The sudden and widespread outbreak of the novel coronavirus disease (COVID‐19) has caused many problems in all the sections of the societies (Liu et al., 2020). In the last few months, the increase in confirmed and suspected cases and deaths due to COVID‐19 in the world, and the imposition of more social restrictions in most countries has caused several psychological disorders among healthcare workers (HCWs) and the general population (Maroufi, 2021). Among HCWs, the frontline workers such as nurses and doctors who are involved directly in handling these patients are at greater risk than others (Spoorthy et al., 2020). With the rapid increase in the number of patients, doctors and nurses have to face enormous workload and high‐risk infections, which may lead to mental health problems such as anxiety, depression (Liu et al., 2020) or insomnia (Walton et al., 2020). This psychological distress caused by acute infectious diseases may persist for a long time and even lead to post‐traumatic stress disorder (PTSD) (Xiong et al., 2020).
Investigations demonstrated that several factors have such adverse psychological consequences among HCWs, including excessive work hours, depletion of personal protection equipment, over‐enthusiastic media news, feeling insufficiently supported, lack of specific drugs and the infection rate among medical staff (Lai et al., 2020; Spoorthy et al., 2020). There are many similarities in psychological symptoms between the COVID‐19 pandemic and the SARS or Ebola outbreak among HCWs (Lai et al., 2020). Moreover, it has been reported that nurses have higher anxiety and depressive symptoms than doctors (Spoorthy et al., 2020). On the other hand, some strategies, including the Internet, telephone or application‐based counselling or intervention, have been developed and administered by psychological health institutions to improve HCW’s mental health during the COVID‐19 pandemic (Lai et al., 2020). But the question is, along with counselling or interventions for nurses, doctors and medical staff, is there any approach that can be practical? We should first review the statistics of reports of psychological problems of health workers during the COVID‐19 pandemic.
Many studies have been conducted during this time. In a study, 1,257 HCWs completed questioners. Results showed that 50.4% of the HCWs suffered from depression, 44.6% from anxiety, 34.0% from insomnia and 71.5% from distress (Spoorthy et al., 2020). In another investigation, using Zung's self‐rating depression scale (SDS) and Zung's self‐rating anxiety scale (SAS), doctors and nurses showed experiencing clinically significant depressive symptoms (Liang et al., 2020). Kang et al. (2020) reported that among 994 medical and nursing staff in Wuhan, 36.9% had subthreshold mental health disturbances, 34.4% had mild disturbances, 22.4% had moderate disturbances and 6.2% had severe disturbances (Kang et al., 2020). Xiong et al., (2020) reported the outcome of a cross‐sectional survey among 223 nurses. Results showed the prevalence of anxiety and depression symptoms were 40.8% and 26.4%, respectively. In addition, they reported that self‐efficacy was negatively correlated with anxiety (r = −.161) (Xiong et al., 2020).
1. PHYSICAL ACTIVITY
Studies focused on the psychological effects of the COVID‐19 pandemic among HCWs. Some of which declared that health authorities should consider the conditions and methods to provide psychological support to both patients and HCWs. These methods may consist of using the Internet, telephone or web applications, to assess and monitor stress, depression and anxiety (Spoorthy et al., 2020). Increasing awareness, utilizing appropriate protective equipment or reducing work hours are suggested as practical approaches to improve HCW's mental health circumstances (Kang et al., 2020; Lai et al., 2020; Liang et al., 2020; Liu et al., 2020; Walton et al., 2020; Xiong et al., 2020).
We want to look at this issue from another perspective. Previous studies, American Sports Medicine Association (ACSM) and World Health Organization (WHO) have suggested regular physical activity to eliminate inappropriate mental conditions. Regular exercise and physical activity can alter the prevention and treatment of anxiety and depression (Maroufi, 2021). Regular physical activity regulates brain‐derived neurotrophic factor (BDNF), which increases cognitive function and the ability to face depression and anxiety (Hu et al., 2020). Studies showed that all types of exercise, such as aerobic, resistance or high‐intensity training, effectively reduced psychological disorders (Maroufi, 2021). Randomized controlled studies have illustrated that exercise is associated with an anti‐depressant effect (Martinsen, 2008). A meta‐analysis reported that using the Hamilton rating scale for depression, regular exercise and physical activity individuals diagnosed with clinical depression or those who do not respond to medication can be treated (Nagata et al., 2020).
The intensity, volume and frequency are the other remarkable variables to set up an exercise programme based on ACSM and WHO guidelines (Table 1). Moreover, the COVID‐19 pandemic‐related psychological distress is expected to have an improper impact on nurses, doctors and medical staff's physiological health. Anxiety and depression, despite psychological effects, may cause a sense of passivity and withdrawal, which has unpleasant consequences related to physiological markers during the pandemic (Maroufi, 2021). The primary adverse effects of lack of appropriate physical activity (Maroufi, 2021) and workplace environmental stressors (Shechter et al., 2020) are obesity, cardiometabolic syndrome and systemic inflammation, contributing to further health risks during the COVID‐19 pandemic. Due to the COVID‐19 pandemic, medical staff and HCWs have faced the magnitude of death of patients than usual; hence, the risk of post‐traumatic stress disorder (PTSD) has already arisen (Walton et al., 2020). Studies illustrated exercise interventions, regardless of the type or intensity, may reduce PTSD significantly (Hegberg et al., 2019). However, there is no direct evidence that shows the physical activity can alter the psychological circumstances in nurses, doctors or medical staff during the COVID‐19 pandemic; it seems, based on pre‐pandemic studies, following regular exercises and physical activities may improve their situations.
TABLE 1.
Recommended effective physical activity for psychological indices’ changes and weight loss
| Weight loss | Physical activity | |
|---|---|---|
| No significant weight loss | >150 min. week−1 | |
| 2–3 kg.week−1 | 150–225 min. week−1 | |
| 5–7.5 kg.week−1 | 225–420 min. week−1 | |
| Weight stabilization after a period of weight loss | 200–300 min. week−1 | |
2. CONCLUSION
In conclusion, along with the psychological care of nurses, doctors and medical staff, setting up regular physical activity may have positive outcomes for the psychological health of HCWs during the COVID‐19 pandemic. Although the vaccination has been started globally, keeping the mental health of HCWs in mind, we can continue to fight against COVID‐19 stronger than past.
CONFLICT OF INTEREST
There is no conflict of interest.
AUTHOR CONTRIBUTION
Equal contributorship.
Maroufi K, Razavi R. Nurses’ mental health and COVID‐19 pandemic: Is there any approach?. Nurs Open. 2021;8:2004–2006. 10.1002/nop2.930
Funding information
The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not‐for‐profit sectors
REFERENCES
- Hegberg, N. J., Hayes, J. P., & Hayes, S. M. (2019). Exercise intervention in PTSD: A narrative review and rationale for implementation. Frontiers in Psychiatry, 10, 133. 10.3389/fpsyt.2019.00133 [DOI] [PMC free article] [PubMed] [Google Scholar]
- Hu, S., Tucker, L., Wu, C., & Yang, L. (2020). Beneficial effects of exercise on depression and anxiety during the Covid‐19 pandemic: A narrative review. Frontiers in Psychiatry, 11, 1217. 10.3389/fpsyt.2020.587557 [DOI] [PMC free article] [PubMed] [Google Scholar]
- Kang, L., Li, Y. I., Hu, S., Chen, M., Yang, C., Yang, B. X., Wang, Y., Hu, J., Lai, J., Ma, X., Chen, J., Guan, L., Wang, G., Ma, H., & Liu, Z. (2020). The mental health of medical workers in Wuhan, China dealing with the 2019 novel coronavirus. The Lancet Psychiatry, 7(3), e14. 10.1016/S2215-0366(20)30047-X [DOI] [PMC free article] [PubMed] [Google Scholar]
- Lai, J., Ma, S., Wang, Y., Cai, Z., Hu, J., Wei, N., Wu, J., Du, H., Chen, T., Li, R., Tan, H., Kang, L., Yao, L., Huang, M., Wang, H., Wang, G., Liu, Z., & Hu, S. (2020). Factors associated with mental health outcomes among health care workers exposed to coronavirus disease 2019. JAMA Network Open, 3(3), e203976. 10.1001/jamanetworkopen.2020.3976 [DOI] [PMC free article] [PubMed] [Google Scholar]
- Liang, Y., Chen, M., Zheng, X., & Liu, J. (2020). Screening for Chinese medical staff mental health by SDS and SAS during the outbreak of COVID‐19. Journal of Psychosomatic Research, 133, 110102. 10.1016/j.jpsychores.2020.110102 [DOI] [PMC free article] [PubMed] [Google Scholar]
- Liu, Z., Han, B., Jiang, R., Huang, Y., Ma, C., Wen, J., & Ma, Y. (2020). Mental health status of doctors and nurses during COVID‐19 epidemic in China. SSRN Electronic Journal. [Google Scholar]
- Maroufi, K. (2021). Physical activity can change the physiological and psychological circumstances during COVID‐19 pandemic: A narrative review. Journal of Sports Medicine and Therapy, 6, 1–7. 10.29328/journal.jsmt.1001051 [DOI] [Google Scholar]
- Martinsen, E. W. (2008). Physical activity in the prevention and treatment of anxiety and depression. Nordic Journal of Psychiatry, 62(sup47), 25–29. 10.1080/08039480802315640 [DOI] [PubMed] [Google Scholar]
- Nagata, S., McCormick, B. P., & Austin, D. R. (2020). Physical activity as treatment for depression in recreation therapy: Transitioning from research to practice. Therapeutic Recreation Journal, 54(1). 10.18666/TRJ-2020-V54-I1-9745 [DOI] [Google Scholar]
- Shechter, A., Diaz, F., Moise, N., Anstey, D. E., Ye, S., Agarwal, S., Birk, J. L., Brodie, D., Cannone, D. E., Chang, B., Claassen, J., Cornelius, T., Derby, L., Dong, M., Givens, R. C., Hochman, B., Homma, S., Kronish, I. M., Lee, S. A. J., … Abdalla, M. (2020). Psychological distress, coping behaviors, and preferences for support among New York healthcare workers during the COVID‐19 pandemic. General Hospital Psychiatry, 66, 1–8. 10.1016/j.genhosppsych.2020.06.007 [DOI] [PMC free article] [PubMed] [Google Scholar]
- Spoorthy, M. S., Pratapa, S. K., & Mahant, S. (2020). Mental health problems faced by healthcare workers due to the COVID‐19 pandemic–A review. Asian Journal of Psychiatry, 51, 102119. 10.1016/j.ajp.2020.102119 [DOI] [PMC free article] [PubMed] [Google Scholar]
- Walton, M., Murray, E., & Christian, M. D. (2020). Mental health care for medical staff and affiliated healthcare workers during the COVID‐19 pandemic. European Heart Journal: Acute Cardiovascular Care, 9(3), 241–247. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Xiong, H., Yi, S., & Lin, Y. (2020). The psychological status and self‐efficacy of nurses during COVID‐19 outbreak: A cross‐sectional survey. Inquiry: The Journal of Health Care Organization, Provision, and Financing, 57, 46958020957114. [DOI] [PMC free article] [PubMed] [Google Scholar]