Common mental disorder and related factors to the work of physiotherapists in the COVID-19 pandemic

Abstract Introduction The physiotherapists were one of the health professional categories on the Coronavirus (COVID-19) pandemic front line, however little is known how the pandemic has affected the mental health of these professionals. Objective To analyze the relation-ship between the presence of common mental disorder (CMD) and elements related to the work of physiotherapists who have been assisting patients with COVID-19. Methods: This is a cross-sectional survey study composed by physiotherapists from four states of Brazil: Alagoas, Paraíba, Pernambuco and Rio Grande do Norte. Working conditions evaluated were type of contract, weekly worked hours, time working, job satisfaction, and psychosocial aspects related to work. The CMD assessment was performed using the Self-Reporting Questionnaire-20 (SRQ-20). Results A total of 288 physiotherapists answered the electronic form, out of which 76.2% had CMD. Fear of reinfection (OR 2.75, 95%CI: 1.35-5.63) and previous infection by COVID-19 (OR: 2.03, 95%CI: 1.09-3.78) were factors related to a higher chance of risk of CMD. However, those who reported being satisfied with the work (OR: 0.28, 95%CI 0.11-0.72) and being more than 30 years old (OR: 0.46, 95%CI 0.24-0.88) had a lower chance of CMD risk. Conclusion Physiotherapists showed a higher prevalence of CMD. Fear of reinfection and previous infection by COVID-19 were risk factors to CMD, while satisfaction with the work and being more than 30 years old were protective factors to CMD.


Introduction
Treating patients with COVID-19 presented a challenge to health workers at both the beginning of the pandemic, when the pathology's mechanisms were still being understood, and nowadays with health professionals seeking to deal with acute and chronic outcomes of this new condition.[1][2][3] Health professionals represent a vulnerable group during pandemics because they experience several dilemmas, such as the risk of death to high risk of infection, fear of contagion and dissemination to family members, and lack of personal protective equipment.These factors together can increase stressors, work overload and psychological pressure, which in turn lead to high levels of anxiety, stress and depressive symptoms, as well as more subtle symptoms such as insomnia.4,5 These less severe mental disorders, also called common mental disorders (CMD), may be comprised of signs and symptoms such as insomnia, fatigue, forgetfulness and irritability, and have been increasingly investigated among health professionals during the recent COVID-19 pandemic context.6-8 Among the health professionals involved in providing care for these patients, the pandemic revealed the importance of physiotherapists in the front line of coping with COVID-19.Physiotherapists had intensive care units (ICUs) as their main scenarios of action, 9 and presented important roles in advanced respiratory care.10 In addition, the importance of these professionals is highlighted since they also work in hospitals, primary healthcare and/or in homes with the objective of returning patients' full functionality.

Methods
The study implemented a cross-sectional, obser- and working conditions for data collection.Working conditions were evaluated through information about the type of contract (temporary and permanent), weekly worked hours (in hours), and time working (years).
Participants were also asked about job satisfaction (yes or no) and psychosocial aspects related to work: support for the prevention of health problems, coronavirus infection of professionals and fear of (re)infection, all of them with yes or no answers.
The CMD assessment was performed using the Self-

Results
A total of 288 physiotherapists answered the electronic form, however, five questionnaires had to be excluded as the professionals who responded had less than three months of providing care for COVID-19.showed that some factors such as limited resources, deterioration in the work performance of professionals, emotional exhaustion and social distancing have a considerable impact on the mental health of workers.

Conclusion
The physiotherapists showed a higher prevalence of CMD.Factors such as fear of reinfection, previous infection by COVID-19 where risk factors to CMD, while being satisfied with the work and being more than 30 years old were protective factors in the studied sample.
The COVID-19 pandemic has exacerbated the presence of CMDs in physiotherapists assisting patients infected with the coronavirus.These findings seem to be directly related to the age of the professionals, as well as satisfaction with the professional activity performed and the support received at their workplace.In view of these facts, there is an urgent need to create interdisciplinary actions and guarantee effective public policies aimed at these professionals at work and outside it in order to minimize the risks inherent to work and its consequent impact on the mental health of health workers.
Monteiro GAS et al.

11, 12
Thus, better understanding of the impact of the workplace on mental health in physiotherapists is needed to analyze the factors which favor or determine CMD.Therefore, this study sought to describe the mental health profile of physiotherapists working during the COVID-19 pandemic and to analyze the possible relationship between the presence of CMD and elements related to the work of physiotherapists who have been assisting patients with COVID-19.

Reporting
Questionnaire-20 (SRQ-20), an instrument developed by the World Health Organization to measure levels of suspected CMD.It was tested and validated for Brazilian population, for which it had sensitivity of 68% and specificity of 70.7%, and showed a predictive capacity of 73.9% and a cut-off value for best performance between 6/7. 15 The SRQ-20 is composed of 20 questions for tracking non-psychotic disorders involving the following groups of symptoms: depressive/anxious mood, somatic symptoms, decreased vital energy and depressive thoughts.The sum of each positive answer was used to identify mental suffering.The cut-off used for the presence of CMD was values greater than seven points.15,16 Data collection was performed on the Google® Forms platform and disseminated via WhatsApp, e-mail, Facebook and Instagram.The project was submitted to the Ethics and Research Committee of the Health Sciences Center of Universidade Federal de Pernambuco, and approved under No. 42898920.5.0000.5208.All collected data were transferred to the SPSS version 22.0 software program.Occupational data and psychosocial aspects related to work were analyzed using the Chi-squared statistical test.Finally, a multiple logistic regression model was performed based on the relationship between CMD and occupational data and psychosocial aspects.Variables included on the multiple logistic regression was those that presented p-value < 0.20 in the bivariate analysis.Data were considered significant when p < 0.05.

Palavras-chave: COVID-19. Profissionais de saúde. Saúde mental.
distinction of gender or age, to be registered in Regional Council of Physiotherapy and Occupational Therapy of the 1st Region (CREFITO-1) and to accept to participate in the study by signing an informed consent form.

Table 1 -
General characteristics according to common mental disorder (CMD) Regarding the occupational characteristics of the sample, 66.3% worked in ICUs, 13.8% in outpatient clinics and/or in rehabilitation centers, 7.8% in wards, 6.4% in primary care, 4.3% in households, 0.7% in urgency and emergency care, and 0.7% referred to other workplaces.Note: Values in bold indicate statistical significance.FISIOTERAPIA EM MOVIMENTO Physical Therapy in Movement Monteiro GAS et al.Fisioter Mov.2023;36:e36105 4

Table 2 -
Bivariate analyzes between occupational data, psychosocial aspects related to work and common mental disorder Monteiro GAS et al.Fisioter Mov.2023;36:e36105 5

Table 3 -
Multiple logistic regression between the presence of common mental disorder (CMD), occupational data, and psychosocial aspects related to work -Note: OR = odds ratio.*Confidence interval: lower and upper limit.