# Psychological Burden of Long COVID and Associated Factors Among Nurses Two Years Post-infection: A Cross-Sectional Study

## TL;DR

This study finds that nurses with long COVID still face high anxiety and depression two years after infection, especially older nurses and those with worse depressive symptoms.

## Contribution

The study is among the first to assess psychological burden and risk factors for long COVID in nurses two years post-infection.

## Key findings

- Nurses with long COVID had significantly higher anxiety and depression scores than those without.
- Older age and higher depression levels were independent risk factors for long COVID.
- Anxiety and depression levels varied across clinical departments, with high-risk departments showing higher scores.

## Abstract

Background: The COVID-19 pandemic has generated sustained physical and psychological impacts on healthcare workers. Growing evidence suggests that some individuals develop persistent multisystem manifestations long after the acute phase, collectively referred to as long COVID. Nurses, who have borne heavy workloads and ongoing psychological stress since the pandemic, may be particularly vulnerable; however, limited research has examined their mental health status two years after infection.

Aims: This study aimed to evaluate anxiety and depression levels among nurses two years after COVID-19 infection, compare psychological characteristics across clinical departments, and identify factors associated with long COVID.

Methods: A cross-sectional online survey was conducted among nurses at a tertiary hospital, yielding 735 valid responses. Data were collected using a general information questionnaire, the Generalized Anxiety Disorder-7 (GAD-7), and the Patient Health Questionnaire-9 (PHQ-9). Participants were categorized into long COVID (n = 263) and non-long COVID (n = 472) groups. Between-group differences were examined using appropriate parametric or non-parametric tests, and variables with P < 0.10 were entered into multivariable logistic regression to identify independent predictors.

Results: Nurses with long COVID were significantly older and exhibited higher GAD-7 and PHQ-9 scores than those without long COVID (all P < 0.001). Multivariate analysis showed that higher PHQ-9 scores (odds ratio (OR) = 1.147, 95% confidence interval (CI): 1.108-1.188) and older age (OR = 1.040, 95% CI: 1.011-1.070) were independently associated risk factors for long COVID. Although the prevalence of long COVID did not differ significantly across departments (P = 0.378), anxiety and depression levels varied, with nurses in high-risk exposure departments reporting higher GAD-7 and PHQ-9 scores than those in outpatient and medical-technical departments.

Conclusion: Two years after infection, nurses with long COVID continue to experience substantial psychological burden, particularly among older individuals and those with more severe depressive symptoms. Although long COVID was evenly distributed across clinical departments, significant interdepartmental differences in anxiety and depression underscore the influence of work characteristics and environment. Targeted psychological support and ongoing mental health monitoring are warranted to promote recovery and enhance occupational resilience in the post-pandemic era.