 (0.35–4.23) 0.751 1.23 (0.38–4.00) 0.729 1.63 (0.56–4.75) 0.367 0.74 (0.29–1.85) 0.515
        Tested, results
pending		 0.49 (0.06–4.24) 0.516 1.65 (0.30–9.12) 0.566 2.69 (0.85–8.51) 0.093 1.94 (0.71–5.30) 0.197
        Not tested,
presumed positive		 0.97 (0.42–2.25) 0.935 1.25 (0.55–2.82) 0.599 1.46 (0.73–2.92) 0.290 0.89 (0.49–1.60) 0.687
        Not tested, no
need for test		 1.00 [Reference]   1.00 [Reference]   1.00 [Reference]   1.00 [Reference]  
    Frontline status
        Direct 1.07 (0.59–1.96) 0.815 0.85 (0.47–1.52) 0.579 1.22 (0.75–1.98) 0.433 1.24 (0.86–1.80) 0.246
        Indirect 1.30 (0.70–2.42) 0.411 0.99 (0.53–1.83) 0.968 0.82 (0.48–1.42) 0.481 0.85 (0.57–1.29) 0.450
        None 1.00 [Reference]   1.00 [Reference]   1.00 [Reference]   1.00 [Reference]  
    Specialty risk level
        Low 1.00 [Reference]   1.00 [Reference]   1.00 [Reference]   1.00 [Reference]  
        Moderate 1.10 (0.61–1.99) .760 1.18 (0.66–2.11) 0.572 0.73 (0.44–1.19) 0.207 1.15 (0.78–1.70) 0.469
        High 0.91 (0.48–1.75) 0.781 0.87 (0.45–1.66) 0.666 0.77 (0.45–1.31) 0.337 1.11 (0.73–1.69) 0.631
    Profession
        Physician 1.00 [Reference]   1.00 [Reference]   1.00 [Reference]   1.00 [Reference]  
        Nurse 2.32 (1.21–4.48)* 0.012 1.17 (0.60–2.31) 0.644 1.25 (0.73–2.12) 0.418 0.70 (0.46–1.05) 0.085
        Physician, nursing,
or medical assistant		 0.87 (0.28–2.67) 0.810 0.42 (0.13–1.33) 0.140 1.34 (0.62–2.10) 0.463 0.73 (0.40–1.32) 0.297
        Health technologist
or technician		 2.66 (1.16–6.12)* 0.021 3.70 (1.67–8.23)** 0.001 1.25 (0.61–2.53) 0.541 0.62 (0.35–1.11) 0.109
        Medical trainee 1.04 (0.50–2.18) 0.919 1.09 (0.55–2.17) 0.797 1.03 (0.57–1.85) 0.925 0.68 (0.44–1.06) 0.086
        Other clinical role 1.22 (0.48–3.09) 0.674 0.71 (0.27–1.84) 0.475 1.13 (0.54–2.34) 0.746 1.22 (0.71–2.11) 0.472
        Other non-clinical
role		 2.05 (0.91–4.66) 0.085 2.48 (1.12–5.50)* 0.025 2.06 (1.07–3.98)* 0.031 1.28 (0.76–2.15) 0.357
Interpersonal-level factors
    Social support needs 2.22 (1.78–2.78)*** <0.001 2.30 (1.84–2.88)*** <0.001 1.76 (1.47–2.10)*** <0.001 1.17 (1.01–1.35)* 0.038
    Change in living situation due to COVID-19
        Yes 1.12 (0.66–1.89) 0.683 1.23 (0.73–2.06) 0.435 1.32 (0.84–2.05) 0.226 0.91 (0.64–1.30) 0.596
        No 1.00 [Reference] 1.00 [Reference] 1.00 [Reference] 1.00 [Reference]
Hospital-level factors
    PPE shortage—beginning of pandemic
        Yes 0.86 (0.54–1.36) 0.514 1.11 (0.70–1.76) 0.666 1.03 (0.71–1.49) 0.887 0.82 (0.62–1.09) 0.172
        No 1.00 [Reference]   1.00 [Reference]   1.00 [Reference]   1.00 [Reference]  
        Don’t know 1.25 (0.61–2.56) 0.545 2.02 (1.00–4.08) 0.051 0.96 (0.51–1.81) 0.891 0.74 (0.45–1.22) 0.237
    Roles changed
        Yes 0.93 (0.56–1.53) 0.764 1.40 (0.83–2.37) 0.210 1.05 (0.70–1.59) 0.808 0.95 (0.70–1.29) 0.751
        No 1.00 [Reference] 1.00 [Reference] 1.00 [Reference] 1.00 [Reference]
    Hours changed
        More hours 1.18 (0.70–1.97) 0.539 1.11 (0.67–1.85) 0.682 1.14 (0.75–1.76) 0.539 0.75 (0.53–1.05) 0.095
        Fewer hours 1.24 (0.74–2.07) 0.420 1.01 (0.61–1.69) 0.958 1.06 (0.69–1.61) 0.803 1.19 (0.87–1.64) 0.275
        No change 1.00 [Reference]   1.00 [Reference]   1.00 [Reference]   1.00 [Reference]  
    Hospital policies
        Transparent 0.93 (0.71–1.24) 0.627 0.98 (0.73–1.30) 0.860 0.85 (0.67–1.09) 0.194 1.00 (0.82–1.22) 0.994
        Implemented quickly 0.94 (0.76–1.16) 0.536 0.93 (0.75–1.14) 0.477 1.01 (0.85–1.21) 0.918 0.97 (0.84–1.12) 0.706
        Difficult to follow 1.35 (1.10–1.66)** 0.004 1.06 (0.85–1.31) 0.612 1.01 (0.85–1.21) 0.903 0.91 (0.80–1.05) 0.192
    Team cohesion 0.98 (0.93–1.03) 0.438 0.95 (0.90–1.00) 0.069 0.95 (0.90–0.99)* 0.022 1.01 (0.97–1.05) 0.748
Community-level factors
    HCW appreciation 0.84 (0.66–1.06) 0.142 0.97 (0.77–1.24) 0.820 0.98 (0.80–1.20) 0.838 1.15 (1.01–1.31) 0.720
    HCW stigmatization 1.13 (0.94–1.38) 0.203 1.03 (0.85–1.25) 0.756 1.42 (1.21–1.66)*** <0.001 1.15 (1.01–1.31)* 0.038
    Satisfaction with
state/local
government response		 0.93 (0.79–1.11) 0.429 0.97 (0.82–1.15) 0.733 1.00 (0.86–1.15) 0.942 1.05 (0.94–1.18) 0.409
    Satisfaction with
federal government
response		 0.90 (0.73–1.10) 0.306 0.77 (0.62–0.95)* 0.014 0.89 (0.75–1.06) 0.187 0.89 (0.78–1.01) 0.072
    Media consumption
(hours per day)		 1.16 (0.98–1.37) 0.078 1.37 (1.18–1.60)*** <0.001 1.22 (1.06–1.41)** 0.005 1.10 (0.98–1.23) 0.113

adjOR = adjusted Odds Ratio.

CI = Confidence Interval.

*0.05 > p-value > = 0.01.

**0.01 > p-value > = 0.001.

***p-value < 0.001.