The COVID-19 pandemic presented an unprecedented global health crisis, significantly impacting healthcare workers (HCWs). Unlike other professions, HCWs, particularly medical and paramedical staff, experienced intensified workload during the pandemic's acute phases. Numerous studies have highlighted the detrimental effects on both the physical and mental health of HCWs. In Italy, a substantial number of HCWs contracted COVID-19, exceeding 260,000 cases, representing a significant portion of the overall infections. This heightened vulnerability is attributed to multiple factors. The increased likelihood of infection places HCWs at a disadvantage. The constant exposure to the virus, coupled with the high-stress environment of managing a global pandemic, resulted in significant mental health challenges. The study aimed to investigate the long-term effects of the pandemic on the psychological well-being and sleep quality of nurses and physicians in Italy, seeking to understand the disparities in impact based on profession and exposure to frontline work.

Existing literature extensively documents the negative consequences of the COVID-19 pandemic on the mental and physical health of healthcare workers. Studies reveal increased rates of stress, anxiety, depression, and sleep disturbances among HCWs during the pandemic. A systematic review and meta-analysis showed a pooled prevalence of 42% for sleep problems in this population. The impact on mental well-being has been linked to factors such as increased workload, exposure to infected patients, fear of infection, and the emotional toll of witnessing suffering and death. Previous research has also highlighted the role of personal experiences with COVID-19 (e.g., infection, loss of loved ones) as significant predictors of mental health outcomes. Furthermore, differences in the pandemic's impact across various healthcare professions have been noted, with some studies suggesting that nurses may be disproportionately affected compared to physicians. This review lays the groundwork for this study which builds upon the existing evidence by examining the longer-term impacts of the pandemic and the potential differences between nurses and physicians in Italy.

This cross-sectional study employed a retrospective design using a web-based survey distributed to healthcare workers (HCWs) in the Azienda Sanitaria Locale (ASL) Roma 6 in central Italy. The survey, completed by 287 HCWs (212 nurses and 75 physicians) between February and June 2022, collected socio-demographic, occupational, and COVID-19-related data. Participants answered questionnaires assessing sleep quality and psychological health, considering both pre-pandemic and current conditions. The questionnaires included: * **Socio-demographic, occupational, and COVID-19-related information:** This section gathered data on age, gender, marital status, education level, profession, department, years of service, frontline work status, COVID-19 infection history, quarantine periods, and experiences with COVID-19 among relatives and friends. * **Impact of Event Scale (IES):** This 15-item scale measured post-traumatic stress disorder (PTSD) symptoms. * **Pittsburgh Sleep Quality Index (PSQI):** This 19-item scale assessed subjective sleep quality. * **Pittsburgh Sleep Quality Index-Addendum (PSQI-A):** This measure evaluated seven disruptive nocturnal behaviors associated with PTSD. * **Depression Anxiety Stress Scale (DASS-21):** This 21-item scale measured depression, anxiety, and stress symptoms. Statistical analyses involved descriptive statistics, analyses of covariance (ANCOVA), and multiple linear regressions. ANCOVA examined the effects of the pandemic on traumatic events, sleep, and psychological variables, considering profession and gender as factors. Separate MANCOVAs were used to explore the impact of frontline work, with "Years on the job" as a covariate. Multiple linear regressions assessed the relationship between COVID-19-related experiences and current sleep and psychological health.

A total of 287 HCWs participated (212 nurses, 75 physicians). The average age was 46.12 years, with an average of 18.45 years of service. Most participants were female (76.4%). **Impact of the Pandemic:** * ANCOVA revealed that both male and female nurses experienced a higher impact of traumatic events than physicians. Length of service acted as a protective factor. * MANCOVA showed significant differences between nurses and physicians in sleep and psychological variables, both across time and between professions, with nurses displaying more substantial negative changes. * Nurses, irrespective of the time period, reported worse conditions on most examined dimensions (PSQI, PSQI-A, DASS-Depression, DASS-Anxiety) than physicians, except for DASS-Stress. * Both groups showed higher scores (worsening) on all scales during the current period compared to pre-pandemic levels. **Impact of Frontline Engagement:** * MANCOVAs indicated a significant main effect of "Time" for both nurses and physicians, showing a general worsening over time. For nurses, working on the frontline further exacerbated the negative impact on psychological variables. **COVID-19-Related Predictors:** * Multiple linear regressions revealed significant predictors of current sleep and psychological conditions: having relatives or friends who died from COVID-19 was positively correlated with higher scores on all scales, while agreement with government measures showed a negative correlation.

This study confirms and extends previous research by demonstrating the significant negative impact of the COVID-19 pandemic on the mental health and sleep of Italian HCWs, especially nurses. The findings highlight a greater vulnerability among nurses compared to physicians, possibly due to increased workload, direct patient care, and a higher proportion of women in nursing. Frontline work further increased the risk of negative outcomes among nurses. Personal experiences with COVID-19, particularly the loss of loved ones, significantly contributed to the current psychological distress and sleep problems. These results underscore the critical need for comprehensive support programs to improve the well-being of HCWs and mitigate the long-term consequences of the pandemic. The protective role of experience suggests the need to support and mentor younger professionals.

This study reveals the lingering negative effects of the COVID-19 pandemic on the mental health and sleep of Italian healthcare workers, particularly nurses. The increased vulnerability of nurses necessitates the development of targeted interventions and preventive programs. Future research should investigate the effectiveness of specific programs addressing psychological well-being and sleep quality among HCWs, tailored to their unique needs and risk factors.

The retrospective design may have introduced recall bias, potentially overestimating the pandemic's negative effects. Subjective experiences and dissatisfaction with work conditions could have influenced the results. The absence of prospective measures or objective tools limits the generalizability of findings. The study's focus on HCWs in one Italian region restricts broader national generalizability. Socio-demographic differences between nurses and physicians might also have confounded the results.