European Journal of Cardiovascular Medicine

Healthcare workers (HCWs) represent the foundation of healthcare delivery systems and are essential to the maintenance of population health. Their professional responsibilities involve continuous exposure to emotionally demanding situations, high workloads, complex clinical decision-making, and frequent encounters with human suffering and mortality. These occupational demands make healthcare professionals particularly vulnerable to psychological distress, including stress, anxiety, and depression (1-2).

Stress is a natural response to environmental demands that exceed an individual’s adaptive capacity. In healthcare environments, stress arises from long working hours, staff shortages, high patient turnover, administrative burden, time pressure, ethical dilemmas, and responsibility for patient outcomes3. Chronic exposure to such stressors can result in emotional exhaustion, anxiety disorders, depressive symptoms, and burnout. Anxiety is characterized by excessive worry, hyperarousal, and impaired functioning, while depression involves persistent low mood, reduced motivation, fatigue, and cognitive impairment. Together, these conditions significantly affect both personal well-being and professional performance (4).

Evidence from international literature consistently demonstrates high prevalence rates of psychological distress among healthcare workers compared to the general population (5-6). Doctors, nurses, and allied health professionals frequently report symptoms of stress, anxiety, and depression due to demanding work environments. Frontline healthcare workers, in particular, face higher psychological burdens due to prolonged patient contact, emergency care responsibilities, high-risk exposure, and emotionally charged clinical situations. Female healthcare workers have also been reported to experience higher levels of psychological distress, potentially due to the combined pressures of professional roles and domestic responsibilities (7).

The consequences of poor mental health among healthcare workers extend beyond individual suffering. Psychological distress has been linked to decreased job satisfaction, burnout, absenteeism, increased turnover, reduced productivity, and compromised patient safety. Impaired mental health can negatively influence clinical judgment, communication, empathy, and adherence to safety protocols, thereby affecting the quality of healthcare delivery. From a systemic perspective, mental health problems among HCWs contribute to workforce instability and increased healthcare costs (8).

Despite growing awareness, most research in this field has relied on cross-sectional designs, which provide only a snapshot of mental health status at a single point in time. Such studies cannot capture the dynamic nature of psychological well-being or identify trends, progression, and causal relationships. Mental health is not static; it evolves with cumulative exposure to occupational stressors, changing work environments, and life circumstances. Therefore, prospective studies are essential for understanding how stress, anxiety, and depression develop and progress over time (9).

A prospective study design allows for repeated assessments, enabling evaluation of trends, incidence, and predictors of mental health outcomes. It also facilitates comparison between different groups, such as frontline and non-frontline healthcare workers, and supports identification of high-risk populations. Such evidence is crucial for designing preventive strategies, targeted interventions, and institutional policies aimed at protecting healthcare workers’ psychological well-being (10-11).

Given the limited availability of longitudinal data, especially in developing healthcare settings, the present study was designed as a prospective comparative study to assess the prevalence and progression of stress, anxiety, and depression among healthcare workers over one year. By following 200 healthcare workers prospectively, this study aims to provide comprehensive insight into mental health trends and associated risk factors, thereby contributing to evidence-based mental health planning in healthcare systems.

Study Design

The present study was designed as a prospective comparative cohort study to assess the prevalence and progression of stress, anxiety, and depression among healthcare workers over a period of one year. The study was conducted in a tertiary care hospital, including various clinical and non-clinical departments where healthcare workers are actively involved in patient care. The total duration of the study was one year (12 months), including participant recruitment, baseline assessment, follow-up evaluations, and data analysis.

Study Population

The study population comprised healthcare workers, including doctors, nurses, and allied health professionals employed at the study site during the study period.

Sample Size

A total of 200 healthcare workers were enrolled in the study. The sample size was determined based on previous studies reporting moderate prevalence of stress, anxiety, and depression among healthcare workers, with adequate power to detect changes over time.

Sampling Technique

Participants were selected using convenience sampling from eligible healthcare workers who met the inclusion criteria and consented to participate.

Inclusion Criteria

• Healthcare workers aged 18 years and above
• Doctors, nurses, and allied health professionals
• Employed at the institution during the study period
• Willing to participate and provide written informed consent

Exclusion Criteria

• Healthcare workers with a known psychiatric illness currently under treatment
• Individuals unable to complete self-administered questionnaires
• Those unwilling to participate or lost to follow-up

Study Tools

The following standardized and validated instruments were used for data collection:

1. Perceived Stress Scale (PSS-10):
   Measures perceived stress over the past month. Higher scores indicate greater perceived stress.
2. Generalized Anxiety Disorder Scale (GAD-7):
   Assesses severity of anxiety symptoms. A score ≥10 indicates moderate anxiety.
3. Patient Health Questionnaire-9 (PHQ-9):
   Measures severity of depressive symptoms. A score ≥10 indicates moderate depression.

A semi-structured questionnaire was used to collect socio-demographic and occupational details such as age, gender, designation, years of experience, working hours per week, shift pattern, and frontline status.

Data Collection Procedure

After obtaining approval from the Institutional Ethics Committee, eligible participants were recruited. Written informed consent was obtained from all participants prior to enrollment.

Data were collected at three time points:

• Baseline (Month 0)
• Midpoint (Month 6)
• End of study (Month 12)

Participants completed the questionnaires in a self-administered format during each assessment period.

Statistical Analysis

Data were entered into Microsoft Excel and analyzed using SPSS software.

• Descriptive statistics (mean, standard deviation, frequency, percentage) were used to summarize variables.
• Repeated-measures ANOVA was used to evaluate changes in mental health scores over time.
• Independent t-test and Chi-square test were used for group comparisons.
• A p-value < 0.05 was considered statistically significant

Table 1: Socio-Demographic Characteristics (N = 200)

Table 2: Prevalence of Stress, Anxiety, and Depression Over Time

Table 3: Mean Scores Over Time

Table 4: Frontline vs Non-frontline at 12 Months