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Ann. psychophysiol. 
ISSN 2412-3188 (Online)|2410-1354 (Print) 

APP| Published By AEIRC| https://doi.org/10.29052/2412-3188.v9.i1.2022.28-38 
 

 
Original Article 

Prevalence of stress, anxiety, depression, 
and job dissatisfaction in health care 
professional dealing with covid-19 patients 
Afshan Arzoo1  & Saima Masoom Ali2  
1Dow Institute of Medical Technology, Dow University of Health Sciences, Karachi-Pakistan 
2Department of Psychology, University of Karachi, Karachi-Pakistan 
 

Abstract 
Background: In Pakistan, Health care professionals already suffer a lot mentally 
due to work burden and health risks, COVID-19 added more stress to the situation. 
This study aims to evaluate stress, anxiety, and depression with job satisfaction in 
health care professionals treating COVID-19 Patients. 
Methodology: A cross-sectional study was conducted among health care 
professionals, working at COVID-19 hospitals (private and public sector hospitals 
both). Data was collected from special units like isolation wards, and intensive care 
units. The study questionnaire consists of a socio-demographic section followed 
by the Depression, Anxiety, and Stress Scale (DASS-21) for measuring stress, 
anxiety, and depression (SAD). Moreover, War Cook Wall (1979) job satisfaction 
questionnaire was also used.  
Results: Study data reveals moderate to severe levels of anxiety (21.7% to 22.5%) 
and depression (22.5%, 13.3%) among healthcare providers. An association 
between age, marital status, organization, and occupation with depression at a p-
value < 0.05 was noticed. A moderate degree of job satisfaction is found in overall 
job satisfaction. The majority of participants showed dissatisfaction in terms of 
income. Overall average level of satisfaction was found in rest of the items of WCW 
questionnaire. 
Conclusion: The study disclosed that the majority of healthcare professionals were 
found to have stress, anxiety, and depression. 
 

Keywords 
COVID-19, Healthcare professional, Depression, Anxiety, and Stress, Job   

Satisfaction. 

 

  

 

 

 

 

Citation: Arzoo A, Ali SM. Prevalence of 
stress, anxiety, depression, and job 
dissatisfaction in health care professional 
dealing with covid-19 patients. APP. 2022; 
9(1): 28-38 
 
Corresponding Author Email: 
afshan.arzoo@duhs.edu.pk 
 
DOI: 10.29052/2412-3188.v9.i1.2022.28-38 
 
Received 16/03/2022 
 
Accepted 26/05/2022 
 
Published 01/06/2022 
 
Copyright © The Author(s). 2022. This is 
an open-access article distributed under 
the terms of the Creative Commons 
Attribution 4.0 International License, 
which permits unrestricted use, 
distribution, and reproduction in any 
medium, provided the original author and 
source are credited.  
 

 

Funding: The author(s) received no 
specific funding for this work. 

Conflicts of Interests: The authors have 
declared that no competing interests 
exist. 
 

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Introduction  
At the end of 2019, In Wuhan, China a new 
virus was identified which was not 
previously found in a human is known as 
Coronavirus (COVID-19)1.  The infection 
grows very quickly worldwide that in March 
2020, World Health Organization 
announced it as an epidemic, a global health 
emergency. End of November 20, COVID 19 
spread in 220 countries, infecting 62 million+ 
people in the world, and 1456k plus deaths 
occurred due to this infectious disease2. 
Coronavirus is an infectious disease that 
spread through a droplet of saliva or 
discharge from the nose and infects other 
people mainly the lungs and airways by 
infected person cough and sneezing. This 
disease affects people in different ways with 
moderate to severe illness leading to 
hospitalization and intensive care 
management2. In response to this outbreak, 
there had been confusion in decision making 
and insufficient resources to properly 
allocate the professionals for their protection 
as well as to treat patients3.  This situation 
advanced towards further harm to patient 
health which may ultimately compromise 
the quality of healthcare workers4. 
 
On account of the destructive effects of 
COVID-19 globally, affected countries in the 
world have been picking exceptional 
measures to curb this outbreak like 
quarantine, complete lockdown in the 
severely affected areas, and smart lockdown 
in mild to moderate suffering areas. Closing 
of intercity transportations, ban on public 
gatherings, and physical education 
converted to online education5. 
Psychological symptoms like stress, anxiety, 
panic, fear and paranoid behaviors in people 
rose extremely that people avoid all kinds of 
gatherings and get together even within the 
home. Reduced levels of autonomy and 
highly disturbed about their earnings, and 
employment surety has already been noticed 

in a population6.  Not only local people of 
communities, it is noticed that healthcare 
workers are also at high risk of developing 
psychological problems easily due to 
multiple reasons like late working in COVID 
units, and high chances of getting infected 
because of close relationships with the 
patients in hospitals. This would open to 
stress, anxiety, burnout, and depressive 
symptoms, like the fear of getting an 
infection, which was so common that many 
healthcare workers took casual or earned 
leaves, which ultimately compromise the 
role of the health sector to provide healthcare 
aid during the catastrophe. All of the above-
mentioned risk factors can exaggerate stress, 
anxiety, and depression along with job 
dissatisfaction7. 
 
Occupational stress is a heightened source of 
job-related illnesses plus burnout, especially 
in healthcare providers8. When COVID-19 
came into being it added spice to work-
related stress and psychological issues in the 
battle of saving lives. Additionally late 
working hours in special units and demand 
to do more from HCWs during the 
worldwide reaction to this pandemic. The 
need for HCWs increases as the disease 
spread out of our imagination because they 
represent one of the riskiest individuals in 
curbing the transmittable disease. Many 
HCWs working as the forefronts soldiers of 
the COVID-19 outbreak have become 
infected and a majority of them had been in 
quarantine after exposure9. 
 
According to American Psychiatric 
Association, Anxiety is a response of the 
body to a perceived threat that is triggered 
by an individual’s beliefs, feelings, and 
thoughts and is characterized by worrying 
thoughts, tension, increased blood pressure, 
respiratory rate, pulse rate, sweating, the 
difficulty of swallowing, dizziness, and chest 
pain10. Whereas depression can be defined as 
“Depression is a common and serious 



 
 

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medical illness that negatively affects how 
you feel, the way you think, and how you 
act”. Depression causes feelings of sadness 
and/or a loss of interest in activities you 
once enjoyed. It can lead to a variety of 
emotional and physical problems and can 
ultimately decrease your ability to function 
at work and home11. Last year's meta-
analysis revealed that stress, anxiety, and 
depression along with other psychological 
stressors were common outcomes in 
healthcare providers during the COVID-19 
pandemic, and is mostly in females and in 
those who had direct physical contact with 
COVID-19 patients12. 
 
A recent overview of the literature showed 
that the majority of the study participants 
(51.6%, mean age 25 -31 years) were 
presented with having perceived stress for 
coronavirus disease. Immediate screening 
and counseling of stress-related issues 
among frontline healthcare workers based 
on the findings are suggested13. Last year 
study done in Canada revealed that one-
third of the study candidates were disturbed 
about the current epidemic14. Another 
German research reported a higher number 
of HCWs were upset about COVID-1915. 
Online poll research done in the USA tells 
that 56% of candidates were tensed about the 
spread of COVID-19 infection from person to 
person16. One more related research run in 
the USA revealed that participants were 
more disturbed about COVID-19 in contrast 
to seasonal influenza and routine infections 
7,16.  Very few studies have a look into the 
psychological well-being and the 
professional domain of HCWs during the 
COVID-19 pandemic17.  
 
As there is a run of the third wave of 
coronavirus and prediction of the fourth 
wave that is delta variant in Pakistan 
nowadays which is more lethal than 
previous waves. Karachi city is on top of the 
list for COVID Positive patients on daily 

basis; ultimately it creates pressure on 
hospitals and medical professionals. 
According to the economic survey of 
Pakistan 2019-2020, the health sector in 
Pakistan already is in the most critical 
condition having poor infrastructure and 
very low manpower. In the economic 
survey, it is mentioned that the health sector 
showed some improvement, but the 
improvement is not up to the mark and 
ultimately health sector still suffering and 
taking its last breaths. The total population 
of Pakistan is 227 million by June 202118. The 
pathetic situation is that only 1979 hospitals 
for this population (public sector hospital 
1279, a private sector hospital 700). The 
available bed for approx 1700 people is only 
1 and 1 physician for approx 950 persons. 
The ratio of doctor to nurse is also pathetic 
that only one nurse is to serve two doctor 
orders as per the economic survey of 
Pakistan 2019-2020. So, the rationale of this 
study is to effectively research the domain of 
health care and processes as this sector is 
very important and neglected. The common 
research topics include immediate care and 
surgery, genetics, vaccine development, 
plasma antibodies, vaccine trials, and 
worldwide reaction to the COVID-19 
epidemic but there is a lack of psychological 
health research and only a few studies have 
talked about the effects of the COVID-19 
outbreak in healthcare workers welfare and 
safety. The main aim of this study is to study 
the stress, anxiety, and depression with job 
satisfaction among health care professionals 
dealing with COVID-19 Patients in hospitals.  
 

Methodology 
Participants 
A cross-sectional study was conducted from 
15th Dec 2020 to 15 March 2021. The subjects 
for this study were healthcare professionals, 
working public and private hospitals dealing 
with COVID-19 patients. 
 



 
 

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Health care professional is a broad term, but 
we included Doctors, nurses, ICU 
technicians, respiratory therapists/ICU 
Technologists. The calculated sample size 
was 140 but as of COVID-19, 3rd and 4th 
wave, the majority of hospitals refused to 
participate in the study.  
 
A purposive sampling technique was used in 
this study and a total 129 healthcare 
providers participated in this study. While, 9 
forms were incomplete, therefore, excluded 
from the statistical analysis.  
 
Measures 
The questionnaire consisted of three 
sections. The first section focused towards 
socio-demographics of the study 
participants that includes gender, age, 
marital status, living arrangement, 
organization, and occupation.  
 
The second section was for depression, 
anxiety, and stress. Which was evaluated by 
the Depression, Anxiety, and Stress Scale 
(DASS-21 Lovibond and Lovebird, 1995). 
The scale is comprised of 21 items measured 
on a 4- points Likert scale (never, sometimes, 
often, almost always) which evaluates the 
three psychological sub-dimensions of 
psychological distress, namely anxiety, 
depression, and stress. The score was 
distributed in normal, mild, moderate, 
severe, and extremely severe categories for 
each subscale. Regarding the construct 
validity, this scale was detected identifying 
values above the 75° percentile based on 
normative data19. 
 
And the third section was for Job satisfaction 
and it was measured with the previously 
validated version of the 10-item Warr–Cook–
Wall (WCW) job satisfaction scale developed 
by Warr et al4. The WCW instrument 
measures extrinsic satisfaction from items 
1,3,6, and 8 and intrinsic satisfaction from 
items 5 and item 10 asks for overall job 

satisfaction. For scoring each item rated on a 
7-point Likert scale (1 = extremely 
dissatisfied to 7 = extremely satisfied). The 
ranks of low satisfaction, moderate 
satisfaction, and high satisfaction of 
individual items were set to score of the 
individual item as mentioned in the 
research. For each item, 1 to 3 score was 
categorized as low satisfaction, score 4 to 
score 5 was marked as moderate satisfaction, 
and score 6 to score 7 was marked as high 
satisfaction20. 
 
Procedure 
The data was collected in two folds. The first 
method was to collect data electronically. 
The second method was the in-person data 
collection method. Health care providers 
were approached, and participants were 
explained the objective of this study, the 
study participants were asked to fill out the 
questionnaire and return the filled one on 
the spot.  The area for approaching subjects 
in hospitals was their sitting room and SOPs 
for the COVID-19 prevention were 
completely followed by subjects and 
researcher.  
 
Statistical Analysis 
The data were statistically analyzed using 
SPSS (Statistical package for social science 
version 26.0). Descriptive statistical tests 
were conducted to observe the frequencies of 
socio-demographic variables of the sample. 
Overall percentages for the DASS-21 
subscale Scoring are also seen in 
percentages. One-way ANOVA was used to 
test all hypotheses for this study. To see the 
association between two variables Chi-
Square test was applied. The significance 
level was set at α=0.05. 
 

Result 
Table one represents the total of 120 subjects 

who took part in this study of which the 

majority were male participants 71 (59.2%). 



 
 

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While the majority of the respondents 54 

(45.0%) age were between 26-30 years. 

Majority of subjects were married that is 58 

(48.3%). Of the total participants who were 

serving in a Private organization 75 (62.5%), 

and the majority were living in a joint family 

system 80 (66.7%). Maximum no of 

participants was nurses that are 42 (35.0%) 

(Table 1).  

 

Table 1: Frequency distribution along with percentages of socio-demographic variables. 

 

Study Variables n (120) % 

Gender Male 71 59.2 

Female 49 40.8 

Age 21-25 33 27.5 

26-30 54 45.0 

31-35 22 18.3 

36-40 9 7.5 

>45 2 1.7 

Marital Status Married 57 50 

Unmarried 58 48.3 

Divorced 3 2.5 

Widow 2 1.7 

Organization Public Sector 45 37.5 

Private Sector 75 62.5 

Living 
Arrangement 

Joint Family 80 66.7 

Nuclear Family 30 25.0 

Alone 10 8.3 

Occupation Doctor 37 30.2 

Nurses 42 35.0 

ICU Technician 9 7.5 

Respiratory therapist/ICU Technologist 32 26.7 

 

Table 2 shows the overall distribution of DASS-21 Scoring in overall (N=120) members. In which 

moderate levels of depression, anxiety, and stress were seen in participants that are 22.5%, 21.7%, 

and 25.0%. While the extremely severe level of anxiety is also seen. It shows the overall presence 

of depression, anxiety, and stress up to some extent (Table 2). 

 

Table 2: Severity percentages of DASS-21 (N=120). 

 

Severity Depression 
n (%) 

Anxiety 
 n (%) 

Stress 
n (%) 

Normal  48 (40.0) 29 (24.2) 53 (44.2) 

Mild  16 (13.3) 6 (5.0) 18 (15.0) 

Moderate  27 (22.5) 26 (21.7) 30 (25.0) 

Severe  16 (13.3) 27 (22.5) 14 (11.7) 

Extremely severe 11 (9.2) 30.0 (25.0) 4 (3.3) 

Total   120 

 

Table 3 represent the normal spread of DASS-21 with occupational variables. 



 
 

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Table 3: Frequency distribution of health care professionals with DASS-21 Scoring (N=120). 
 

Occupation  DASS-21 Scoring. Total 

Normal Mild Moderate Severe Extremely 
Severe 

Doctor 10 4 7 6 10 37 
Nurse 9 2 8 4 17 40 
ICU technician 1 0 2 5 1 9 
RT/ICU Technologist 9 0 9 12 2 32 
Total 29 6 26 27 30 118 

 

The frequency distribution of the health care professionals with association of DASS-21 Scoring 

is shown in Table 4. 

 

Table 4: Frequency distribution of health care professionals with DASS-21 Scoring (N=120). 

 

 
Items 

Job Satisfaction Scale 

Mild                 Moderate         High 
   n %                       n %                n % 

1. Physical working condition (EX) 30  (25.0) 64 (53.3) 26 (21.7) 

2. Freedom of working method 30 (25.0) 61 (50.8) 27 (22.5) 

3. Colleagues and fellow workers (EX) 24 (20) 64 (53.3) 32 (26.7) 

4. Recognition for your work 24 (20.0) 63 (52.5) 33 (27.5) 

5. Amount of responsibility (INT) 29 (24.2) 60 (50.0) 31 (25.8) 

6. Income (EX) 51 (42.5) 60 (50.8) 8 (6.7) 

7. Opportunity to use your ability 27 (22.5) 62 (51.7) 30 (25.0) 

8. Hours of work (EX) 31 (25.8) 61 (50.8) 27 (22.5) 

9. Amount of variety in your job 28 (23.3) 61 (50.8) 30 (25.0) 

10. Overall job satisfaction 24 (20.0) 63 (52.5) 33 (27.5) 

       Total   120 

 

The significance of organizations associated with stress, anxiety and depression through DASS-

21 is shown in Table 5 (α = <0.05). 

 

Table 5: Association of Stress, anxiety, and depression through DASS-21 to Organization. 

 

 ANOVA 

 Df SS MS F P 

DASS stress scoring Between Groups 1 .801 .801 .546 .461 
Within Groups 117 171.770 1.468   

DASS anxiety scoring Between Groups 1 1.603 1.603 .707 .402 
Within Groups 117 262.914 2.267   

DASS depression scoring Between Groups 1 11.810 11.810 6.531 .012 

Within Groups 117 209.783 1.808   

Total (N)      118 

 

 



 
 

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Table 6 shows the significance of age with stress, anxiety and depression through DASS-21 at (α 

= <0.05). 
 

Table 6: Association of Stress, anxiety, and depression through DASS-21 to Age: 

 

 ANOVA 

 Df SS MS F P-value 

DASS stress scoring Between Groups 4 5.886 1.472 1.006 .407 
Within Groups 114 166.685 1.462   

DASS anxiety scoring Between Groups 4 10.760 2.690 1.198 .316 
Within Groups 114 253.757 2.246   

DASS depression scoring Between Groups 4 21.481 5.370 3.033 .020 

Within Groups 114 200.112 1.771   

Total (N)      118 

 

Table 7 shows the significance of occupation with stress, anxiety and depression through DASS-

21 (α = <0.05). 

 

Table 7: Association of Stress, anxiety, and depression through DASS-21 to Occupation: 

 

 ANOVA 

 Df SS MS F P 

DASS stress scoring Between Groups 3 4.399 1.466 1.003 .394 
Within Groups 115 168.172 1.462   

DASS anxiety scoring Between Groups 3 6.628 2.209 .977 .406 
Within Groups 115 257.889 2.262   

DASS depression scoring Between Groups 3 15.244 5.081 2.807 .043 

Within Groups 115 206.349 1.810   

 

The significance of marital status with stress, anxiety and depression through DASS-21 is shown 

in Table 8 (α = <0.05). 

 

Table 8: Association of Stress, anxiety, and depression through DASS-21 to Marital Status: 

 

 ANOVA 
  Df SS MS F P 

DASS stress scoring Between Groups 3 3.835 1.278 .871 .458 
Within Groups 115 168.736 1.467   

DASS anxiety scoring Between Groups 3 10.944 3.648 1.640 .184 
Within Groups 115 253.573 2.224   

DASS depression 
scoring 

Between Groups 3 23.071 7.690 4.416 .006 

Within Groups 115 198.523 1.741   

Total (N)      118 

 

 

 

 



 
 

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There is a significant relationship between occupation and overall job satisfaction (25.27, N=120) 

df = 4, p = .000 (Table 9). 

 

Table 9: Correlation of Occupation and overall job satisfaction: 

 

               Chi-Square Tests 
 χ 2 Df P value 

Pearson Chi-Square 25.27 4 .000 
Total (N)   120 

 

Discussion 
Our study focuses to see the psychological 
outcome of the COVID-19 pandemic on 
health care workers and also how much they 
are satisfied with their jobs during this 
pandemic. In this study, the overall 
prevalence of psychological issues in health 
care providers shows that depression was 
seen and ranged from moderate to severe 
and extremely severe 22.5% to 13.3% and 
9.2%, while anxiety shows more significant 
and ranged from moderate to severe and 
extremely severe that is 21.7%, 22.5%, 25.0 %. 
Whereas, stress is also seen at a moderate 
level of 25.0%. This finding is consistent with 
many other previous findings21-23.  
 
Generally, Nurses are subject to numerous 
aggravations from the biological, emotional, 
and societal working atmosphere which are 
noticeably high among the front-line nurses 
working in COVID-19 tertiary care hospitals. 
Significant moderate level of anxiety 
measured by DASS-21, the overall impact is 
seen in nurses which is a notable finding in 
this study that is 31 nurses out of 40 in this 
study have psychologically affected in this 
outbreak. These findings were supported by 
other findings in which occupational stress 
was significantly seen in paramedics24. This 
is also consistent with another study that 
revealed that the unexpected emergencies 
originated from the COVID-19, the high 
number of reported cases validated or 
suspicious, and work overload indulging 

nurses under intense pressure. 17, Another 
study expresses that this virus emerged 
panic emotions in people and if paramedics 
are not planned to face these emotions they 
may ultimately go into significant tension25. 
Well, it was also observed that doctors also 
expressed notable levels of anxieties treating 
patients during this pandemic. In this study 
27 out of 37 doctors reported anxiety at 
different levels from mild to extremely 
severe. Usually, physicians don’t report any 
stressors or anxiety feeling in their normal 
practice but this outbreak also upset doctors' 
mental health very seriously26. Whereas, 
anxiety and stress were reported by doctors 
in many studies27,28.  
 
We have also seen the job satisfaction in 
health care providers to see how satisfied 
they are with their jobs so we saw a moderate 
level of satisfaction in all items of the scale 
shown in table 4. But the health care 
providers showed low satisfaction with their 
income as 42.5% of participants are not 
happy with their income. The annual income 
of HCW is not satisfactory at all29. Health 
care providers are not happy with their 
salaries not only in Pakistan but also 
worldwide24,30-32. When job satisfaction 
compare with occupation to evaluate the 
association between job satisfaction and 
different occupation of healthcare providers 
so the result was significant as shown in 
table  9 and showed an association between 
them at α=0.05. This finding is contrary to 
the previous finding in which COVID 19 



 
 

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associated stressors in HCW had high-stress 
levels, workload, and the average level of job 
dissatisfaction presented33,34. But one study 
supports our findings of a significant 
association between job satisfaction and 
occupational stress among professionals 
with other socio-demographic variables seen 
in health care professionals24. We can 
comment on this finding. After all, the 
literature and our hypothesis are contrary to 
our findings because the literature is not 
from the COVID-19 era. There are several 
factors in which we get this result significant 
as the sample size was small enough that we 
can’t comment on these findings. If the 
sample size increases maybe there would be 
a chance of change in results. Secondly in 
Pakistan, the impact of COVID-19 posed no 
such serious impact on people and the 
Healthcare sector as in the rest of the world 
and neighboring countries35,36. This might be 
due to the government having precautionary 
measures on time, especially the smart 
lockdown strategy, which ultimately leads to 
less burden on disease and the economy 
even in lethal variants37.  
 
When DASS subscale scoring compared with 
a socio-demographic variable by one-way 
ANOVA in tables 5,6,7 and 8 shows 
significance at α=0.05, we see a good 
significant level for age, marital status, 
organization, and occupation. It indicates 
there is a strong relationship between age 
group with depression, marital status with 
depression, organization with depression, 
and occupation with depression at a P value 
of 0.020, 0.006, 0.012, and 0.043 respectively. 
This finding of our study is strongly 
supported by other literature results as 
occupational stress in healthcare workers 
with a variety of socio-demographic 
variables depends dynamically13,24,27,34. 
 
Limitations of the study 
The study was limited to those health care 
professionals who are dealing with COVID-

19 Patients in special COVID Units. Sample 
size was small because of multiple reasons 
like the refusal of hospital management. 
Duration of this study was short, and the 
lockdown measures for safety also limit our 
study. Due to the small sample size, the 
statistical finding was also limited. 
 

Conclusion 
In conclusion, the study disclosed that the 
majority of healthcare professionals showed 
stress, anxiety, and depression during the 
COVID-19 era. The other socio-demographic 
variables like age, organization, and 
occupation have a strong association with 
depression. We saw a significant 
relationship between occupation and job 
satisfaction of health care professionals.  
 

Acknowledgment  
Authors would like to acknowledge and 
thank to Sindh Infectious Disease Hospital 
and Research Centre, Nepa, Karachi, and 
Dow University Hospital COVID-19 Units 
for the support and help in data collection.  
 

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