Risk perception, mental health impacts and coping strategies during COVID-19 pandemic among Filipino healthcare workers

  • Roy Rillera Marzo
    Department of Community Medicine, International Medical School, Management and Science University, Selangor, Malaysia; Department of Community Medicine, Faculty of Medicine, Asia Metropolitan University, Johor Bahru, Malaysia.
  • Emilio Quilatan Villanueva III
    Department of Pathology, College of Medicine, University of the Philippines, Manila, Philippines.
  • Udita Chandra
    Department of Clinical Research, Meril Life Sciences Pvt.Ltd., Gujrat, India.
  • Mila Nu Nu Htay
    Department of Community Medicine, Melaka-Manipal Medical College, Manipal Academy of Higher Education (MAHE), Melaka, Malaysia.
  • Rajeev Shrestha
    Department of Pharmacy, District Hospital Lamjung, Lamjung, Nepal.
  • Sunil Shrestha
    School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway, Selangor Darul Ehsan, Malaysia.


Background: COVID-19 pandemic has caused an extraordinary situation, especially for the healthcare workers (HCWs), leading to increased psychological stress. The aim of the study was to estimate the prevalence of different grades of anxiety and depression across different centers in the Philippines and identify demographic factors associated with them.

Design and Method: A cross-sectional, web-based, multi-center study was conducted among HCWs of Philippines from April 20- May 20, 2020. The study instruments used were the Generalized Anxiety Disorder (GAD-7) scale and Patient Health Questionnaire (PHQ-9). Risk perception scores were analyzed using Mann-Whitney and Kruskal-Wallis test. Logistic regression was done to identify factors significantly associated with symptoms of anxiety and depression determined.

Results: A total of 516 HCWs were included in the study. Most of them have anxiety symptoms (70.74%), but only half of them have symptoms of depression (50.97%). In addition, gender, age, marital status, living status, occupation, work premises, and availability of mental health services were significantly associated with the participants’ anxiety symptoms; In contrast, gender, marital status, occupation, and work premises were significantly associated with depression symptoms.

Conclusion: This study reiterates the fact and demonstrates that COVID-19 has disrupted the mental well-being of HCWs in the Philippines. Majority of HCW was psychologically affected by COVID-19. Therefore, there is a dire need to address mental illness amongst HCWs and frame guidelines based on proven algorithms to overcome these mental illnesses.


Wang C, Horby PW, Hayden FG, Gao GF. A novel coronavirus outbreak of global health concern. Lancet 2020;395:470-473. DOI: https://doi.org/10.1016/S0140-6736(20)30185-9

WHO. WHO Coronavirus (COVID-19) Dashboard. WHO. Published 2021. Accessed May 20, 2021. Available from: https://covid19.who.int/

Wong LP, Sam IC. Behavioral responses to the influenza A(H1N1) outbreak in Malaysia. J Behav Med 2011;34:23-31. DOI: https://doi.org/10.1007/s10865-010-9283-7

Wu P, Fang Y, Guan Z, et al. The psychological impact of the SARS epidemic on hospital employees in China: Exposure, risk perception, and altruistic acceptance of risk. Can J Psychiatry 2009;54:302-311. DOI: https://doi.org/10.1177/070674370905400504

Marzo RR, Ismail Z, Nu Htay MN, et al. Psychological distress during pandemic Covid-19 among adult general population: Result across 13 countries. Clin Epidemiol Glob Heal 2021;10:100708. DOI: https://doi.org/10.1016/j.cegh.2021.100708

Marzo RR, Singh A, Mukti RF. A survey of psychological distress among Bangladeshi people during the COVID-19 pandemic. Clin Epidemiol Glob Heal 2021;10;100693. DOI: https://doi.org/10.1016/j.cegh.2020.100693

Marzo RR, Villanueva EQ, Faller EM, Baldonado AM. Factors associated with psychological distress among filipinos during coronavirus disease-19 pandemic crisis. Open Access Maced J Med Sci 2020;8:309-13. DOI: https://doi.org/10.3889/oamjms.2020.5146

Respati T, Irasanti SN, Sartika D, Akbar IB, Marzo RR. A nationwide survey of psychological distress among Indonesian residents during the COVID-19 pandemic. Int J Public Heal Sci 2021;10:119-26. DOI: https://doi.org/10.11591/ijphs.v10i1.20609

Htay MNN, Marzo RR, AlRifai A, et al. Immediate impact of COVID-19 on mental health and its associated factors among healthcare workers: A global perspective across 31 countries. J Glob Health 2020;10:1-6. DOI: https://doi.org/10.7189/jogh.10.020381

Giorgi G, Lecca LI, Alessio F, et al. COVID-19-Related Mental Health Effects in the Workplace: A Narrative Review. Int J Environ Res Public Health 2020;17:7857. DOI: https://doi.org/10.3390/ijerph17217857

Maunder R, Hunter J, Vincent L, et al. The immediate psychological and occupational impact of the 2003 SARS outbreak in a teaching hospital. CMAJ. 2003;168:1245-51.

Bai Y, Yao L, Wei T, et al. Presumed Asymptomatic Carrier Transmission of COVID-19. JAMA 2020;323:1406. DOI: https://doi.org/10.1001/jama.2020.2565

Cirrincione L, Plescia F, Ledda C, et al. COVID-19 Pandemic: Prevention and Protection Measures to Be Adopted at the Workplace. Sustainability 2020;12:3603. DOI: https://doi.org/10.3390/su12093603

CDC. Healthcare Workers: Information on COVID-19. Accessed May 22, 2021. Available from: https://www.cdc.gov/coronavirus/2019-ncov/hcp/index.html

World Health Organization. Shortage of personal protective equipment endangering health workers worldwide. World Heal Organ, March 2020. Accessed May 20, 2021. Available from: https://www.who.int/news/item/03-03-2020-shortage-of-personal-protective-equipment-endangering-health-workers-worldwide

World Health Organization. Coronavirus Disease ( Covid-19 ) Outbreak : Rights , Roles and Responsibilities of Health Workers , Including Key Considerations for Occupational Safety. World Heal Organ, December 2019. Accessed May 20, 2021. Available from: https://www.who.int/docs/default-source/coronaviruse/who-rights-roles-respon-hw-covid-19.pdf?sfvrsn=bcabd401_0

Xiang YT, Yang Y, Li W, et al. Timely mental health care for the 2019 novel coronavirus outbreak is urgently needed. Lancet Psychiat 2020;7:228-9. DOI: https://doi.org/10.1016/S2215-0366(20)30046-8

Eysenbach G. Improving the quality of web surveys: the Checklist for Reporting Results of Internet E-Surveys (CHERRIES). J Med Internet Res 2004;6:e34. DOI: https://doi.org/10.2196/jmir.6.3.e34

Spitzer RL, Kroenke K, Williams JB, Löwe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med 2006;166:1092-7. DOI: https://doi.org/10.1001/archinte.166.10.1092

Zhang YL, Liang W, Chen ZM, et al. Validity and reliability of Patient Health Questionnaire-9 and Patient Health Questionnaire-2 to screen for depression among college students in China. Asia-Pacific Psychiatry 2013;5:268-75. DOI: https://doi.org/10.1111/appy.12103

Dai Y, Hu G, Xiong H, et al. Psychological impact of the coronavirus disease 2019 (COVID-19) outbreak on healthcare workers in China. medRxiv 2020: doi:10.1101/2020.03.03.20030874 DOI: https://doi.org/10.1101/2020.03.03.20030874

Pappa S, Ntella V, Giannakas T, Giannakoulis VG, Papoutsi E, Katsaounou P. Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis. Brain Behav Immun 2020;88:901-907. DOI: https://doi.org/10.1016/j.bbi.2020.05.026

Chew NWS, Lee GKH, Tan BYQ, et al. A multinational, multicentre study on the psychological outcomes and associated physical symptoms amongst healthcare workers during COVID-19 outbreak. Brain Behav Immun 2020;88:559-65. DOI: https://doi.org/10.1016/j.bbi.2020.04.049

Zhu J, Sun L, Zhang L, et al. Prevalence and influencing factors of anxiety and depression symptoms in the first-line medical staff fighting against COVID-19 in Gansu. Front Psychiatry 2020;11:00386. DOI: https://doi.org/10.3389/fpsyt.2020.00386

Lai J, Ma S, Wang Y, et al. Factors associated with mental health outcomes among health care workers exposed to Coronavirus Disease 2019. JAMA Netw Open 2020;3:e203976. DOI: https://doi.org/10.1001/jamanetworkopen.2020.3976

Wang C, Pan R, Wan X, et al. Immediate psychological responses and associated factors during the initial stage of the 2019 Coronavirus Disease (COVID-19) epidemic among the general population in China. Int J Environ Res Public Health 2020;17:1729. DOI: https://doi.org/10.3390/ijerph17051729

Cheung T, Fong TKH, Bressington D. COVID-19 under the SARS Cloud: Mental Health nursing during the pandemic in Hong Kong. J Psychiatr Ment Health Nurs 2021;28:115-17. DOI: https://doi.org/10.1111/jpm.12639

Bohlken J, Schömig F, Lemke MR, et al. COVID-19 Pandemic: Stress experience of healthcare workers: A short current review. Psychiatr Prax 2020;47:190-7. DOI: https://doi.org/10.1055/a-1159-5551

West CP, Dyrbye LN, Shanafelt TD. Physician burnout: contributors, consequences and solutions. J Intern Med 2018;283:516-29. DOI: https://doi.org/10.1111/joim.12752

Montemurro N. The emotional impact of COVID-19: From medical staff to common people. Brain Behav Immun 2020;87:23-4. DOI: https://doi.org/10.1016/j.bbi.2020.03.032

Liu Q, Luo D, Haase JE, et al. The experiences of health-care providers during the COVID-19 crisis in China: a qualitative study. Lancet Glob Heal 2020;8:e790-8. DOI: https://doi.org/10.1016/S2214-109X(20)30204-7

Xiao H, Zhang Y, Kong D, et al. The effects of social support on sleep quality of medical staff treating patients with Coronavirus Disease 2019 (COVID-19) in January and February 2020 in China. Med Sci Monit 2020;26:e923549-1. DOI: https://doi.org/10.12659/MSM.923549

Kang L, Ma S, Chen M, et al. Impact on mental health and perceptions of psychological care among medical and nursing staff in Wuhan during the 2019 novel coronavirus disease outbreak: A cross-sectional study. Brain Behav Immun 2020;87:11-17. DOI: https://doi.org/10.1016/j.bbi.2020.03.028

Blake H, Bermingham F, Johnson G, Tabner A. Mitigating the psychological impact of COVID-19 on healthcare workers: A digital learning package. Int J Environ Res Public Health 2020;17:2997. DOI: https://doi.org/10.3390/ijerph17092997