Psychological distress among community health workers during the COVID-19 pandemic: integration of two cross-sectional studies

Abstract

Introduction: The crucial role of community health workers (CHWs) during the COVID-19 pandemic has been highlighted in various studies, yet the physical and mental strain they endured remains underexplored. Objective: To estimate the prevalence of common mental disorders (CMD) among CHWs during two phases of the pandemic and investigate associations between work characteristics and CMD. Methods: Data were collected in São Paulo during October–November 2020 (N=177) and 2021 (N=143). CMD was assessed using the GHQ-12. Information on sociodemographics, access to personal protective equipment (PPE), and experiences of discrimination, conflicts, and violence was gathered. Associations were analyzed with Poisson regression. Results: CMD prevalence decreased from 49.7% in phase 1 to 36.3% in phase 2. Insufficient PPE access was reported in both phases. Violence was more frequent in phase 1 (59.3%) than in phase 2 (39.2%). Participants exposed to discrimination, conflict, or violence had a higher CMD risk (phase 1: PR = 2.11; phase 2: PR = 2.43). Insufficient PPE access increased CMD risk only in phase 1 (PR = 1.62). Conclusion: Strategies to reduce violence against CHWs and ensure adequate PPE access are critical to mitigating their psychological distress during health crises.