Suicide risk and associated factors in healthcare workers seeking psychological support during COVID-19: a cross-sectional study

Abstract

Healthcare workers have been one of the groups most severely affected by the COVID-19 pandemic, leaving them with serious psychological effects. Some of these effects have not been treated promptly, leading to further psychological symptoms. The objective of this study was to evaluate suicide risk in healthcare workers seeking psychological help during the COVID-19 pandemic, and factors associated with this risk on participants that were searching for treatment during the COVID-19 pandemic. This is a cross-sectional study analyzing data from 626 Mexican healthcare workers seeking psychological help due to the COVID-19 pandemic through the www.personalcovid.com platform. Before they entered treatment, the Plutchik Suicide Risk Scale, the Depression Scale of the Center for Epidemiologic Studies, the Pittsburgh Sleep Quality Index, and the Professional Quality of Life Measure, were administered. Results: 49.4% (n = 308) presented suicide risk. The most severely affected groups were nurses (62%, n = 98) and physicians (52.7%, n = 96). Predictors of suicide risk in healthcare workers were secondary traumatic stress, high depressive affect, low positive affect, emotional insecurity and interpersonal problems, and medication use. Conclusions: The suicidal risk detected was high, found mostly in nurses and doctors. This study suggests the presence of psychological effects on healthcare workers, despite the time that has elapsed since the onset of the pandemic.

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Suicide risk and associated factors in healthcare
workers seeking psychological support during
COVID-19: a cross-sectional study
Reyna Jazmín Martínez-Arriaga, Alejandro Dominguez-Rodriguez, Paulina
Erika Herdoiza-Arroyo, Rebeca Robles-Garcia, Anabel de la Rosa-Gómez,
Jairo Alejandro Figueroa González & Yineth Alejandra Muñoz Anacona
To cite this article: Reyna Jazmín Martínez-Arriaga, Alejandro Dominguez-Rodriguez, Paulina
Erika Herdoiza-Arroyo, Rebeca Robles-Garcia, Anabel de la Rosa-Gómez, Jairo Alejandro
Figueroa González & Yineth Alejandra Muñoz Anacona (2023): Suicide risk and associated
factors in healthcare workers seeking psychological support during COVID-19: a cross-sectional
study, Psychology, Health & Medicine, DOI: 10.1080/13548506.2023.2216469
To link to this article: https://doi.org/10.1080/13548506.2023.2216469
© 2023 The Author(s). Published by Informa
UK Limited, trading as Taylor & Francis
Group.
Published online: 24 May 2023.
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Suicide risk and associated factors in healthcare workers
seeking psychological support during COVID-19: a
cross-sectional study
Reyna Jazmín Martínez-Arriaga
a
, Alejandro Dominguez-Rodriguez
b,c
,
Paulina Erika Herdoiza-Arroyo
d
, Rebeca Robles-Garcia
e
, Anabel de la Rosa-Gómez
f
,
Jairo Alejandro Figueroa González
g
and Yineth Alejandra Muñoz Anacona
h
a
Departamento de Clínicas de Salud Mental, Centro Universitario de Ciencias de la Salud, Universidad de
Guadalajara, Jalisco, Mexico;
b
Department of Psychology, Health and Technology, University of Twente,
Enschede, The Netherlands;
c
Health Sciences Area, Valencian International University, Valencia, Spain;
d
School of Psychology, Universidad Internacional del Ecuador, Quito, Ecuador;
e
Epidemiological and
Psychosocial Research Directorate, Instituto Nacional de Psiquiatría “Ramón de la Fuente Muñiz”, Mexico
City, Mexico;
f
Facultad de Estudios Superiores Iztacala, Universidad Nacional Autónoma de México, Mexico
City, Mexico;
g
Departamento de Psicología Aplicada, Centro Universitario de Ciencias de la Salud,
Universidad de Guadalajara, Jalisco, Mexico;
h
Health Psychology Master, Centro Universitario de Ciencias de
la Salud, Universidad de Guadalajara, Jalisco, Mexico
ABSTRACT
Healthcare workers have been one of the groups most severely
aected by the COVID-19 pandemic, leaving them with serious
psychological eects. Some of these eects have not been treated
promptly, leading to further psychological symptoms. The objective
of this study was to evaluate suicide risk in healthcare workers
seeking psychological help during the COVID-19 pandemic, and
factors associated with this risk on participants that were searching
for treatment during the COVID-19 pandemic. This is a cross-
sectional study analyzing data from 626 Mexican healthcare work-
ers seeking psychological help due to the COVID-19 pandemic
through the www.personalcovid.com platform. Before they entered
treatment, the Plutchik Suicide Risk Scale, the Depression Scale of
the Center for Epidemiologic Studies, the Pittsburgh Sleep Quality
Index, and the Professional Quality of Life Measure, were adminis-
tered. Results: 49.4% (n = 308) presented suicide risk. The most
severely aected groups were nurses (62%, n = 98) and physicians
(52.7%, n = 96). Predictors of suicide risk in healthcare workers were
secondary traumatic stress, high depressive aect, low positive
aect, emotional insecurity and interpersonal problems, and med-
ication use. Conclusions: The suicidal risk detected was high, found
mostly in nurses and doctors. This study suggests the presence of
psychological eects on healthcare workers, despite the time that
has elapsed since the onset of the pandemic.
ARTICLE HISTORY
Received 9 October 2022
Accepted 16 May 2023
KEYWORDS
Healthcare workers;
COVID-19; suicide ideation;
depression; sleep quality
CONTACT Alejandro Dominguez-Rodriguez alejandro.dominguez.r@campusviu.es Department of Psychology,
Health and Technology, University of Twente, Drienerlolaan 5, Enschede, The Netherlands
PSYCHOLOGY, HEALTH & MEDICINE
https://doi.org/10.1080/13548506.2023.2216469
© 2023 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/
licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly
cited. The terms on which this article has been published allow the posting of the Accepted Manuscript in a repository by the author(s) or
with their consent.

Introduction
The COVID-19 pandemic has posed a challenge for health systems worldwide,
affecting healthcare workers (HCWs) in various ways, including their mental health
(O’Higgins et al., 2022). At the beginning of the pandemic, the mental health
consequences for HCWs who had treated patients with the virus included burnout,
emotional exhaustion, psychological distress, secondary traumatic stress, constant
exhaustion, feeling depressed or unhappy, diminished sleep quality and decreased
concentration (Alrawashdeh et al., 2021; Orrù et al., 2021; Pan American Health
Organization, 2022). Physicians and nurses have reported the poorest sleep and
highest depression (Power et al., 2022). This may have been associated with the
characteristics of their job position (those HCWs who were on the frontline were
the most affected) (Power et al., 2022).
According to mental health data on Mexican healthcare workers responsible for
COVID-19 patients, the most frequent mental health problems during the early phase
of the pandemic were insomnia, depression, posttraumatic stress, and health anxiety/
somatization symptoms, reporting higher frequencies in those working directly with
COVID-19 patients (Robles et al., 2021). In comparison with the initial COVID-19
phase, depression and health anxiety/somatization symptoms as well as grieving due to
COVID-19, personal COVID-19 status, and having relatives or close friends with
COVID-19 were more frequent during the COVID-19 peak (Robles et al., 2022).
Besides, the psychological impact of HCWs includes a limited ability to enjoy everyday
activities, constant exhaustion, feeling depressed or unhappy, reduced concentration,
diminished sleep quality, decreased concentration, as well as depression and suicidal
thoughts or ideation (Pan American Health Organization, 2022). Bismark et al. (2022)
found cases of suicide ideation and self-harm in HCWs during the COVID-19 pandemic,
with those at greatest risk being men, younger, lived alone and had a personal history of
mental disorders. According to Mortier et al. (2021), during the early phase of the
pandemic, approximately 8% of HCWs reported suicidal thoughts and behaviors, 4.9%
of whom experienced passive suicide ideation and 3.5% of whom had active suicide
ideation, both with and without planning or attempts.
Physicians and nurses have reported the highest rates of suicide risk compared to the
general population (Melnyk, 2020), with nurses presenting a greater vulnerability (Davis
et al., 2021).
Some of the reasons could be the high job demands, avoidance of use of mental health
services owing to fear of stigma, greater access to means to complete suicide via medica-
tions (Davis et al., 2021).
During the first stage of COVID-19 in Mexico, 16% of frontline HCWs reported
suicide ideation (in contrast with 13.4% of those working at a non-COVID-19 center),
reporting the paramedics the highest rates (17.5% compared with 9.8% of nurses, 11% of
psychologists, 14.3% of social workers, 15.9% of specialist residents, 16.0% of medical
specialists, and 16.6% of undergraduate students) (Robles et al., 2020). The identification
of suicide ideation risk factors could permit the development and implementation of
specific strategies and interventions to reduce this phenomenon among frontline HCWs.
The www.personalcovid.com platform is an online multi-component intervention
that is aimed at HCWs. Was created in 2021 to address the high impact of the pandemic
2R. J. MARTÍNEZ-ARRIAGA ET AL.

on the mental health of HCWs. To know more about ‘Personal COVID’ see Dominguez-
Rodriguez et al., (2022). This article analyzes the psychological and sociodemographic
factors associated with suicide risk among HCWs who registered on the platform to
receive the psychological intervention.
Material and methods
Study design
This was a cross-sectional, descriptive study of populations through survey research
(Montero & León, 2007), undertaken during a single time frame between 17 July 2021,
and 22 February 2022. Data were collected through the web platform www.personal
covid.com, a multicomponent intervention designed for HCWs (Dominguez-Rodriguez
et al., 2022).
Participants and procedures
To enroll in the online intervention, participants were required to create an account with
an email address. They were not asked to provide sensitive or identifiable data, such as
the name, address, or phone number of the hospital or clinic to which they are affiliated,
to preserve their anonymity. Participants were asked to give their informed consent,
before answering the validated questionnaires. Variables were measured before partici-
pants received the intervention. The questionnaires were provided to them inside the
platform www.personalcovid.com, in this sense the participants did not need to access no
other web page or resource. The questionnaires were provided similarly in a traditional
form as it would be Google Forms with one page per questionnaire, indicating a process
bar that indicated how much the participant process and how much is remaining. The
details of how many participants enrolled, how many dropped out of the process and how
many were excluded and included can be found on Figure 1.
Psychological measures
Plutchik suicide risk scale
This questionnaire evaluates current suicide risk through fifteen questions with
a dichotomous format (yes/no). It explores the history of suicide attempts, suicide
ideation and plans considering suicide. It establishes a cut-off point of > 6 to identify
those at risk of suicide at the time of evaluation and discriminates those with suicide risk
and a history of suicide attempts (Plutchik & Van Praag, 1994). This scale has a reliability
of α = 0.74 and has been used in studies with a Mexican sample (Alderete-Aguilar et al.,
2017).
Professional quality of life measure (ProQoL-V)
This instrument, measuring the quality of life during the last 30 days of workers in the
caring or helping professions (Stamm, 2010), comprises 30 items answered on a six-point
Likert-style scale, ranging from 0 (Never) to 5 (Always). The ProQol-V evaluates three
dimensions: Compassion Satisfaction (CS), Burnout (BO), and Secondary Traumatic
PSYCHOLOGY, HEALTH & MEDICINE 3

Stress (STS). The last two are part of the compassion fatigue construct. For CS, scores
below 23 suggest a low satisfaction related to the job. For BO, scores above 41 suggest
feelings of not being effective in the position, and for STS, scores above 43 suggest work-
related, secondary exposure to extremely or traumatically stressful events (Stamm, 2010).
The instrument presents adequate reliability for CS (α = .90), BO (α = .80), and STS (α
= .84) scales (Heritage et al., 2018).
Pittsburgh sleep quality index (PSQI)
Sleep quality was evaluated through the PSQI (Buysse et al., 1989). The index assesses
sleep habits during the past month using 18 self-reported items, which form seven
components, rating from 0 (no difficulty) to 3 (severe difficulty). The sum of the
component scores results in a global score (range 0 to 21), with higher scores indicating
worse sleep quality. The instrument suggests a cut-off score of ≥ 5 to differentiate
between good and poor sleep quality (Buysse et al., 1989). In this study, global score
will be used. This instrument has proven to be reliable (α = .78) (Jiménez-Genchi et al.,
2008).
Center for epidemiologic studies depression scale (CES-D)
Depression levels were evaluated through the CES-D (Eaton et al., 1998). It is a self-
report scale that assesses depression symptoms, based on the DSM criteria. Using a scale
of 5 points, (not at all or less than 1 day; 1–2 days; 3–4 days; 5–7 days; nearly every day for
2 weeks), the participants indicated how often they experienced each of the questions/
Created account for enrollment
(N=1,721)
Excluded (n=645)
Did not confirmed the email account
(n=348)
Confirmed account but did not
accept informed consent (n=297)
Assessed for enrollment
(n = 1076)
Did not completed the assessment
(n = 363)
Included in the analysis
(n = 713)
Participants from other countries
(n = 90)
Participants included
(n = 623)
Figure 1. Study Flowchart.
4R. J. MARTÍNEZ-ARRIAGA ET AL.

symptoms. It is divided into six factors: Depressed affect, Positive Affect, Emotional
Insecurity, and Interpersonal Problems, Somatization, Emotional Well-being, and
Delayed Activity (González-Forteza et al., 2008). This instrument has been used in health
research and has proven to be a valid scale among the Mexican population (α = 0.93)
(González-Forteza et al., 2008).
Sociodemographic information
Sociodemographic information included open questions such as age. A dichotomous
format (yes/no) was used to explore employment status. Moreover, for participants with
an affirmative answer, the occupation and the length of experience there were addition-
ally asked, with open questions. Closed questions included educational attainment, with
seven options presented in a drop- down menu ranging from primary school to doctoral
degree and adding the category other. Additional closed questions asked whether the
person was receiving psychological treatment (yes/no) and whether the person had
attempted suicide in the past three months (yes/no). The last question was included in
addition to the Plutchik Suicide Risk Scale. Finally, another question explored whether
the person was on medication (yes/no).
Ethical considerations
The study was approved by the Research Ethics Committee of the Autonomous
University of Ciudad Juárez (CEI-2021-1-266) and is registered in Clinical Trials
(NCT04890665). Participants who did not meet the inclusion criteria were excluded
from the study. Those participants with suicidal risk were provided with telephones so
that they could receive specialized psychological care. Those phones were from public
institutions that provide free psychological care.
Statistical analysis
SPSS 24 was used for the statistical analysis. For descriptive statistics, means and standard
deviations of continuous variables such as age, length of experience, sleep quality (PSQI),
aspects of professional quality of life (ProQol-V) and depression (CES-D) were calcu-
lated. For the categorical variables, percentages and frequencies were obtained. To
compare variables, the occupation variable was categorized as ‘physicians’, ‘nurses’,
‘psychologists’ and ‘administrative staff’, since these were the most common occupations.
The rest were categorized as ‘other’. Likewise, the education variable was grouped into
‘Basic education’ (elementary school, middle school and high school) and ‘Higher
education’ (undergraduate and postgraduate). The risk of suicide variable was divided
into ‘with versus without suicide risk’, considering the cut-off point of >6.
Normality was calculated for all the dependent variables with the Kolmogorov-
Smirnov test, obtaining normality in the sample. The Chi-squared test was used to
compare suicide risk and variables such as gender, occupation, education, psychological
treatment, medication use and suicide attempts in the past three months. Student’s t-test
was used to compare suicide risk with age, length of experience, professional quality of
life, sleep quality, and depression. Pearson’s correlations were used to analyze bivariate
correlations among the continuous variables in this study (suicide risk, age, length of
PSYCHOLOGY, HEALTH & MEDICINE 5

experience, professional quality of life, sleep quality, and depression). Student’s t-test and
one-way ANOVA were used to compare psychological variables (professional quality of
life, sleep quality, and depression), with sociodemographic variables and psychological
treatment, medication use, and suicide attempts. A Tukey Test for post hoc analysis was
conducted. Finally, a logistic regression analysis was performed to explore the variables
associated with suicide risk, in which only the significant variables were included. The
Nagelkerke-R2 was used to examine the percentage of variance associated with suicide
risk explained by the continuous predictors. Adjusted odds ratio with 95% confidence
intervals was also reported to measure the strength of association.
Results
Six hundred and twenty-three participants were included. Sociodemographic and psy-
chological characteristics are shown in Table 1. The health workers who participated
were mostly physicians, nurses, psychologists and staff working in administrative posi-
tions. The ‘other’ category includes health workers such as laboratory technicians,
radiological technicians, stretcher bearers, cleaning staff, dentists, laboratory workers,
paramedics, chemists, social workers and physiotherapists.
The 49.4% (n = 308) of participants presented suicide risk, 84.1% (n = 259) were
women, 15.3% men (n = 47) and 0.3% (n = 2) self-reported as other. The profession
with the most cases of suicide risk was nurses, with 62% (n = 98), followed by physicians,
with 52.7% (n = 96) (Table 1). Only 14.8% of the total sample (n = 92) received psycho-
logical treatment, while 15.7% (n = 98) used medication. Of the latter, physicians were
the ones that most consumed them (6.5%, n = 41), as shown in Table 2.
Table 3 presents correlational statistics. Suicide risk was negatively correlated with age,
length of experience, compassion satisfaction, and positive affect. At the same time, it
correlated positively with the subscales of burnout, secondary traumatic stress, poor sleep
quality, and depression, except for positive affect.
Regarding psychological variables, differences were found in quality of life, sleep
quality and depression, according to each occupation. Based on one-way ANOVA post
hoc tests, significantly higher CS was found in psychologists than physicians (p = .001,
95% CI [.96, − 5.25]), while greater BO was observed in physicians than psychologists (p
< .001, 95% CI [2.58–5.89]), administrative staff (p = .020, 95% CI [.23–4.55]), and other
occupations (p = .007, 95% CI [.38, 4.06]), and greater STS was observed in nurses than
psychologists (p < .001, 95% CI [4.04, 8.43]). Psychologists presented significantly lower
BO levels than physicians (p < .001, 95% CI [−5.89, −2.58]), nurses (p < .001, 95% CI
[−4.68, −1.27]) and other professions (p = .039, 95% CI [−3.98, −.06]) and lower levels of
STS than all other occupations (p < .001). Regarding sleep quality, psychologists had
significantly better sleep quality than nurses (p = .007, 95% CI [−2.95, −.29]) and admin-
istrative staff (p = .004, 95% CI [−4.01, −.48]), as shown in Table 4.
In relation to the dimensions of depression, significantly lower levels of depressed
affect were found in psychologists than physicians (p = .009, 95% CI [−3.83, −.32]) and
nurses (p < .001, 95% CI [−5.10, −1.48]), while lower levels of positive affect were
observed in nurses than psychologists (p < .001, 95% CI [−2.79, −.68]) and other occupa-
tions (p = .002, 95% CI [−2.70, −.37]). Lower levels of emotional insecurity and inter-
personal problems were detected in psychologists than nurses (p < .001, 95% CI [−8.31,
6R. J. MARTÍNEZ-ARRIAGA ET AL.

−2.24]) and physicians (p = .020, 95% CI [−6.18, −.30]), lower levels of somatization were
found in psychologists than nurses (p < .001, 95% CI [−5.42, −1.30]) and physicians (p
= .011, 95% CI [−4.3, −.33]), lower levels of emotional well-being were observed in nurses
than psychologists (p = .027.95% CI [−1.89, −.06]) and lower levels of delayed activity
were identified in psychologists than nurses (p < . 001, 95% CI [−5.28, −1.39]) as shown
in Table 4.
Table 1. Sociodemographic characteristics and study variables associated with suicide risk in health
workers.
Without
suicide risk
With
suicide risk
Statistics
Mean ±
SD f (%) f (%) f (%) p value χ2 t
Age 35 ± 8.4 35.8±8.5 34.4±8.3 .041* - 2.045
Gender
Female 515 (82.7) 256 (41.0) 259 (41.5) .192 3.298 -
Male 106 (17) 59 (11.2) 47 (7.5)
Other 2 (.3) 0 2 (.3)
Work
Yes 607 (97.4) 309 298 .321 1.121 -
No 16 (2.6) 6 10
Length of experience 8.8 ± 7.2 9.28±7.4 8.41±7 .133 - 1.503
Occupation
Physician 182 (29.2) 86 (47.3) 96 (52.7) <0.001** 21.612 -
Nurses 158 (25.4) 60 (38) 98 (62)
Psychologists 131 (21) 83 (63.4) 48 (36.6)
Administrative staff 59 (9.5) 33 (55.9) 26 (44.1)
Others 93 (14.9) 53 (57) 40 (43)
Education
Basic education 39 (6.3) 19 20 .884 .246 -
Higher education 550 (88.3) 280 270
Other 34 (5.5) 16 18
Psychological treatment
Yes 92 (14.8) 43 49 .431 .658 -
No 530 (85.1) 272 258
Medication use
Yes 98 (15.7) 29 69 <.001** 20.624 -
No 524 (84.1) 286 238
Suicide attempt in the past
three months
Yes 11 (1.8) 0 11 <.001** 11.490 -
No 611 (98.1) 315 296
Professional quality of life
ProQOL CS 38.7±6.7 40.5±5.9 36.8±6.9 <.001** - 7.174
ProQOL BO 28.2±5.3 26.1±4.5 30.3±5.2 <.001** - −10.659
ProQOL STS 24.7±6.9 21.8±5.9 27.5±6.6 <.001** - −11.176
Sleep quality
Sleep quality score 11.0±4.0 9.4±3.7 12.6±3.5 <.001** - −10.680
Depression
CES-D DA 6.5±5.5 3.4±3.6 9.6±5.3 <.001** - −16.879
CES-D PA 4.4±3.2 5.8±3.2 3.0±2.4 <.001** - 11.828
CES-D EI 12.2±9.2 6.9±6.1 17.6±8.8 <.001** - −17.492
CES-D S 9.8±6.2 6.6±5.2 13.1±5.5 <.001** - −15.176
CES-D EW 4.4±2.7 4.3±2.9 4.5±2.5 0.33 - −.973
CES-D DA 7.1±5.9 4.0±4.1 10.2±5.8 <.001** - −15.190
Abbreviations. CS=Compassion Satisfaction; BO=Burnout; STS=Secondary Traumatic Stress; DA=Depressed Affect;
PA=Positive Affect; EI=Emotional Insecurity and Interpersonal Problems; S=Somatization; EW=Emotional Well-being;
DA=Delayed Activity.
*p<.05. ** p<.001.
PSYCHOLOGY, HEALTH & MEDICINE 7

Finally, according to the regression, the variables obtained in the final model that
predict suicide risk in the health workers studied were STS, high depressive affect, low
positive affect, emotional insecurity and interpersonal problems, and medication use, as
shown in Table 5.
Discussion
The objective of the study was to analyze the psychological and sociodemographic
factors associated with the presence of suicide risk in healthcare workers seeking
psychological support on a virtual platform designed to help users cope with the
COVID-19 pandemic.
A high prevalence of suicide risk was found in the study population since nearly half
the HCWs surveyed met the suicide risk criteria (49%, n = 308). Likewise, prior to the
COVID-19 pandemic, the elevated risk of suicide in physicians due to burnout had
already been reported (West et al., 2018). Despite the lack of specific data, it is estimated
that the suicide rate of healthcare workers in Mexico is between 28 and 40 per 100 000
inhabitants, more than twice that of the general population (Cruz, 2018). In Mexico,
during the first stage of COVID-19, the prevalence of suicidal ideation reported in HCWs
was higher compared to other countries (8% vs. 16%) (Mortier et al., 2021; Robles et al.,
2020). This may be due to the high levels of mental health problems presented in HCWs
in Mexico (burnout, STS, anxiety, depression, etc.), besides, the suicidal ideation is more
common than other suicidal behaviors, such as self-harm, attempted or completed
suicide (Robles et al., 2020).
The participants in the current study were seeking psychological treatment. This could
explain the higher mental health and suicide risks. It is essential to include personnel
trained to care for people at suicide risk in mental health support strategies, such as
comprehensive support groups.
Likewise, another aspect that may explain the difference in suicide risk rates in the
different studies, is how it is measured. In this study, the suicidal risk was evaluated through
the Plutchik Suicide Risk Scale, which assesses ideation, attempts, planning, and some
associated symptoms. In other studies carried out in Mexican HCWs, suicidal thoughts
have been evaluated through a question (In the past month, have you felt that you wanted
to die, or thought about being dead?) (Robles et al., 2021). This may have influenced the
Table 2. Psychological variables by occupation.
Physicians Nurses Psychologists Administrative Staff Other
p value χ2f (%) f (%) f (%) f (%) f (%)
Psychological treatment
Yes 32 (5.1) 10 (1.6) 27 (4.3) 9 (1.4) 14 (2.2) .009* 13.496
No 150 (24.1) 147 (23.6) 104 (16.7) 50 (8.0) 79 (12.7)
Are you on medication?
Yes 41 (6.5) 12 (1.9) 23 (3.6) 13 (2.0) 9 (1.4) .001* 18.733
No 141 (22.6) 145 (23.3) 108 (17.3) 46 (7.3) 84 (13.5)
Suicide attempt
Yes 2 (.3) 8 (1.2) 1 (.1) 0 0 .007* 13.972
No 180 (28.9) 149 (23.9) 130 (20.9) 59 (11.0) 93 (14.9)
*p<.05. ** p<.001.
8R. J. MARTÍNEZ-ARRIAGA ET AL.

Table 3. Bivariate correlation between psychological and sociodemographic variables.
1 2 3 4 5 6 7 8 9 10 11 12 13
1. Suicide risk -
2. Age −.116** -
3. Length of experience −.108** .744** -
4. ProQOL CS −.323** .140** .135** -
5. ProQOL BO .481** −.137** −.081* −.619** -
6. ProQOL STS .499** −.027 .023 −.314** .591** -
7. Sleep quality .509** .068 .039 −.127** .285** .404** -
8. CES-D DA .694** −.148** −.120** −.310** .479** .516** .488** -
9. CES-D PA −.523** .084* −082** .397** −.446* −.377** −.431** −.560** -
10. CES-D EI .697** −.136** −.110** −.351** .533** .584** .518** .868** −.554** -
11. CES-D S .638** −.121** −.088* −.267* .448** .516** .645** .759** −.508** −772** -
12. CES-D EW .061 −.001 −.025 .089* .031 .065 .066 .089* .194** .144** .175** -
13. CES-D DA .647** −.094* −.066 −.331** .489** .536** .489** .816** −.537** −821** .772** .133** -
Abbreviations. ProQOL= Professional Quality of Life; CS=Compassion Satisfaction; BO=Burnout; STS=Secondary Traumatic Stress; CES-D=Center for Epidemiologic Studies Depression Scale;
DA=Depressed affect; PA=Positive Affect; EI=Emotional Insecurity and Interpersonal Problems; S=Somatization; EW=Emotional Well-being; DA=Delayed Activity.
*p<.05. ** p<.001.
PSYCHOLOGY, HEALTH & MEDICINE 9

Table 4. Association between sociodemographic and psychological variables.
ProQOL
Mean ± SD
Sleep
quality
Mean ±
SD
Depression
Mean ± SD
Variables CS BO STS DA PA EI S EW DA
Gender
Female 38.7
±6.5
28.2
±5.1
24.9
±6.9
11.1±4 6.8±5.5 4.3±3.1 12.7
±9.2
10.2
±6.2
4.4
±2.7
7.3±5.9
Male 38.7
±7.3
28±5.8 23.3
±6.7
10.1±4 4.9±5.1 5±3.6 9.7±8.7 7.9±5.8 4.2
±2.7
5.6±5.4
Other 32
±2.8
37±2.8 29±7 14±1.4 15.5
±3.5
1±0 28.5
±7.7
15.5
±6.3
4±0 14.5
±7.7
p value .366 .063 .071 .043* <.001** .042* .001* .001* .716 .006*
Employed
Yes 38.8
±6.5
28.2
±5.3
24.6
±6.8
11±4 6.4±5.4 4.5±3.2 12.1
±9.1
9.8±6.2 4.4
±2.7
7±5.8
No 33.5
±9.3
29.8±5 26.7
±9.2
11.6±3.7 9±6.5 2.8±2.2 15.6
±12.2
11.2
±6.9
4.5
±2.2
10.1
±7.5
p value .002* .216 .231 .569 .063 .038* .133 .372 .854 .036*
Occupation
Physician 37.4
±6.7
30±5.3 25.5
±6.6
11±3.8 6.7±5.3 4.4±3.2 12.4
±8.7
10.2
±5.8
4.3
±2.5
7.2±5.6
Nurse 38.4
±6.6
28.7
±5.1
26.7
±6.9
11.4±4.1 7.9±5.7 3.5±2.5 14.4
±9.7
11.2
±6.5
4±2.6 8.5±6.2
Psychologists 40.5
±6
25.7
±4.9
20.4
±5.6
9.8±3.7 4.6±4.9 5.2±3.4 9.1±8.3 7.9±6 5±2.8 5.2±5.3
Administrative staff 38.4
±6.5
27.6
±4.8
26±6.2 12.1±4.3 5.9±5.3 4.5±3.2 12±9.4 10±6.4 4±2.7 7±6.1
Other 39.3
±7.2
27.8
±4.9
24.6±7 11.1±4.1 6.6±5.7 5±3.3 12.5
±9.4
9.4±6.2 4.5±3 7.1±6
p value .001* <.001** <.001** .002* <.001** <.001** <.001** <.001** .032* <.001**
Education
Basic education 37
±8.1
28.6
±4.7
25.1
±8.4
12.5±3.8 7.7±6.5 3.7±3.3 13.5
±10.5
10.6
±7.6
4.2
±2.9
9±6.7
Higher education 38.9
±6.5
28.1
±5.4
24.5
±6.8
10.9±4 6.4±5.4 4.5±3.2 12.1
±9.1
9.7±6.2 4.4
±2.7
6.9±5.8
Other 37.1
±6.9
29±4 26.7
±6.1
11.1±3.4 6.9±5.9 4.4±3 13.1
±9.2
10.3±6 3.8
±2.5
7.6±5.5
p value .087 .564 .192 .045* .297 .322 .552 .643 .375 .086
Psychological
treatment
Yes 38.5
±6.6
27.7
±4.8
24.6
±6.7
11.5±4.2 6.2±5.4 4.6±3 11.7
±9.4
10±6.5 4.6
±2.7
7±6.3
No 38.7
±6.7
28.3
±5.4
24.7
±6.9
10.9±4 6.5±5.5 4.4±3.2 12.3
±9.2
9.8±6.2 4.4
±2.7
7.1±5.8
p value .839 .350 .876 .155 .630 .625 .575 .786 .424 .949
Are you on
medication?
Yes 37.7
±6.8
29.7
±5.5
27±7.4 13.5±3.8 8.6±5.6 3.6±2.9 16.4
±9.4
13.3
±5.7
4.9
±2.4
10.4
±6.2
No 38.9
±6.6
27.9
±5.2
24.2
±6.7
10.5±3.9 6.1±5.4 4.6±3.2 11.4±9 9.2±6.1 4.3
±2.8
6.5±5.6
p value .130 .002* <.001** <.001** <.001** .004 <.001** <.001** .047* <.001**
Suicide attempt
Yes 32.2
±9.6
30.9
±5.8
28.1
±9.4
14.1±4.3 16.1
±4.1
2±2.7 29.4
±9.5
19.2
±7.2
6.5
±2.5
17±6.2
No 38.8
±6.6
28.2
±5.3
24.6
±6.8
10.9±4 6.3±5.3 4.5±3.2 11.9
±8.9
9.6±6.1 4.4
±2.7
6.9±5.7
p value .027* .096 .094 .009* <.001** .013* <.001** <.001** .015* <.001**
Abbreviations. CS=Compassion Satisfaction; BO=Burnout; STS=Secondary Traumatic Stress; DA=Depressed Affect;
PA=Positive Affect; EI=Emotional Insecurity and Interpersonal Problems; S=Somatization; EW=Emotional Well-being;
DA=Delayed Activity.
*p<.05. ** p<.001.
10 R. J. MARTÍNEZ-ARRIAGA ET AL.

low rates reported in other Mexican studies since they have specifically evaluated suicidal
thoughts.
Does profession matter?
The impact on the mental health of HCWs has differed according to their occupation.
This study found that nurses and physicians experienced the most significant effects on
their mental health. Moreover, they suffered the highest levels of BO, STS, depressed
affect, emotional insecurity, interpersonal problems, somatization, and delayed activity.
It has also been reported that the most severely affected group are frontline HCWs, with
the highest levels of anxiety and depression (Ayhan-Balik et al., 2022; Mushtaq et al.,
2022). Recent studies have found that physicians and nurses continue to be the health
personnel whose mental health has been the most severely affected (Moro et al., 2022),
with higher suicide rates reported compared to the general population (Melnyk, 2020).
Regarding sociodemographic variables, suicide risk was found to be negatively corre-
lated with age. This is recurrent in the literature since younger health workers have been
the most severely affected by the pandemic, presenting higher levels of post-traumatic
stress, anxiety, and depression (Martínez-Arriaga et al., 2021; Mushtaq et al., 2022). This
may also be related to years of experience since it has been reported that younger nurses
exhibited greater difficulty understanding and controlling negative thoughts related to
adverse events (Foster et al., 2020).
Diminished sleep quality was another psychological consequence detected in this
study. Those with the poorest sleep quality were administrative workers (mean = 12.1)
and nurses (mean = 11.4). Along these lines, the systematic review by Cénat et al. (2021)
found higher levels of insomnia in health workers compared to the general population.
Unlike other studies, this one found elevated levels of sleep disturbances in a group rarely
explored: the administrative staff of health centers. Future studies should address this
issue to identify specific vulnerabilities in this group.
Furthermore, it is necessary to address healthcare workers’ mental health as a priority
for this collective (Jiménez-López et al., 2015). Although the COVID-19 pandemic has
raised awareness of healthcare workers mental health, it is essential to design proposals to
change working conditions and provide timely mental health care for this population.
Regarding the limitations of this study, it is important to recall that the participants
evaluated were people who used the www.personalcovid.com platform to receive psy-
chological support. This automatically creates a bias since they are people with psycho-
logical distress actively seeking some form of psychological care.
Table 5. Logistic regression analysis of suicidal risk in healthcare workers.
95% CI
Model
a
B OR pLower limit Upper limit
ProQOL STS .045 1.046 .018* 1.008 1.086
CES-D DA .107 1.112 .005* 1.033 1.198
CES-D PA −.117 .890 .004* .821 .964
CES-D EI .094 1.098 <.001** 1.046 1.152
Medication use −.646 .524 .029* .294 .035
*p<.05. ** p<.001.
PSYCHOLOGY, HEALTH & MEDICINE 11

Another limitation is that data were collected through a cross-sectional design. This
makes it difficult to determine whether the symptoms persisted, increased, or decreased
as would be possible in a longitudinal study. Likewise, it would not be possible to know if
the HCWs had a suicidal risk prior to the COVID-19 pandemic. However, the results
presented are significant in terms of enhancing understanding of the mental health of
HCWs in Mexico during COVID-19 pandemic.
A final limitation is the higher number of women (n = 515) than men (n = 106).
Unfortunately, although the psychological treatment offered is not gender-bound, the ratio
of men to women seeking treatment is one to five. Previous studies have observed this
tendency (Yousaf et al., 2015), not only with HCWs. A future line of research could explore
the strategies required to increase the number of male HCWs receiving psychological
treatment.
Finally, one of the strengths of this study is that it increases the literature on under-studied
populations such as healthcare workers in Mexico, which improves knowledge of the
COVID-19 pandemic and means of providing support for HCWs. Moreover, this study
increases the knowledge of administrative personnel working in hospitals during the
pandemic.
Conclusions
The psychological effects reported in the population studied were evident. Suicide risk in
the study population was high (49.4%) as were depression scores and poor sleep quality.
This study suggests the presence of psychological effects on HCWs, despite the time that
has elapsed since the onset of the pandemic. The challenges involved in protecting the
mental health of this population mean that it is essential to promote effective psychological
care programs adapted to the circumstances and preferences of HCWs.
Acknowledgments
The authors want to thank the HCWs that participated in this study and for their work during the
pandemic.
Disclosure statement
The authors declare that the research was conducted in the absence of any conflict of interest.
Funding
The Autonomous University of Ciudad Juárez (UACJ) provided the funds to develop the Personal
COVID Platform. The funding body had no role in the study design, manuscript writing, or
submitting the paper to a specific journal. The Open Access APC for this publication was covered
by the University of Twente.
ORCID
Alejandro Dominguez-Rodriguez http://orcid.org/0000-0003-3547-8824
12 R. J. MARTÍNEZ-ARRIAGA ET AL.

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