The pandemic due to COVID-19 brought new risks for depression of health care workers, which may have differently influenced men and women. We aimed to investigate (1) whether health care workers in Czechia experienced an increase in depression during the COVID-19 pandemic, (2) which factors contributed the most to this change, and (3) whether the magnitude of the associations differed by gender. We studied 2564 participants of the Czech arm of the international COVID-19 HEalth caRe wOrkErS (HEROES) Study. Online questionnaire was administered to health care workers in summer 2020 (wave 0) and spring 2021 (wave 1). Depression was defined by reaching 10 or more points on the Patient Health Questionnaire. Logistic regression investigated the association of participant´s characteristics with depression and multivariable decomposition for non-linear models assessed, to what extent the characteristic explained the change in depression occurrence. The prevalence of depression increased twice during the pandemic (11% in wave 0 and 22% in wave 1). Stress accounted for 50% of the difference, experience of death due to COVID-19 for 15% and contact with COVID-19 patients for 14%. Greater resilience and sufficient personal protective equipment were strongly associated with lower occurrence of depression. The protective association of resilience with depression was stronger in men than in women. We conclude that interventions to promote mental health of health care workers in future health crisis should aim at decreasing stress and enhancing resilience. They should be delivered especially to individuals who have contact with the affected patients and may face their death.

3rd Faculty of Medicine Charles University Prague Prague Czechia

Department of Epidemiology 2nd Faculty of Medicine Charles University Prague 5 Úvalu 84 150 06 Prague 5 Czechia

Faculty of Science Amsterdam Public Health Research Institute Vrije Universiteit Amsterdam Amsterdam The Netherlands

Faculty of Science Charles University Prague Prague Czechia

Medical College Prague Czechia

National Institute of Mental Health Klecany Czechia

Paediatric Emergency Department Motol University Hospital Prague Czechia

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Navigating dual crises: mental health of Czech health care workers during the Ukrainian refugee influx and COVID-19 pandemic

Trajectories of symptoms of depression, distress, and resilience in healthcare workers during the COVID-19 pandemic and toward its end in Czechia