High Levels of Depression Among Healthcare Workers Four Years After the COVID-19 Pandemic: A Cross-Sectional Survey from a High-Workload, Deteriorating Healthcare System

Abstract

Background: Healthcare workers (HCWs) in Iraq have endured significant psychological burdens throughout the COVID-19 pandemic. Despite the prolonged impact of the pandemic, studies evaluating the long-term mental health consequences among HCWs remain scarce. To our knowledge. Objective: To assess the psychological impact of the COVID-19 pandemic on HCWs four years after the pandemic. Methods: A cross-sectional study was conducted between May and December 2024. The Patient Health Questionnaire-9 (PHQ-9) was utilized to evaluate depression. Multiple logistic regressions were performed to identify factors independently associated with depression. Results: 948 HCWs were included in this study. 60.3% of them were female, with a mean age of 28.81 years. We found a high level of depression, with 69.4% of HCWs being affected. Younger and single HCWs had a higher depression rate, with a prevalence of 67.4% and 74.3%, respectively. Higher levels of depression were associated with lower educational attainment (84.1%). Also, those with a history of medical, psychological, or family psychological conditions were strongly associated with higher depression levels. Depression affected 72.9% of individuals who had experienced COVID-19 infection before. Medical staff working on the frontlines showed particularly high depression rates at 80.3%. The mild and moderate depression symptoms were most common, since they affected 28.9% and 28.1%, respectively. Conclusions: For the first time in Iraq, this study revealed that 69.4% of healthcare workers (HCWs) suffered from depression four years after the COVID-19 pandemic. Depression was more prevalent among doctors or nurses and those with lower educational attainment.