Health care workers have been exposed to COVID-19 more than people in other professions, which may have led to stigmatization, discrimination, and violence toward them, possibly impacting their mental health. We investigated (1) factors associated with stigma, discrimination, and violence, (2) the association of stigma, discrimination, and violence with mental health, (3) everyday experiences of stigmatization, discrimination, and violence. We chose a combination of a quantitative approach and qualitative content analysis to analyze data collected at three time points: in 2020, 2021 and 2022. A higher age was associated with lower odds of experiencing stigma, discrimination, and violence, whereas female gender was related to more negative experiences. The intensity of exposure to COVID-19 was associated with greater experience with stigmatization, discrimination, and violence across all three years (for example in 2022: odds ratio, 95% confidence interval: 1.74, 1.18-2.55 for mild exposure; 2.82, 1.95-4.09 for moderate exposure; and 5.74, 3.55-9.26 for severe exposure, when compared to no exposure). Stigma, discrimination, and violence were most strongly associated with psychological distress in 2020 (odds ratio = 2.97, 95% confidence interval 2.27-3.88) and with depressive symptoms in 2021 (odds ratio = 2.78, 95% confidence interval 2.12-3.64). Attention should be given to the destigmatization of contagious diseases and the prevention of discrimination, violence, and mental health problems, both within workplaces and among the public.

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

Department of Epidemiology 2nd Faculty of Medicine Charles University Prague Czechia

Division of Medical Psychology 3rd Faculty of Medicine Charles University Prague Czechia

Faculty of Science Charles University Prague Czechia

Medical College Prague Czechia

National Institute of Mental Health Klecany Czechia

Paediatric Emergency Department Motol University Hospital Prague Czechia

Zobrazit více v PubMed

Saeed F, Mihan R, Mousavi SZ, Reniers RLEP, Bateni FS, Alikhani R, et al. A narrative review of stigma related to infectious disease outbreaks: What can be learned in the face of the Covid-19 pandemic? Front. Psychiatry. 2020;11:565919. doi: 10.3389/fpsyt.2020.565919. PubMed DOI PMC

Link BG, Phelan JC. Conceptualizing stigma. Ann. Rev. Soc. 2001;27(1):363–385. doi: 10.1146/annurev.soc.27.1.363. DOI

Corrigan PW. Defining the Stereotypes of health conditions: Methodological and practical considerations. Stigma Heal. 2017;3(2):131. doi: 10.1037/sah0000085. DOI

Saragih ID, Tarihoran DETAU, Rasool A, Saragih IS, Tzeng H, Lin C. Global prevalence of stigmatization and violence against healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis. J. Nurs. Scholarsh. 2022;54(6):762–771. doi: 10.1111/jnu.12794. PubMed DOI PMC

Chaudoir SR, Earnshaw VA, Andel S. “Discredited” Versus “discreditable”: Understanding How Shared and Unique Stigma Mechanisms Affect Psychological and Physical Health Disparities. Social Psychological Perspectives on Stigma. Routledge; 2016. pp. 75–87. PubMed PMC

Earnshaw VA, Chaudoir SR. From conceptualizing to measuring HIV stigma: A review of HIV stigma mechanism measures. AIDS Behav. 2009;13:1160–1177. doi: 10.1007/s10461-009-9593-3. PubMed DOI PMC

Gronholm PC, Nosé M, Van Brakel WH, Eaton J, Ebenso B, Fiekert K, et al. Reducing stigma and discrimination associated with COVID-19: Early stage pandemic rapid review and practical recommendations. Epidemiol. Psychiatr. Sci. 2021;30:e15. doi: 10.1017/S2045796021000056. PubMed DOI PMC

Goffman E. Stigma: Notes on the managment of spoiled identity. Penguin; 1974.

Corrigan PW, Rao D. On the self-stigma of mental illness: Stages, disclosure, and strategies for change. Can. J. Psychiatr. 2012;57(8):464–469. doi: 10.1177/070674371205700804. PubMed DOI PMC

Alajmi AF, Al-Olimat HS, Abu Ghaboush R, Al Buniaian NA. Social avoidance and stigma among healthcare workers serving COVID-19 patients in Saudi Arabia. SAGE Open. 2022;12(2):21582440221095845. doi: 10.1177/21582440221095845. DOI

Taylor S, Landry CA, Rachor GS, Paluszek MM, Asmundson GJG. Fear and avoidance of healthcare workers: An important, under-recognized form of stigmatization during the COVID-19 pandemic. J. Anxiety Disord. 2020;1(75):102289. doi: 10.1016/j.janxdis.2020.102289. PubMed DOI PMC

Jeleff M, Traugott M, Jirovsky-Platter E, Jordakieva G, Kutalek R. Occupational challenges of healthcare workers during the COVID-19 pandemic: A qualitative study. BMJ Open. 2022;12(3):e054516. doi: 10.1136/bmjopen-2021-054516. PubMed DOI PMC

Grover S, Singh P, Sahoo S, Mehra A. Stigma related to COVID-19 infection: Are the health care workers stigmatizing their own colleagues? Asian J Psychiatr. 2020;1(53):102381. doi: 10.1016/j.ajp.2020.102381. PubMed DOI PMC

Franklin P, Gkiouleka A. A Scoping Review of Psychosocial Risks to Health Workers during the Covid-19 Pandemic. Int. J. Environ. Res. Public Health. 2021;18(5):2453. doi: 10.3390/ijerph18052453. PubMed DOI PMC

Vento S, Cainelli F, Vallone A. Violence against healthcare workers: A worldwide phenomenon with serious consequences. Front. Public Heal. 2020;8:570459. doi: 10.3389/fpubh.2020.570459. PubMed DOI PMC

Dye TD, Alcantara L, Siddiqi S, Barbosu M, Sharma S, Panko T, et al. Risk of COVID-19-related bullying, harassment and stigma among healthcare workers: An analytical cross-sectional global study. BMJ Open. 2020;10(12):e046620. doi: 10.1136/bmjopen-2020-046620. PubMed DOI PMC

Yuan K, Huang XL, Yan W, Zhang YX, Gong YM, Su SZ, et al. A systematic review and meta-analysis on the prevalence of stigma in infectious diseases, including COVID-19: A call to action. Mol. Psychiatry. 2021;27(1):19–33. doi: 10.1038/s41380-021-01295-8. PubMed DOI PMC

Lee S, Waters SF. Asians and Asian Americans’ experiences of racial discrimination during the COVID-19 pandemic: Impacts on health outcomes and the buffering role of social support. Stigma Heal. 2021;6(1):70–78. doi: 10.1037/sah0000275. DOI

Dar SA, Khurshid SQ, Wani ZA, Khanam A, Haq I, Shah NN, et al. Stigma in coronavirus disease-19 survivors in Kashmir, India: A cross-sectional exploratory study. PLoS One. 2020;15(11):e0240152. doi: 10.1371/journal.pone.0240152. PubMed DOI PMC

Jain S, Das AK, Talwar V, Kishore J, Ganapathy U. Social stigma of COVID-19 experienced by frontline healthcare workers of department of anaesthesia and critical care of a tertiary healthcare institution in Delhi. Indian J. Crit. Care Med. 2021;25(11):1241. doi: 10.5005/jp-journals-10071-24008. PubMed DOI PMC

Weltens I, Bak M, Verhagen S, Vandenberk E, Domen P, van Amelsvoort T, et al. Aggression on the psychiatric ward: Prevalence and risk factors. A systematic review of the literature. PLoS One. 2021;16(10):e0258346. doi: 10.1371/journal.pone.0258346. PubMed DOI PMC

Stangl AL, Earnshaw VA, Logie CH, Van Brakel W, Simbayi LC, Barré I, et al. The Health Stigma and Discrimination Framework: A global, crosscutting framework to inform research, intervention development, and policy on health-related stigmas. BMC Med. 2019;17(1):1–13. doi: 10.1186/s12916-019-1271-3. PubMed DOI PMC

Sirois FM, Owens J. Factors associated with psychological distress in health-care workers during an infectious disease outbreak: A rapid systematic review of the evidence. Front. Psychiatr. 2021;11:589545. doi: 10.3389/fpsyt.2020.589545. PubMed DOI PMC

Pan SW, Shen GC, Liu C, Hsi JH. Coronavirus stigmatization and psychological distress among Asians in the United States. Ethn Health. 2021;26(1):110–125. doi: 10.1080/13557858.2020.1849570. PubMed DOI

Ramaci T, Barattucci M, Ledda C, Rapisarda V. Social stigma during COVID-19 and its impact on HCWs outcomes. Sustainability. 2020;12(9):3834. doi: 10.3390/su12093834. DOI

Mascayano F, van der Ven E, Moro MF, Schilling S, Alarcón S, Al Barathie J, et al. The impact of the COVID-19 pandemic on the mental health of healthcare workers: Study protocol for the COVID-19 HEalth caRe wOrkErS (HEROES) study. Soc. Psychiatr. Psychiatr. Epidemiol. 2022;57(3):633. doi: 10.1007/s00127-021-02211-9. PubMed DOI PMC

Goldberg DP, Williams P. A Users’ Guide To The General Health Questionnaire. GL Assessment; 1988.

Anjara SG, Bonetto C, Van Bortel T, Brayne C. Using the GHQ-12 to screen for mental health problems among primary care patients: Psychometrics and practical considerations. Int. J. Ment. Health Syst. 2020;14:1–13. doi: 10.1186/s13033-020-00397-0. PubMed DOI PMC

Kroenke K, Spitzer RL, Williams JBW. The PHQ-9: Validity of a brief depression severity measure. J. Gen. Int. Med. 2001;16(9):606–613. doi: 10.1046/j.1525-1497.2001.016009606.x. PubMed DOI PMC

Van Buuren S, Groothuis-Oudshoorn K. MICE: Multivariate imputation by chained equations in R. J. Stat. Softw. 2011;45:1–67. doi: 10.18637/jss.v045.i03. DOI

Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qual. Health Res. 2005;15(9):1277–1288. doi: 10.1177/1049732305276687. PubMed DOI

Vaismoradi M, Turunen H, Bondas T. Content analysis and thematic analysis: Implications for conducting a qualitative descriptive study. Nurs. Heal. Sci. 2013;15(3):398–405. doi: 10.1111/nhs.12048. PubMed DOI

Whitley R, Crawford M. Qualitative research in psychiatry. Can. J. Psychiatr. 2005;50(2):108–114. doi: 10.1177/070674370505000206. PubMed DOI

Kleinheksel AJ, Rockich-Winston N, Tawfik H, Wyatt TR. Demystifying content analysis. Am. J. Pharm. Educ. 2020;84(1):7113. doi: 10.5688/ajpe7113. PubMed DOI PMC

Schubert M, Ludwig J, Freiberg A, Hahne TM, Romero Starke K, Girbig M, et al. Stigmatization from work-related COVID-19 exposure: A systematic review with meta-analysis. Int. J. Environ. Res. Public Health. 2021;18(12):6183. doi: 10.3390/ijerph18126183. PubMed DOI PMC

Earnshaw VA, Watson RJ, Eaton LA, Brousseau NM, Laurenceau JP, Fox AB. Integrating time into stigma and health research. Nat. Rev. Psychol. 2022;1(4):236–247. doi: 10.1038/s44159-022-00034-2. PubMed DOI PMC

Clement S. et al. Mass media interventions for reducing mental health‐related stigma. Cochrane Database Syst. Rev.7, CD009453 (2013). PubMed PMC

Mak WWS, Mo PKH, Ma GYK, Lam MYY. Meta-analysis and systematic review of studies on the effectiveness of HIV stigma reduction programs. Soc. Sci. Med. 2017;188:30–40. doi: 10.1016/j.socscimed.2017.06.045. PubMed DOI

Zhang S, Zhao Z, Zhang H, Zhu Y, Xi Z, Xiang K. Workplace violence against healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis. Environ. Sci. Pollut. Res. 2023;30:74838–74852. doi: 10.1007/s11356-023-27317-2. PubMed DOI PMC

Fan X, Shen Y, Xue Z, Guo X, Zhang Z, Lv H, et al. What can the medical education do for eliminating stigma and discrimination associated with mental illness among future doctors? effect of clerkship training on chinese students’ attitudes. Int. J. Psychiatr. Med. 2014;47(3):241–254. doi: 10.2190/PM.47.3.e. PubMed DOI

Uphoff EP, Lombardo C, Johnston G, Weeks L, Rodgers M, Dawson S, et al. Mental health among healthcare workers and other vulnerable groups during the COVID-19 pandemic and other coronavirus outbreaks: A rapid systematic review. PLoS One. 2021;16(8):e0254821. doi: 10.1371/journal.pone.0254821. PubMed DOI PMC

Jani N, Mathur S, Kahabuka C, Makyao N, Pilgrim N. Relationship dynamics and anticipated stigma: Key considerations for PrEP use among Tanzanian adolescent girls and young women and male partners. PLoS One. 2021;16(2):e0246717. doi: 10.1371/journal.pone.0246717. PubMed DOI PMC

Gorini A, Fiabane E, Sommaruga M, Barbieri S, Sottotetti F, La Rovere MT, et al. Mental health and risk perception among Italian healthcare workers during the second month of the Covid-19 pandemic. Arch. Psychiat.r Nurs. 2020;34(6):537–544. doi: 10.1016/j.apnu.2020.10.007. PubMed DOI PMC

Kunz M, Strasser M, Hasan A. Impact of the coronavirus disease 2019 pandemic on healthcare workers: Systematic comparison between nurses and medical doctors. Curr. Opin. Psychiatr. 2021;34(4):413. doi: 10.1097/YCO.0000000000000721. PubMed DOI PMC

Salari N, Hosseinian-Far A, Jalali R, Vaisi-Raygani A, Rasoulpoor S, Mohammadi M, et al. Prevalence of stress, anxiety, depression among the general population during the COVID-19 pandemic: A systematic review and meta-analysis. Global Health. 2020;16(1):1–11. PubMed PMC

Rossi R, Socci V, Pacitti F, Di Lorenzo G, Di Marco A, Siracusano A, et al. Mental health outcomes among frontline and second-line health care workers during the coronavirus disease 2019 (COVID-19) pandemic in Italy. JAMA Netw. open. 2020;3(5):e2010185. doi: 10.1001/jamanetworkopen.2020.10185. PubMed DOI PMC

Song X, Fu W, Liu X, Luo Z, Wang R, Zhou N, et al. Mental health status of medical staff in emergency departments during the Coronavirus disease 2019 epidemic in China. Brain Behav. Immun. 2020;88:60–65. doi: 10.1016/j.bbi.2020.06.002. PubMed DOI PMC

Frost DM. Social stigma and its consequences for the socially stigmatized. Soc. Pers. Psychol. Compass. 2011;5(11):824–839. doi: 10.1111/j.1751-9004.2011.00394.x. DOI

Rizvi Jafree S, Naqi SA. Significant other family members and their experiences of COVID-19 in Pakistan: A qualitative study with implications for social policy. Stigma Heal. 2020;5(4):380. doi: 10.1037/sah0000269. DOI

Mahmud A, Islam MR. Social stigma as a barrier to Covid-19 responses to community well-being in Bangladesh. Int. J. Community Well-Being. 2021;4(3):315–321. doi: 10.1007/s42413-020-00071-w. PubMed DOI PMC

Lohiniva AL, Dub T, Hagberg L, Nohynek H. Learning about COVID-19-related stigma, quarantine and isolation experiences in Finland. PLoS One. 2021;16(4):e0247962. doi: 10.1371/journal.pone.0247962. PubMed DOI PMC

Tsukuda M, Kayano T, Yoshiyasu ITO. Experiences of COVID-19-related stigma: A qualitative study on nurses caring for patients With COVID-19. J. Nurs. Res. 2022;30(6):e241. doi: 10.1097/jnr.0000000000000528. PubMed DOI

Baldassarre A, Giorgi G, Alessio F, Ginevra Lulli L, Arcangeli G, Mucci N. Stigma and discrimination (SAD) at the time of the SARS-CoV-2 pandemic. Int. J. Environ. Res. Public Heal. 2020;17:6341. doi: 10.3390/ijerph17176341. PubMed DOI PMC

Ghanbari R, Lovasi GS, Bader MDM. Exploring potential for selection bias in using survey data to estimate the association between institutional trust and depression. Ann. Epidemiol. 2023;77:61–66. doi: 10.1016/j.annepidem.2022.11.004. PubMed DOI

Kekkonen V, Kivimäki P, Valtonen H, Hintikka J, Tolmunen T, Lehto SM, et al. Sample selection may bias the outcome of an adolescent mental health survey: Results from a five-year follow-up of 4171 adolescents. Public Health. 2015;129(2):162–172. doi: 10.1016/j.puhe.2014.11.015. PubMed DOI

Kaźmierczak I, Zajenkowska A, Rogoza R, Jonason PK, Ścigała D. Self-selection biases in psychological studies: Personality and affective disorders are prevalent among participants. PLoS One. 2023;18(3):e0281046. doi: 10.1371/journal.pone.0281046. PubMed DOI PMC

Deuschl G, Beghi E, Fazekas F, Varga T, Christoforidi KA, Sipido E, et al. The burden of neurological diseases in europe: An analysis for the global burden of disease study 2017. Lancet Public Heal. 2020;5(10):e551–e567. doi: 10.1016/S2468-2667(20)30190-0. PubMed DOI