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e ISSN: 2645-9248 Journal homepage: www.jidhealth.com Open Access
The prevalence of depression and anxiety in nurses caring for covid-19
patients in Saudi Arabia: a single center experience
Emad Hakami1, Ahlam Alsomali1, Mohammed Senitan2
Abstract
Background: Healthcare workers in direct contact with confirmed COVID-19 patients often face a negative impact on
psychological health. This study aims to examine the prevalence of anxiety and depression among nurses caring for
COVID-19 patients.
Methods: A cross-sectional survey was conducted during the COVID-19 pandemic from January 2022 to April 2022 at
King Faisal Specialist Hospital and Research Center in Riyadh, Saudi Arabia. The prevalence of depression and
anxiety was assessed using the Patient Health Questionnaire (PHQ-9), and the Generalized Anxiety Disorder-7 (GAD-
7) questionnaire. Kruskal–Wallis’s test was used to compare the total scores of the PHQ-9 and GAD-7 with respect to
demographic characteristics. P<0.05 was considered statistically significant.
Results: A total of 123 nurses were included in the study. Most of them were females (69.92%), aged 30–39 years
(45.53%), had a bachelor's degree in nursing (75.61%), and had more than ten years of experience (3830.89%). The
depression and anxiety prevalence in the study was 78.1% and 72.4%, respectively. Nurses aged 30–39 years were
significantly associated with depressive symptoms. Female nurses showed significantly higher scores for depression
and anxiety than males 74.42% and 67.45%, respectively.
Conclusion: The findings suggest that nurses are at risk for developing depression and anxiety. Therefore, regular
mental health screening is necessary for nurses, particularly during a pandemic.
Keywords: Depression, Anxiety, Healthcare workers, COVID-19, Pandemic, Saudi Arabia
Background
In March 2020, the World Health Organization (WHO)
declared the coronavirus disease 2019 (COVID-19) a pandemic
[1]. The disease affected over 600 million people worldwide
and caused over 6 million deaths. Saudi Arabia reported over
800,000 cases and 9000 deaths [2]. Pandemics present unique
challenges to healthcare providers, as the treatment course is
often unknown, social isolation is required following symptom
onset, and frontline healthcare providers are concerned not only
with their patients' safety but also their own and family
members' health. Furthermore, many healthcare providers are
suddenly required to engage in unfamiliar activities in stressful
settings, such as high-risk, high-intensity units, which are likely
to be associated with higher levels of psychological distress.
These characteristics of an outbreak diminish the availability of
social support, such as assistance from coworkers and families,
which is believed to mitigate the detrimental effects of stress
[3]. Healthcare providers are expected to work long hours under
extreme stress in pandemic situations. When treating sick
patients, they are at risk of becoming infected. They are also
exposed to fake news and rumors, which increases their anxiety.
Working in such an environment increases the risk of various
psychological and mental illnesses as well as physical and
emotional distress [4]. Globally, several populations have
experienced a negative impact on psychological health related
to the pandemic [5]. Among them, frontline healthcare workers
are at high risk because of direct exposure to patients and
increased workload [5]. Infectious disease outbreaks are known
to have a psychological impact on healthcare workers and the
general population [6].
___________________________________________________
nurseemad@gmail.com
1Department of Cardiovascular Nursing King Faisal Specialist Hospital and
Research Center, Riyadh, Saudi Arabia
A full list of author information is available at the end of the article
https://doi.org/10.47108/jidhealth.Vol6.Iss2.269
http://www.jidhealth.com/
Hakami E, et al., Journal of Ideas in Health (2023); 6(1):828-835 829
In Al Thobaity and Alshammari's study [7], it was found that
depression and anxiety are among the most common issues
nurses face when dealing with COVID-19 patients. The
psychological reactions of healthcare providers to COVID-19
are complex. According to a review of 44 studies [8], severe
anxiety symptoms were reported in 45% of healthcare workers.
Additionally, depressive symptoms were reported to be ranging
from 27.5%–50.7% [8]. Individual and work-related features,
such as the level of exposure to infected patients, are considered
risk factors for negative psychological states. In a study of 502
healthcare providers working in direct contact with confirmed
cases of COVID-19, 51.4% reported having anxiety, with
25.1% having mild, 11% having moderate, and 15.3% having
severe anxiety.
The prevalence of depression among healthcare workers
during the COVID-19 outbreak was found to be moderate to
very severe [6]. The poor infectivity and mortality rate put
incredible pressure on all medical teams [8]. The source of
anxiety among nurses varies between fear of susceptibility to
infection and the possibility of death [8]. Nurses are mainly
concerned with spreading the infection to vulnerable family
members, such as the elderly, immunocompromised, and young
children [8]. Nursing workload, fear of infection, and poor
family relationships were associated with a higher risk of
depressive symptoms. Nurses working in high- and low-risk
COVID-19 areas showed a higher level of depression than those
working in middle-risk COVID-19 areas. The city of residence
and type of hospital also influence the risk of depression; a
higher risk was observed among those working in general
tertiary hospitals [9]. We believe that as the pandemic worsens
and the number of cases increases exponentially, the
psychological impact and actual pressure faced by healthcare
professionals in each country will also increase [8]. This study
aimed to determine the prevalence of anxiety and depressive
symptoms among nurses and to evaluate the depression and
anxiety levels among nurses caring for confirmed cases of
COVID-19 at King Faisal Specialist Hospital and Research
Centre Riyadh.
Methods
Study design and setting
Data for this study were collected via a cross-sectional survey
during the COVID-19 pandemic from January 2022 to April
2022 at King Faisal Specialist Hospital and Research Center in
Riyadh, Saudi Arabia.
Inclusion and exclusion criteria
All nurses involved in the directed care of confirmed cases of
COVID-19 for more than two hours at King Faisal Specialist
Hospital and Research Center in Riyadh City were included in
the study. However, nurses who did not work with confirmed
cases of COVID-19, nurses who did not spend more than two
hours with confirmed cases of COVID-19 patients, not nurses,
missing data were excluded from the study.
Recruitment
Convenience sampling and RedCap were used to recruit
participants. An online survey was mailed to all nurses who
were working or had worked with confirmed COVID-19 cases
in the East wing at King Faisal Specialist Hospital and Research
Center Riyadh, arranged in collaboration with the internal
communication channels of the hospital. The questionnaire link:
https://redcap.kfshrc.edu.sa/surveys/?s=RA7NKLJC7P
Sample size
The sample size was calculated using Raosoft software [10]; it
was estimated at the 90% confidence level with an estimated
50% response distribution and a margin of error of 7%. The
minimum required sample size was 138.
Study tool
The English version of the questionnaire, containing the
following three components, was disseminated among the
nurses:
1. Sociodemographic characteristics, including age, gender,
education level, years of experience, medical history,
nationality, and residency.
2. The Patient Health Questionnaire-9 (PHQ-9) an English
version of the tool was used in the study and this tool is a
widely used and valid tool for detecting depressive symptoms,
comprises nine items rated on a Likert scale from 0 (not
experienced at all) to 3 (experienced nearly daily). These items
detect depressive symptoms that have occurred during the last
two weeks. The maximum total score is 27; the total score is
classified as mild (5–9), moderate (10–14), moderately severe
(15–19), or severe (20–27). The scale's internal consistency was
indicated by a Cronbach's alpha of 0.89 [11]. The diagnostic
validity of the PHQ-9 has been established in studies involving
eight primary care and seven obstetric clinics [12]. The internal
reliability of the PHQ-9 was excellent, with a Cronbach's α of
0.89 in the PHQ Primary Care Study and 0.86 in the PHQ Ob-
Gyn Study. Test-retest reliability of the PHQ-9 was also
excellent [12].
3. The Generalized Anxiety Disorder-7 (GAD-7) questionnaire
is a valid tool for detecting anxiety, comprising seven items
rated on a Likert scale. The maximum total score is 21; the total
score is classified as mild (5–9), moderate (10–14), or severe
(15–21). Internal consistency was evaluated using Cronbach’s
alpha α = 0.95 [3]. The diagnostic validity of the GAD-7 was
established in studies involving 15 primary care clinics in the
United States from November 2004 to June 2005 [3]. The tool
has good reliability as well as criterion, construct, factorial, and
procedural validity [3].
Statistical analysis
The principal investigator collected the questionnaires. The data
were entered into a password-protected Excel database for
management and storage. Double data entry was performed to
ensure data accuracy. The investigator extracted data from the
questionnaires to examine the two outcomes of interest:
depression and anxiety levels. Statistical analysis was
performed using SPSS version 23.0 (SPSS Inc., Chicago, IL,
USA).
We calculated the percentages and frequencies of all
nominal variables for the PHQ-9 and GAD-7 items. In addition,
the mean, median, and standard deviation ranges of the PHQ-9
and GAD-7 total scores were calculated. Furthermore, the non-
parametric Kruskal–Wallis’s test was used to compare the total
scores of the PHQ-9 and GAD-7 with respect to demographic
characteristics.
Hakami E, et al., Journal of Ideas in Health (2023); 6(1):828-835 830
Results
Socio-demographic characteristics of study participants
One- hundred and twenty-three nurses responded to the survey.
The sociodemographic characteristics of the sample are shown
in Table 1. The majority of the respondents were female (86;
69.92%), and aged 30–39 years (56; 45.53%). Most respondents
held a bachelor's degree in nursing (93; 75.61%); 57 (46.34%)
nurses were from Saudi Arabia, and most lived in private
houses outside the hospital premises (88; 71.54%). The
majority of the nurses had over 10 years of experience (38;
30.89%).
Table 1: Frequencies and Percentage of demographics
characteristics (n=123)
Variable Categories N %
Gender Male 37 30.08
Female 86 69.92
Age Groups 18–29 31 25.20
30–39 56 45.53
40–49 26 21.14
50+ 10 8.13
Educational Levels Diploma in Nursing 21 17.07
Bachelors in Nursing 93 75.61
Master’s degree 9 7.32
Nationality Saudi Arabia 57 46.34
India 17 13.82
Philippine 20 16.26
Pakistan 2 1.63
Jordan 3 2.44
Other 24 19.51
Residency Hospital housing 35 28.46
Outside housing 88 71.54
Years of Experience 1-3 29 23.58
4-6 30 24.39
7-10 26 21.14
10+ 38 30.89
The nurses who presented with depressive disorder obtained a
mean score of 10.1 (SD 6.16) (Table 2). The number
(percentage) of nurses with minimal, mild, moderate,
moderately severe, and severe depression were 27 (21.95%), 32
(26.02%), 41 (33.33%), 10 (8.13%), and 13 (10.57%),
respectively. Moreover, the nurses who presented with anxiety
disorder obtained a mean score of 8.13 (SD 5.46) (Table 2). The
number (percentage) of nurses with minimal, mild, moderate,
and severe anxiety levels were 34 (27.64%), 41 (33.33%), 33
(26.83%), and 15 (12.2%), respectively.
Table 2: depression and anxiety among nurses (n=123)
Statistics PHQ-9 scores GAD-7 scores
Observation 123 123
Mean (Standard Deviation) 10.11 (6.17) 8.14 (5.47)
Median 10 8
Interquartile Range 6-13 3-12
Minimum -Maximum 1-27 0-12
Differences in depression level based on sociodemographic
characteristics
Several sociodemographic variables were significantly
associated with depression (Table 3). The chi-square test
showed a significant association between depressive symptoms
and gender: 25 (29.07%) female nurses reported mild
depression while 19 (51.35%) male nurses reported moderate
depression (p = 0.001). Furthermore, among nurses aged 30–39
years, 19 (33.93%) demonstrated mild depression (p = 0.084).
Among nurses with a bachelor’s degree, 36 (38.71%) had
moderate depression (p = 0.577). Among Saudi nurses, 25
(43.86%) showed moderate depression (p = 0.247). Among
nurses living in private houses, 29 (32.95%) reported moderate
depression (p = 0.076). Fifteen (50%) nurses with experience
ranging from 4–6 years demonstrated moderate depression (p =
0.438).
Differences in anxiety based on sociodemographic
characteristics
Several sociodemographic variables were significantly
associated with anxiety (Table 4). Female nurses were more
anxious than males: 27 female (31.4%) and 14 male nurses
(37.84%) reported mild anxiety (p = 0.319). Among nurses
aged 30–39 years, 24 (42.86%) reported mild anxiety (p =
0.003). Among nurses with a bachelor’s degree, 30 (32.26%)
had mild anxiety (p= 0.206). Among Saudi nurses, 22 (38.6%)
demonstrated moderate anxiety (p = 0.003). Among nurses
living in private houses, 28 (31.82%) displayed mild anxiety (p
= 0.003). Among nurses with over 10 years of experience, 16
(42.11%) demonstrated mild anxiety (p = 0.049).
Depression and anxiety based on demographic
characteristics
The Wilcoxon signed-rank test revealed a statistically
significant difference in the mean depression score between
nurses living in hospital housing and private housing (p =
0.0246; Table 5 and Table 6), indicating that nurses’ housing
situation had a significant effect on depression scores. The
Kruskal–Wallis’s test revealed that the individuals’ median
depression scores were not the same across age groups (p =
0.0138) and nationality (p=0.0016), which suggests a
statistically significant difference in median scores between two
or more age groups, as well as nationality. Furthermore, the
Wilcoxon signed-rank test revealed a statistically significant
difference in the mean anxiety score between nurses living in
hospital housing and private housing (p = 0.0001). This
indicates that nurses’ housing situations significantly affected
anxiety scores. The Kruskal–Wallis’s test revealed that the
individuals’ median anxiety scores were not the same across
age groups (p = 0.0014) and nationality (p=0.0001), which
suggests a statistically significant difference in median scores
between two or more age groups, as well as nationality.
Discussion
It is crucial to evaluate mental health conditions among nurses
owing to the potential impact of mental health on their health
and the quality of patient care. To the best of our knowledge, no
study in Saudi Arabia has examined the prevalence of
depression and anxiety in nurses.
Hakami E, et al., Journal of Ideas in Health (2023); 6(1):828-835 831
Table 3. Cross classification between PHQ-9 and demographic data (n=123)
Variable Categories
Minimal
Depression
Mild
Depression
Moderate
Depression
Moderately
Severe
Depression
Severe
Depression
Total p-value
n (%) n (%) n (%) n (%) n (%) n (%)
Gender Male 5 (13.51) 7(18.92) 19(51.35) 6(16.22) 0(0) 37(30.08) 0.001*
Female 22(25.58) 25(29.07) 22(25.58) 4(4.65) 13(15.12) 86(69.92)
Age Groups 18–29 2(6.45) 5(16.13) 14(45.16) 4(12.9) 6(19.35) 31(25.20) 0.084
30–39 11(19.64) 19(33.93) 17(30.36) 5(8.93) 4(7.14) 56(45.53)
40–49 9(34.62) 6(23.08) 8(30.77) 1(3.85) 2(7.69) 26(21.14)
50+ 5(50) 2(20) 2(20) 0(0) 1(10) 10(8.13)
Educational
Levels
Diploma in
Nursing
6(28.57) 7(33.33) 3(14.29) 2(9.52) 3(14.29) 21(17.07)
Bachelors in
Nursing
18(19.35) 22(23.66) 36(38.71) 8(8.6) 9(9.68) 93(75.61) 0.577
Master’s degree 3(33.33) 3(33.33) 2(22.22) 0(0) 1(11.11) 9(7.32)
Nationality Saudi Arabia 6(10.53) 10(17.54) 25(43.86) 7(12.28) 9(15.79) 57(46.34) 0.247
India 6(35.29) 5(29.41) 3(17.65) 1(5.88) 2(11.76) 17(13.82)
Philippines 4(20) 8(40) 6(30) 1(5) 1(5) 20(16.26)
Pakistan 0(0) 1(50) 1(50) 0(0) 0(0) 2(1.63)
Jordan 1(33.33) 1(33.33) 1(33.33) 0(0) 0(0) 3(2.44)
Others 10(41.67) 7(29.17) 5(20.83) 1(4.17) 1(4.17) 24(19.51)
Residency
Hospital
housing
12(34.29) 9(25.71) 12(34.29) 0(0) 2(5.71) 35(28.46) 0.076
Private housing 15(17.05) 23(26.14) 29(32.95) 10(11.36) 11(12.5) 88(71.54)
Years of
Experience
1–3 5(17.24) 8(27.59) 9(31.03) 4(13.79) 3(10.34) 29(23.58) 0.438
4–6 4(13.33) 6(20) 15(50) 2(6.67) 3(10) 30(24.39)
7–10 5(19.23) 8(30.77) 6(23.08) 3(11.54) 4(15.38) 26(21.14)
10+ 13(34.21) 10(26.32) 11(28.95) 1(2.63) 3(7.89) 38(30.89)
Therefore, this study is the first to evaluate the prevalence of
depression and anxiety among nurses working at King Faisal
Specialist Hospital and Research Center in Riyadh, Saudi
Arabia, during the COVID-19 pandemic. Based on a cutoff
value of 5, we found that depression and anxiety were highly
prevalent among the nurses. These results are consistent with
previous studies [1,6,9]. An Iranian study on 441 nurses during
the COVID-19 pandemic reported a high prevalence of
psychiatric symptoms, mainly depression and anxiety [13].
Additionally, research from Saudi Arabia has shown that,
during the COVID-19 outbreak, nurses had higher depression
and anxiety scores than other healthcare providers; furthermore,
nurses had moderate to severe levels of depression and anxiety
[14]. Another study on 3,228 nurses in Sichuan Province and
Wuhan City during the COVID-19 outbreak reported a total
prevalence of 34.3% and 18.1% for anxiety and depression,
respectively, and a prevalence of 47.1% and 28.4%,
respectively, among nurses who cared for COVID-19 patients
[15]. Our results revealed a significant association between
depression symptoms and nurses’ gender. Women showed
higher scores for depression and anxiety than men.
Furthermore, nurses aged 30–39 years reported mild depression.
Similar results were reported in Al Ateeq et al.'s study [6],
which surveyed 502 healthcare providers during the COVID-19
pandemic and found that women had higher scores for
depression and anxiety than men. Similarly, higher scores were
reported by healthcare providers aged 30–39 years. In Zheng et
al.'s study [16] they also found that perceived health status was
related to age and gender among Chinese nurses. Our results
also demonstrated a significant association between anxiety
symptoms and nurses’ age, region of origin, residence, and
experience. Similarly, a previous study showed that depression
and anxiety were significantly associated with work experience
[17]. This study revealed that nurses' housing situation
significantly affected depression, anxiety, and anxiety-
depression levels. As Saudi nurses comprised almost half of the
study sample, this result could be explained by cultural norms
and differences in living conditions between Saudi and non-
Saudi nurses. Most non-Saudi nurses are ex-pats who are likely
to live alone and have families living in their home countries.
Hence, they are less likely to worry about the risk of infecting
their family members and loved ones than Saudi healthcare
workers who live with their families and tend to have an active
social life [18].
Hakami E, et al., Journal of Ideas in Health (2023); 6(1):828-835 832
Table 4. Cross classification between GAD-7 and demographic data (n=123)
Variable Categories
Minimal
Anxiety
Mild
Anxiety
Moderate
Anxiety
Severe
Anxiety
Total p-value
n (%) n (%) n (%) n (%) n (%)
Gender Male 6(16.22) 14(37.84) 12(32.43) 5(13.51) 37(30.08) 0.319
Female 28(32.56) 27(31.4) 21(24.42) 10(11.63) 86(69.92)
Age Groups 18–29 5(16.13) 6(19.35) 11(35.48) 9(29.03) 31(25.20) 0.003*
30–39 14(25) 24(42.86) 14(25) 4(7.14) 56(45.53)
40–49 8(30.77) 8(30.77) 8(30.77) 2(7.69) 26(21.14)
50+ 7(70) 3(0) 0(0) 0(0) 10(8.13)
Educational Levels Diploma in Nursing 8(38.1) 10(47.62) 2(9.52) 1(4.76) 21(17.07) 0.206
Bachelors in
Nursing
23(24.73) 30(32.26) 28(30.11) 12(12.9) 93(75.61)
Master’s degree 3(33.33) 1(11.11) 3(33.33) 2(22.22) 9(7.32)
Nationality Saudi Arabia 8(14.04) 14(24.56) 22(38.6) 13(22.81) 57(46.34) 0.003*
India 6(35.59) 6(35.29) 4(23.53) 1(5.88) 17(13.82)
Philippines 7(35) 8(40) 4(20) 1(5) 20(16.26)
Pakistan 0(0) 1(50) 1(50) 0(0) 2(1.63)
Jordan 0(0) 2(66.67) 1(33.33) 0(0) 3(2.44)
Others 13(54.17) 10(41.67) 1(4.17) 0(0) 24(19.51)
Residency Hospital housing 16(45.71) 13(37.14) 6(17.14) 0(0) 35(28.46) 0.003*
Private housing 18(20.45) 28(31.82) 27(30.68) 15(17.05) 88(71.54)
Years of
Experience
1–3 9(31.03) 6(20.69) 6(20.69) 8(27.59) 29(23.58) 0.049*
4–6 6(20) 8(26.67) 13(43.33) 3(10) 30(24.39)
7–10 6(23.08) 11(42.31) 7(26.92) 2(7.69) 26(21.14)
10+ 13(34.21) 16(42.11) 7(18.42) 2(5.26) 38(30.89)
Unsurprisingly, nurses reported significantly high scores for
depression and anxiety. Nurses are at a higher risk of
developing emotional distress, leading to depression and
anxiety, due to work-related stress [1]. Risk factors, such as
COVID-19-related stress and poor relationship with family,
appeared to increase the risk of developing depression among
Chinese nurses while working in high-risk COVID-19 wards,
city of residence, and type of hospital also influenced the risk of
depression [1]; furthermore, nursing workload and fear of
infection increased the risk of anxiety [1]. A Saudi Arabian
study found that a Middle Eastern nationality, divorced or
widowed marital status, lack of physical activity, and smoking
were risk factors for anxiety and depression among nursing staff
[19]. In Dai et al.’s study [20] they found that nurses working
night shifts report more depressive symptoms than those
working day shifts only; the higher rates of depressive
symptoms in nurses working night shifts might be associated
with poorer sleep quality due to night shifts.
Additionally, nurses are considered frontline workers
directly involved in treating patients with COVID-19, which
may increase their fear of being infected and transmitting the
infection to family members or others. These factors put nurses
at risk for psychological and emotional problems [21]. Some
limitations of this study must be noted. First, as this survey was
conducted in a single center, the findings cannot be generalized
to other centers that were more affected. Second, this study did
not seek information on any mental health conditions that
respondents may have had before the pandemic or respondents’
experience of working during such a pandemic. Finally, the
cross-sectional nature of this study precludes causal inferences.
Longitudinal investigations on the long-term impact of
pandemics on nurses’ psychological health are warranted.
Conclusion
In this study, depression and anxiety symptoms were highly
prevalent among nurses, which ranged from mild to severe.
Therefore, more attention should be paid to the mental health of
female nurses and those aged 30–39 years, as these groups
showed high depression and anxiety levels. Furthermore,
nurses’ housing situation had a significant effect on depression
and anxiety levels. In addition to advocating for solidarity,
altruism, and social inclusion, promoting healthcare services as
a humanitarian and national duty may help make it a more
meaningful experience for nurses. Mental health screening
should be conducted regularly for nurses, particularly during
pandemic situations.
Psychiatric and psychotherapeutic interventions can be
provided to help them cope with the COVID-19 pandemic. It is
also crucial to meet healthcare providers’ physical needs,
including sufficient sleep, safe times, and places to rest. Finally,
longitudinal research is needed to track nurses’ mental health
symptoms and develop evidence-based interventions.
Hakami E, et al., Journal of Ideas in Health (2023); 6(1):828-835 833
Table 5: PHQ-9 scores and Demographic Characteristics (n=123)
Variable Categories Median IQR p-value test
Q25 Q75
Gender Male 10 8 12 0.2811 Mann-Whitney
Female 9 4 13
Age Groups 18–29 11 10 18 0.0138* Kruskal Wallis
30–39 9 6 11
40–49 8 4 12
50+ 5 3 13
Educational Levels Diploma in Nursing 6 4 4 0.3369 Kruskal Wallis
Bachelors in Nursing 7 10 13
Master’s degree 9 3 10
Nationality Saudi Arabia 11 9 16 0.0016* Kruskal Wallis
India 8 3 11
Philippines 8 6 10.5
Pakistan 9.5 7 12
Jordan 9 3 10
Others 6 2.5 10.5
Residency Hospital housing 7 3 12 0.0246* Mann-Whitney
Private housing 10 7 14
Years of Experience 1–3 10 7 14 0.3072 Kruskal Wallis
4–6 10 8 11
7–10 9.5 7 15
10+ 8 3 13
Table 6: GAD-7 scores and demographic characteristics (n=123)
Variable Categories Median IQR p-value test value
Q1 Q3
Gender Male 9 7 12 0.0751 Mann-Whitney
Female 7 2 11
Age Groups 18–29 11 9 15 0.0014* Kruskal Wallis
30–39 7 4 10.5
40–49 7 3 12
50+ 3 2 5
Educational Levels Diploma in Nursing 6 2 7 0.0518 Kruskal Wallis
Bachelors in Nursing 9 5 12
Master’s degree 10 2 12
Nationality Saudi Arabia 11 7 14 0.0001* Kruskal Wallis
India 7 3 10
Philippines 6 2 9.5
Pakistan 10.5 7 14
Jordan 9 7 11
Others 3 1.5 7
Residency Hospital housing 5 2 8 0.0001* Mann-Whitney
Private housing 9 5.5 13
Years of Experience 1–3 9 3 16 0.2061 Kruskal Wallis
4–6 10 7 12
7–10 7 5 11
10+ 7 2 9
Abbreviation
KFSH&RC-R: King Faisal Specialist Hospital and Research
Center Riyadh; PHQ-9: Patient-Health Questionnaire; GAD7:
Generalized Anxiety Disorder 7; SPSS: Statistical Package for
the Social Sciences; WHO: World Health Organization; SARS:
Severe Acute Respiratory Syndrome; MERS: Middle East
Respiratory Syndrome; IRB: Institutional Review Board.
Declaration
Acknowledgment
I would like to express my deep gratitude to Professor Dr.
Mohammed Senitan, my research supervisor, for his patient
guidance, enthusiastic encouragement, and valuable critiques of
this research work. I would also like to thank Dr. Nahed
Alsayed, for her advice and assistance in keeping my progress
on schedule. My thanks are also extended to Dr. Edward Devol
and Ms. Leena Zeyad for their help in doing the data analysis.
Finally, I wish to thank my colleague Ms. Ahlam Alsomali for
her support and encouragement throughout my study.
Funding
The authors received no financial support for their research,
authorship, and/or publication of this article.
Hakami E, et al., Journal of Ideas in Health (2023); 6(1):828-835 834
Availability of data and materials
Data will be available by emailing Nurseemad@gmail.com
Authors’ contributions
Emad Hakami is the responsible author for the concept, design,
literature search, data analysis, data acquisition, manuscript
writing, editing, and reviewing. EBC has read and approved the
final manuscript. Ahlam Alsomali is responsible for writing,
editing, and reviewing the content of the manuscript.
Mohammed Senitan is responsible for the manuscript review.
Ethics approval and consent to participate
The study was conducted in accordance with the ethical
principles of the Declaration of Helsinki (2013), the ICH
Harmonized Tripartite Good Clinical Practice Guidelines, the
policies and guidelines of the Research Advisory Committee of
the King Faisal Specialist Hospital and Research Center in
Riyadh, and the laws of Saudi Arabia. Institutional Review
Board (IRB) approval was acquired from the King Faisal
Specialist Hospital and Research Center, Riyadh, before starting
the study (Reference number 2221044 on March 14, 2022).
Consent forms were signed by participants who agreed to
participate in the study after they had read the research
objectives. They were informed that they had the right to
withdraw from the study at any time without any consequences.
Data were analyzed anonymously and handled following the
research board’s enforced safeguards. Data were safe and were
not revealed by anyone other than the investigators.
Consent for publication
Not applicable
Competing interest
The authors declare that they have no competing interests.
Open Access
This article is distributed under the terms of the Creative
Commons Attribution 4.0 International License
(http://creativecommons.org/licenses/by/4.0/), which permits
unrestricted use, distribution, and reproduction in any medium,
provided you give appropriate credit to the original author(s)
and the source, provide a link to the Creative Commons license,
and indicate if changes were made. The Creative Commons
Public Domain Dedication waiver
(http://creativecommons.org/publicdomain/zero/1.0/) applies to
the data made available in this article unless otherwise stated.
Author Details
1Department of Cardiovascular Nursing King Faisal Specialist
Hospital and Research Center, Riyadh, Saudi Arabia.
2Department of Public Health, Faculty of Health Sciences
Saudi Electronic University, Riyadh, Saudi Arabia.
Article Info
Received: 22 December 2022
Accepted: 02 March 2023
Published: 10 May 2023
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