key: cord-0830276-a8r8y9iz authors: Aljemaiah, Abdulaziz I.; Alyami, Ahmed Ali; Alotaibi, Fawaz S; Osman, Mugtaba title: The prevalence of coronaphobia among nursing staff in Saudi Arabia date: 2022-03-18 journal: J Family Med Prim Care DOI: 10.4103/jfmpc.jfmpc_1412_21 sha: b6b1eba14d302b64384f9f2988abe6ca6edb56c5 doc_id: 830276 cord_uid: a8r8y9iz BACKGROUND: Nursing staff are in direct contact with the consequences of the current coronavirus disease 2019 (COVID-19) crisis. DESIGN AND METHODS: Descriptive questionnaire-based cross-sectional survey of a sample of nursing staff working across Saudi Arabia. RESULTS: The study included (n = 431) nursing professionals. Coronaphobia prevalence among the nursing staff was 80.3% [95% confidence interval (CI): 76.5–84%]. There were (36.7%) who had severe cornaphobia. Working in a clinical department and being Saudi national were associated with increased COVID-19 fear (estimate = 0.109, P = 0.0153 and P = 0.010, respectively). CONCLUSION: Hospital management in Saudi Arabia needs to acknowledge the high prevalence of coronaphobia during the current COVID-19 crisis among nursing staff. Coronavirus disease 2019 (COVID-19) pandemic was associated undoubtedly with substantial fear, worry, and depressive psychological repercussions among healthcare professionals and the public. [1] Expectedly, fear of disease, increased worry, and inability to tolerate uncertainty lead to significant detrimental COVID-19-associated mental health impact. [2, 3] Nursing staff work in the frontline healthcare system and are particularly vulnerable to COVID-19, therefore are at increased risk for coronaphobia; i.e. excessive fear of contracting COVID-19 that is associated with significant socio-occupational dysfunction. [4] The main objective of the current study was to estimate the prevalence and associated factors of coronaphobia among nursing staff practicing in Saudi Arabia. We conducted a cross-sectional questionnaire-based descriptive survey of a large sample of nursing staff practicing during the COVID-19 pandemic in Saudi military hospitals, concluded between August and September 2020. All nursing staff were invited to take part in completing The Fear of COVID-19 scale that was provided to nursing staff in each hospital site via a unique link to the online research site. Each hospital was assigned a research team representative that met with nursing staff and explained the aim and practicality of the study before making a formal invitation to participate. The article was approved by the Research and Ethics Committee in Al-Hada Military Hospital in Taif (Project No. 2020-9, Date approved: 2/8/2020, Series 2020). Written agreement was obtained online from all participants before their engagement with the survey. The study included a large sample of nursing staff practicing during the COVID-19 pandemic in Saudi military hospitals. This is a seven-item scale developed in the wake of the COVID-19 pandemic. [5] Each item has a potential maximum score of 5 and the total has a potential maximum of 35. A 16.5 cutoff was proposed for a diagnosis of coronaphobia. [6] This is consistent with the DSM-V categorization of phobic anxiety that requires at least four symptoms for a confident diagnosis (namely, excessive fear, immediate anxiety, distressing avoidance, and recognition of irrationality), we set the cutoff to exceed 16 of 35 for a mild coronaphobia case and to exceed 22 for a moderate coronaphobia case and to exceed 29 for severe coronaphobia. Data were analyzed using the R-Statistical Software version 3.4.1. To explore the effect of the adjusted background factors (namely gender, age, experience, marital status, nationality, degree, and work department) on the Fear of COVID-19 score, we modeled the data using multiple linear Poisson regression. The level of significance was set at P < 0.05. The study included (n = 431) nursing professionals, mostly from the Western region in Saudi Arabia, n = 158, (36.2%). There was n = 328 (76.1%) nurses working in a clinical department, n = 241, (55.9%) married, n = 235 (53.8%) with a university degree, n = 361 (82.6%) females, and n = 405 (94%) non-Saudis. Some n = 214 (49%) had direct contact with COVID-19 patients. [ Table 1 ] shows details of the basic demographic factors in the participating nursing staff. The total estimate for coronaphobia among the nursing staff was 80.3% [95% confidence interval (CI): 76.5-84%]. There were n = 85 (19.7%) who had mild coronaphobia, n = 142 (32.9%) who had moderate coronaphobia, and n = 158, (36.7%) who had severe coronaphobia. See [ Figure 1 ]. Even after adjusting for the effect of all other factors, working in a clinical department was associated with increased COVID-19 fear (estimate = 0.109, P = 0.0153). Also risk of coronaphobia was increased among Saudi nursing staff (estimate = 0.134, P = 0.010). Being widowed was associated with less fear of COVID-19 (estimate = 0.068, P = 0.002). Table 2 and Figure 2 ]. The results from our survey reveal an increased coronaphobia among frontline nursing professionals in Saudi Arabia. Almost four in five had some level of coronaphobia and one in three had severe coronaphobia. This high prevalence of coronaphobia among nursing staff could well be related to the unforeseen realistic occupational stress caused by handling COVID-19 patients with different severity presentations and unending uncertainty regarding contracting COVID-19 from whoever presents in the workplace. [7] In addition, nursing staff are subjected during the pandemic to new clinical restrictions and guidance. These changes related to protective equipment, hygienic measures, and scrupulous hand washing put a substantial strain on cognitive reserve and would potentially initiate a vicious loop of discomfort, fear, and anxiety. [8] The main risk factors were being Saudi and working in a clinical ward. Saudi national nursing staff could easily fall for the social amplification of COVID-19 risk as they would be perceived by their families as potential source of severe COVID-19 infection. [9] This is far more than their non-Saudi colleagues who would usually live together with their colleagues in special housing compounds with less intense social interactions outside their working hours. Primary care physicians should be aware of the high level of fear among nursing staff during the current COVID-19 crisis. Intuitively, nursing staff working in primary care facilities are susceptible to coronaphobia that may not be obvious to their physician colleagues. They should be supported by their family physicians. Furthermore, employee health physicians should anticipate high levels of anxiety among nursing staff, particularly those working in clinical wards. We note many strengths to the current survey. We were inclusive of many nursing specialties from across Saudi Arabia. Past studies would have focused on a single region or a single hospital. One significant limitation in the current research is the inability to carry full psychiatric interviews to explore in-depth the risk factors and impact of coronaphobia among the affected staff. Future research should be of a longitudinal design to elucidate the cause-effect relationship more clearly. Also, pharmacological, and behavioral interventions that may help nursing staff with coronaphobia should be evaluated with robust clinical trials. To sum up, coronaphobia affected four in five nursing staff in Saudi Arabia. Support to nursing personnel is required at all organizational levels. This is particularly needed for Saudi national nursing staff. All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000 (5) . Informed consent was obtained from all patients for being included in the study. The paper was approved by the Research and Ethics Committee in Al-Hada Military Hospital in Taif before the commencement of respondents' recruitment. Date of ethical approval 28-6-2020. Nil. There are no conflicts of interest. 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