The COVID-19 pandemic placed an immense burden on healthcare workers globally. Frontline healthcare workers (FHCWs), directly exposed to infected patients, faced heightened risks of psychological distress, including depression, anxiety, post-traumatic stress disorder (PTSD), and insomnia. Previous research highlighted increased mental health issues among FHCWs during the pandemic, particularly among nurses and medical residents. Mexico, facing significant challenges in its COVID-19 response, including limited testing, inadequate medical supplies, and government criticism, experienced a high mortality rate among FHCWs. This created a context of increased psychological risk for Mexican healthcare professionals. This study aimed to determine the prevalence of depression, anxiety, PTSD, and insomnia symptoms among FHCWs in a COVID-19 hospital in Northeast Mexico and to identify associated factors such as gender, age, marital status, occupation, and work-related stressors, providing valuable insights into the mental health needs of this population during a critical public health crisis.

Existing literature consistently demonstrated elevated rates of depression, anxiety, sleep disturbances, and PTSD symptoms among FHCWs treating COVID-19 patients internationally. Studies in Mexico also showed high prevalence of mental health issues among healthcare workers, particularly among women, younger individuals, and those in direct patient care roles. Previous research highlighted the role of factors such as gender, age, occupational role (nurses experiencing higher risks than physicians), and personal COVID-19 infection in the development of mental health problems among these professionals. The specific challenges in the Mexican context, like government response and resource limitations, further underscored the need for research on the mental health impact on Mexican FHCWs.

This observational, cross-sectional, and descriptive study was conducted at the Centro Medico Zambrano-Hellion (CMZH), a third-level care hospital in Northeast Mexico treating COVID-19 patients. Data were collected from August 28 to November 30, 2020, using an online survey distributed to all medical staff (physicians, residents/fellows, and nurses) aged 18 years or older providing direct care to COVID-19 patients. The survey included sociodemographic questions (gender, age, marital status, transportation, drug use, occupation, and work hours) and validated questionnaires to assess mental health symptoms: Patient Health Questionnaire-9 (PHQ-9) for depression, Generalized Anxiety Disorder-7 (GAD-7) for anxiety, Impact of Event Scale-Revised (IES-R) for post-traumatic stress, and Insomnia Severity Index (ISI) for insomnia. Participants with pre-existing psychiatric conditions or missing data were excluded. Data analysis involved descriptive statistics, chi-squared tests, and binary logistic regression to determine the association between risk factors and mental health outcomes. A cut-off score of ≥10 was used for PHQ-9, GAD-7, and ISI, and ≥33 for IES-R to indicate the presence of the respective symptoms.

A total of 131 FHCWs completed the survey. The prevalence of symptoms was: depression (35.9%), anxiety (20.6%), PTSD (22.9%), and insomnia (24.4%). Women reported significantly higher rates of depression (78.7% vs 21.3%) and PTSD (83.3% vs 16.7%) compared to men. Depression was more prevalent among single participants (74.5% vs 25.5%) and those under 40 years old (91.5% vs 8.5%). Multivariate analysis revealed that residents/fellows (OR 7.64, 95% CI 2.30-25.35, p=0.001) and nurses (OR 2.93, 95% CI 1.09-7.87, p=0.033) had higher odds of severe depression compared to attending physicians. Being married was associated with lower odds of depression (OR 0.38, 95% CI 0.16-0.90, p=0.028). A sub-analysis comparing residents/fellows and nurses did not find statistically significant differences in the prevalence of other mental health symptoms (anxiety, PTSD, and insomnia).

The findings highlight the significant psychological impact of the COVID-19 pandemic on Mexican FHCWs, with high prevalence rates of mental health symptoms. The observed differences in mental health outcomes across gender and occupational roles align with previous research. The higher prevalence of depression among residents and nurses compared to attending physicians warrants attention. The protective effect of marriage against depression is noteworthy. These results underscore the critical need for targeted mental health interventions for Mexican FHCWs, particularly nurses and residents, who experienced a disproportionately high burden during the pandemic.

This study provides crucial evidence of the substantial mental health burden experienced by frontline healthcare workers in Mexico during the COVID-19 pandemic. The high prevalence of depression, anxiety, PTSD, and insomnia necessitates the implementation of comprehensive mental health support programs for these individuals, particularly focusing on residents and nurses. Future research should investigate the long-term consequences of pandemic-related stress on FHCW mental health and the effectiveness of different intervention strategies.

This cross-sectional study has limitations, including a relatively small sample size, the use of a private hospital setting (potentially limiting generalizability), and the absence of a control group. The study's focus on a single hospital and the dynamic nature of staff assignments prevented detailed sub-analyses based on medical specialties or work shifts. These factors should be considered when interpreting the results.