Psychological Condition of Nurses in the Aftermath of COVID-19 - Indonesian Nurses’ Perspective

Main Article Content

Abdul Rokhman
Nur Hidayati
Masunatul Ubudiyah
Corresponding Author:
Nur Hidayati |


Background: COVID-19 is a global pandemic that strikes various groups, including nurses. Nurses are the health workers who are most exposed to COVID-19. Besides causing physical symptoms, COVID-19 also brings psychological symptoms, which need to be studied more deeply. The purpose of this study was to investigate post-covid psychological impact on nurses from the perspective of Indonesian nurses.
Methods: This study was conducted using a descriptive approach on 187 nurses working in health services in Lamongan Regency who were exposed to COVID-19 and selected by purposive sampling. Psychological conditions studied included depression, which was measured by the Patient Health Questionnaire-9 (PHQ-9); anxiety, measured by general anxiety disorder-7 (GAD-7); and insomnia, measured by the Sleep Condition Indicator (SCI). The data was collected from June to July 2022 using a Google form and analyzed descriptively.
Results: The results showed that 55.1% of nurses were female, 87.7% were aged 22-45 years, 73.8% worked in hospitals, 87.2% worked in health services for more than 20 years, 81.8% smoked, and 18.2% were hospitalized when exposed to COVID-19. The results showed that 31.6% of nurses experienced mild to severe anxiety, 32.1% experienced mild to severe depression, and 9.1% experienced insomnia.
Conclusion: Psychological symptoms experienced by nurses after being exposed to COVID-19 included anxiety, depression, and insomnia. Psychosocial stress factors and or pathophysiology of viral infections may trigger psychological disorders. Future researchers are recommended to examine further the factors contributing to psychological disorders in nurses and how long nurses experience post-covid psychological disorders.

Article Details

How to Cite
A. Rokhman, N. Hidayati, and M. Ubudiyah, “Psychological Condition of Nurses in the Aftermath of COVID-19 - Indonesian Nurses’ Perspective ”, Babali Nurs. Res., vol. 5, no. 2, pp. 240-252, Apr. 2024.
Original Research
Author Biographies

Abdul Rokhman, Universitas Muhammadiyah Lamongan, Lamongan, Indonesia

Nursing Department, Faculty of Health Sciences

Nur Hidayati, Universitas Muhammadiyah Lamongan, Lamongan, Indonesia

Nursing Department, Faculty of Health Sciences

Masunatul Ubudiyah, Universitas Muhammadiyah Lamongan, Lamongan, Indonesia

Nursing Department, Faculty of Health Sciences


[1] World Health Organozation (WHO), “WHO Director-General’s opening remarks at the media briefing on COVID-19 - 11 March 2020,” 2020. .
[2] L. Flesia, M. Monaro, C. Mazza, V. Fietta, E. Colicino, B. Segatto, and P. Roma, “Predicting perceived stress related to the covid-19 outbreak through stable psychological traits and machine learning models,” J. Clin. Med., vol. 9, no. 10, pp. 1–17, 2020, doi: 10.3390/jcm9103350.
[3] X. Li, Y. Zhou, and X. Xu, “Factors associated with the psychological well-being among front-line nurses exposed to COVID-2019 in China: A predictive study,” J. Nurs. Manag., vol. 29, no. 2, pp. 240–249, 2021, doi: 10.1111/jonm.13146.
[4] S.-F. Tsay, C.-C. Kao, H.-H. Wang, and C.-C. Lin, “Nursing ’s response to COVID-19 : Lessons learned from SARS in Taiwan,” Int. J. Nurs. Stud., no. January, 2020, doi: 10.1016/j.ijnurstu.2020.103587.
[5] F. Aloweni, T. C. Ayre, I. Teo, H. K. Tan, and S. H. Lim, “A year after COVID-19: Its impact on nurses’ psychological well-being,” J. Nurs. Manag., vol. 30, no. 7, pp. 2585–2596, 2022, doi: 10.1111/jonm.13814.
[6] P. Galanis, I. Vraka, D. Fragkou, A. Bilali, and D. Kaitelidou, “Nurses’ burnout and associated risk factors during the COVID-19 pandemic: A systematic review and meta-analysis,” J. Adv. Nurs., vol. 77, no. 8, pp. 3286–3302, 2021, doi: 10.1111/jan.14839.
[7] R. Chen, C. Sun, J.-J. Chen, H.-J. Jen, X. L. Kang, C. C. Kao, and K.-R. Chou, “A Large-Scale Survey on Trauma, Burnout, and Posttraumatic Growth among Nurses during the COVID-19 Pandemic,” Int. J. Ment. Health Nurs., vol. 30, no. 1, pp. 102–116, 2021, doi: 10.1111/inm.12796.
[8] S. Pappa, V. Ntella, T. Giannakas, V. G. Giannakoulis, E. Papoutsi, and P. Katsaounou, “Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis.,” Brain. Behav. Immun., vol. 88, pp. 901–907, Aug. 2020, doi: 10.1016/j.bbi.2020.05.026.
[9] Y. Bao, Y. Sun, S. Meng, J. Shi, and L. Lu, “2019-nCoV epidemic: address mental health care to empower society,” Lancet, vol. 395, no. 10224, pp. e37–e38, 2020, doi:
[10] R. Mokhtari, S. Moayedi, and M. Golitaleb, “COVID-19 pandemic and health anxiety among nurses of intensive care units,” Int. J. Ment. Health Nurs., vol. 29, no. 6, pp. 1275–1277, 2020, doi: 10.1111/inm.12800.
[11] R. Brown, P. Da, B. Pravecek, and P. Carson, “Factors associated with changes in nurses ’ emotional distress during the COVID-19 pandemic,” Appl. Nurs. Res., vol. 69, no. January, p. 151659, 2020, doi: 10.1016/j.apnr.2022.151659.
[12] W. M. D’emeh, M. I. Yacoub, and B. S. Shahwan, “Work-Related Stress and Anxiety Among Frontline Nurses During the COVID-19 Pandemic: A Cross-Sectional Study,” J Psychosoc Nurs Ment Heal. Serv, vol. 59, no. 8, pp. 31–42, 2021, doi: 10.3928/02793695-20210322-02.
[13] N. J. Roberts, McAloney-Kocaman, K. Lippiett, E. Ray, L. Welch, and C. Kelly, “Levels of resilience, anxiety and depression in nurses working in respiratory clinical areas during the COVID pandemic,” Respir Med, vol. Jan, no. 176, p. 106219, 2021, doi: 10.1016/j.rmed.2020.106219.
[14] B. Savitsky, Y. Findling, A. Ereli, and T. Hendel, “Anxiety and coping strategies among nursing students during the covid-19 pandemic,” Nurse Educ Pr., vol. Jul, no. 46, p. 102809, 2020, doi: 10.1016/j.nepr.2020.102809.
[15] Z. Cai, Q. Cui, Z. Liu, J. Li, X. Gong, and J. Liu, “Nurses endured high risks of psychological problems under the epidemic of COVID-19 in a longitudinal study in Wuhan China,” J. Psychiatr. Res., vol. 131, no. January, pp. 132–137, 2020, doi: 10.1016/j.jpsychires.2020.09.007.
[16] K. Kroenke, R. L. Spitzer, and J. B. Williams, “The PHQ-9: validity of a brief depression severity measure.,” J. Gen. Intern. Med., vol. 16, no. 9, pp. 606–613, Sep. 2001, doi: 10.1046/j.1525-1497.2001.016009606.x.
[17] F. Instructor, K. Cox, F. Liaison, and C. Goodemann, “Caylin Cedergren , LSW , MSW Student,” pp. 9–10, 2012.
[18] M. Udedi, A. S. Muula, R. C. Stewart, and B. W. Pence, “The validity of the patient health Questionnaire-9 to screen for depression in patients with type-2 diabetes mellitus in non-communicable diseases clinics in Malawi,” BMC Psychiatry, vol. 19, no. 1, pp. 1–7, 2019, doi: 10.1186/s12888-019-2062-2.
[19] N. Fatimah, “Perbedaan Antara Obesitas Dan Non Obesitas Terhadap Kejadian Depresi Pada Ibu Rumah Tangga Di Daerah Kelurahan Cililitan, Jakarta Timur,” Fak. Kedokt. UIN Jakarta, pp. 1–56, 2014.
[20] S. U. Johnson, P. G. Ulvenes, T. Øktedalen, and A. Hoffart, “Psychometric Properties of the General Anxiety Disorder 7-Item (GAD-7) Scale in a Heterogeneous Psychiatric Sample.,” Front. Psychol., vol. 10, p. 1713, 2019, doi: 10.3389/fpsyg.2019.01713.
[21] J. G. Seo and S. P. Park, “Validation of the Generalized Anxiety Disorder-7 (GAD-7) and GAD-2 in patients with migraine,” J. Headache Pain, vol. 16, no. 1, pp. 1–7, 2015, doi: 10.1186/s10194-015-0583-8.
[22] Q. Y. Zhong, B. Gelaye, A. M. Zaslavsky, J. R. Fann, M. B. Rondon, S. X. Sanches, and M. A. Williams, “Diagnostic validity of the generalized anxiety disorder - 7 (GAD-7) among pregnant women,” PLoS One, vol. 10, no. 4, pp. 1–17, 2015, doi: 10.1371/journal.pone.0125096.
[23] A. Budikayanti, A. Larasari, K. Malik, Z. Syeban, L. A. Indrawati, and F. Octaviana, “Screening of Generalized Anxiety Disorder in Patients with Epilepsy: Using a Valid and Reliable Indonesian Version of Generalized Anxiety Disorder-7 (GAD-7),” Neurol. Res. Int., vol. 2019, 2019, doi: 10.1155/2019/5902610.
[24] C. A. Espie, S. D. Kyle, P. Hames, M. Gardani, L. Fleming, and J. Cape, “The Sleep Condition Indicator: A clinical screening tool to evaluate insomnia disorder,” BMJ Open, vol. 4, no. 3, pp. 1–5, 2014, doi: 10.1136/bmjopen-2013-004183.
[25] C. A. Espie, P. F. Machado, J. R. Carl, S. D. Kyle, J. Cape, A. N. Siriwardena, and A. I. Luik, “The Sleep Condition Indicator: reference values derived from a sample of 200 000 adults,” J. Sleep Res., vol. 27, no. 3, 2018, doi: 10.1111/jsr.12643.
[26] M. L. Wong, K. N. T. Lau, C. A. Espie, A. I. Luik, S. D. Kyle, and E. Y. Y. Lau, “Psychometric properties of the Sleep Condition Indicator and Insomnia Severity Index in the evaluation of insomnia disorder,” Sleep Med., vol. 33, pp. 76–81, 2017, doi: 10.1016/j.sleep.2016.05.019.
[27] D. S. f Yu, D. T. f Lee, and J. Woo, “Translation of the chronic heart failure questionnaire.,” Appl. Nurs. Res., vol. 16, no. 4, pp. 278–283, Nov. 2003, doi: 10.1016/j.apnr.2003.08.005.
[28] F. Hasan and H.-Y. Chiu, “Psychometric Properties of the Sleep Condition Indicator for Insomnia in Stroke Survivors,” in The 7th International Nursing Research Conference of World Academy of Nursing Science (7th(WASN), 2022, p. 3.
[29] S. J. Lamontagne, D. A. Pizzagalli, and M. C. Olmstead, “Does inflammation link stress to poor COVID-19 outcome?,” Stress Heal., vol. 37, no. 3, pp. 401–414, 2021, doi: 10.1002/smi.3017.
[30] A. Zalli, O. Jovanova, W. J. G. Hoogendijk, H. Tiemeier, and L. A. Carvalho, “Low-grade inflammation predicts persistence of depressive symptoms.,” Psychopharmacology (Berl)., vol. 233, no. 9, pp. 1669–1678, May 2016, doi: 10.1007/s00213-015-3919-9.
[31] S. Mandal, J. Barnett, S. E. Brill, J. S. Brown, E. K. Denneny, S. S. Hare, M. Heightman, T. E. Hillman, J. Jacob, H. C. Jarvis, M. C. I. Lipman, S. B. Naidu, A. Nair, J. C. Porter, G. S. Tomlinson, J. R. Hurst, “‘Long-COVID’: a cross-sectional study of persisting symptoms, biomarker and imaging abnormalities following hospitalisation for COVID-19.,” Thorax, vol. 76, no. 4, pp. 396–398, Apr. 2021, doi: 10.1136/thoraxjnl-2020-215818.
[32] E. F. Osimo, L. J. Baxter, G. Lewis, P. B. Jones, and G. M. Khandaker, “Prevalence of low-grade inflammation in depression: a systematic review and meta-analysis of CRP levels.,” Psychol. Med., vol. 49, no. 12, pp. 1958–1970, Sep. 2019, doi: 10.1017/S0033291719001454.
[33] Y. Zhang and K. W. Lange, “Coronavirus disease 2019 (COVID-19) and global mental health.,” Glob. Heal. J. (Amsterdam, Netherlands), vol. 5, no. 1, pp. 31–36, Mar. 2021, doi: 10.1016/j.glohj.2021.02.004.
[34] H. Crook, S. Raza, J. Nowell, M. Young, and P. Edison, “Long covid-mechanisms, risk factors, and management.,” BMJ, vol. 374, p. n1648, Jul. 2021, doi: 10.1136/bmj.n1648.
[35] D. Borsboom, “A network theory of mental disorders,” World Psychiatry, vol. 16, no. 1, pp. 5–13, 2017, doi: 10.1002/wps.20375.
[36] J. Dedoncker, M.-A. Vanderhasselt, C. Ottaviani, and G. M. Slavich, “Mental health during the COVID-19 pandemic and beyond: The importance of the vagus nerve for biopsychosocial resilience.,” Neurosci. Biobehav. Rev., vol. 125, pp. 1–10, Jun. 2021, doi: 10.1016/j.neubiorev.2021.02.010.
[37] M.-E. Tremblay, C. Madore, M. Bordeleau, L. Tian, and A. Verkhratsky, “Neuropathobiology of COVID-19: The Role for Glia.,” Front. Cell. Neurosci., vol. 14, p. 592214, 2020, doi: 10.3389/fncel.2020.592214.
[38] A. M. Mahalakshmi, B. Ray, S. Tuladhar, A. Bhat, S. Paneyala, D. Patteswari, M. K. Sakharkar, H. Hamdan, D. M. Ojcius, S. R. Bolla, M. M. Essa, S. B. Chidambaram, and M. W. Qoronfleh, “Does COVID-19 contribute to development of neurological disease?,” Immunity, Inflamm. Dis., vol. 9, no. 1, pp. 48–58, Mar. 2021, doi: 10.1002/iid3.387.
[39] M. G. Mazza, P. Mariagrazia, D. L. Rebecca, M. Cristiano, P. Sara, F. Roberto, C. Fabio, R.-Q. Patrizia, and B. Francesco, “Persistent psychopathology and neurocognitive impairment in COVID-19 survivors: Effect of inflammatory biomarkers at three-month follow-up.,” Brain. Behav. Immun., vol. 94, pp. 138–147, May 2021, doi: 10.1016/j.bbi.2021.02.021.
[40] T. C. Theoharides, C. Cholevas, K. Polyzoidis, and A. Politis, “Long-COVID syndrome-associated brain fog and chemofog: Luteolin to the rescue.,” Biofactors, vol. 47, no. 2, pp. 232–241, Mar. 2021, doi: 10.1002/biof.1726.
[41] S. Dubey, P. Biswas, R. Ghosh, S. Chatterjee, M. J. Dubey, S. Chatterjee, D. Lahiri, and C. J. Lavie, “Psychosocial impact of COVID-19.,” Diabetes Metab. Syndr., vol. 14, no. 5, pp. 779–788, 2020, doi: 10.1016/j.dsx.2020.05.035.
[42] Z. Cai, Q. Cui, Z. Liu, J. Li, X. Gong, and J. Liu, “Nurses endured high risks of psychological problems under the epidemic of COVID-19 in a longitudinal study in Wuhan China,” J. Psychiatr. Res., vol. 131, no. January, pp. 132–137, 2020, doi: 10.1016/j.jpsychires.2020.09.007.
[43] X. Cai, X. Hu, I. O. Ekumi, J. Wang, Y. An, Z. Li, and B. Yuan, “Psychological Distress and Its Correlates Among COVID-19 Survivors During Early Convalescence Across Age Groups.,” Am. J. Geriatr. psychiatry Off. J. Am. Assoc. Geriatr. Psychiatry, vol. 28, no. 10, pp. 1030–1039, Oct. 2020, doi: 10.1016/j.jagp.2020.07.003.
[44] Y. Lahav, “Psychological distress related to COVID-19 - The contribution of continuous traumatic stress.,” J. Affect. Disord., vol. 277, pp. 129–137, Dec. 2020, doi: 10.1016/j.jad.2020.07.141.
[45] M. G. Mazza, R. D. Lorenzo, C. Conte, S. Poletti, B. Vai, I. Bollettini, E. M. T. Melloni, R. Furlan, F. Ciceri, P. Rovere-Querini, and F. Benedett, “Anxiety and depression in COVID-19 survivors: Role of inflammatory and clinical predictors.,” Brain. Behav. Immun., vol. 89, pp. 594–600, Oct. 2020, doi: 10.1016/j.bbi.2020.07.037.
[46] C. Huang, L. Huang, Y. Wang, X. Li, L. Ren, X. Gu, et al., “6-month consequences of COVID-19 in patients discharged from hospital: a cohort study,” Lancet, vol. 397, no. 10270, pp. 220–232, 2021, doi:
[47] V. Rass, R. Beer, A. J. Schiefecker, M. Kofler, A. Lindner, et al, “Neurological outcome and quality of life 3 months after COVID-19: A prospective observational cohort study.,” Eur. J. Neurol., vol. 28, no. 10, pp. 3348–3359, Oct. 2021, doi: 10.1111/ene.14803.
[48] V. A. Canady, “Study finds COVID‐19 survivors exhibit MH signs one month after treatment.,” Mental Health Weekly, vol. 30, no. 32. pp. 1–3, Aug. 2020, doi: 10.1002/mhw.32474.
[49] S. N. AL-Quraan, R. Masa’Deh, and M. E. AbuRuz, “The Effect of Anxiety and Depression on the Performance of Nurses Working in Intensive Care Units,” Int. Med. J., vol. 57, no. December, pp. 1127–1137, 2019,
[50] E. Baldi, G. M. Sechi, C. Mare, F. Canevari, A. Brancaglione, et al., “Out-of-Hospital Cardiac Arrest during the Covid-19 Outbreak in Italy.,” The New England journal of medicine, vol. 383, no. 5. United States, pp. 496–498, Jul. 2020, doi: 10.1056/NEJMc2010418.
[51] A. M. South, D. I. Diz, and M. C. Chappell, “COVID-19, ACE2, and the cardiovascular consequences.,” Am. J. Physiol. Heart Circ. Physiol., vol. 318, no. 5, pp. H1084–H1090, May 2020, doi: 10.1152/ajpheart.00217.2020.
[52] T. Shanafelt, J. Ripp, and M. Trockel, “Understanding and Addressing Sources of Anxiety Among Health Care Professionals During the COVID-19 Pandemic.,” JAMA, vol. 323, no. 21, pp. 2133–2134, Jun. 2020, doi: 10.1001/jama.2020.5893.
[53] E. E. McGinty, R. Presskreischer, H. Han, and C. L. Barry, “Psychological Distress and Loneliness Reported by US Adults in 2018 and April 2020.,” JAMA, vol. 324, no. 1, pp. 93–94, Jul. 2020, doi: 10.1001/jama.2020.9740.
[54] N. Greenberg, M. Docherty, S. Gnanapragasam, and S. Wessely, “Managing mental health challenges faced by healthcare workers during covid-19 pandemic.,” BMJ, vol. 368, p. m1211, Mar. 2020, doi: 10.1136/bmj.m1211.
[55] G. V. Joy, J. Kunjavara, M. K. Larsen, and R. J. George, “Coping with COVID-19: Strategies of Frontline Nurses,” Babali Nurs. Res., vol. 3, no. 3, pp. 161–167, 2022, doi: 10.37363/bnr.2022.33113.