Previous research has highlighted the negative impact of the COVID-19 pandemic on healthcare workers' (HCWs) mental health, yet protective factors remain underexplored. Emerging studies emphasize the importance of trust in government and interpersonal relationships in reducing infections and fostering positive vaccine attitudes. This study investigates the relationship between HCWs' trust in the workplace and government and depressive symptoms during the pandemic. The COVID-19 HEalth caRe wOrkErS study surveyed 32,410 HCWs from 22 countries, including clinical and nonclinical staff. Participants completed the Patient Health Questionnaire-9 and ad-hoc questions assessing trust in the workplace and government. Logistic regression and multilevel models examined associations between trust levels and depressive symptoms. High workplace trust (OR = 0.72 [0.68, 0.76]) and government trust (OR = 0.72 [0.69, 0.76]) were linked to lower odds of depressive symptoms, with significant between-country variation. Country-level analyses showed that workplace trust was more protective in more developed countries and under stricter COVID-19 restrictions. Despite cross-country variation, HCWs with higher trust in the workplace and government had ~28% lower odds of experiencing depressive symptoms compared to those with lower trust. Promoting trust may help mitigate the mental health impact of future crises on HCWs.

2nd Faculty of Medicine Charles University Prague Prague Czech Republic

Centre for Biomedical Research Network on Mental Health Madrid Spain

Chuquisaca Department Consultora Salud Global Chuquisaca Bolivia

Chuquisaca Department Universidad San Francisco Xavier de Chuquisaca Dirección de Investigación Ciencia y Tecnología Sucre Bolivia

Department of Clinical Epidemiology and Biostatistics Pontifical Xavierian University Bogotá Colombia

Department of Clinical Neuro and Developmental Psychology Vrije Universiteit Amsterdam Amsterdam The Netherlands

Department of Epidemiology Harvard T H Chan School of Public Health Boston MA USA

Department of Medical Sciences and Public Health University of Cagliari Cagliari Italy

Department of Mental Health Graduate School of Medicine The University of Tokyo Tokyo Japan

Department of Oral and Maxillofacial Surgery University College Hospital Ibadan Nigeria

Department of Psychiatry and Clinical Psychology Saint George University of Beirut Beirut Lebanon

Department of Psychiatry Universidad Autónoma de Madrid Madrid Spain

Department of Psychiatry University of Groningen University Medical Center Groningen Groningen The Netherlands

Department of Psychiatry University of Ibadan Ibadan Nigeria

Department of Public Health and Family Medicine Pontificia Universidad Católica de Chile Santiago Chile

Department Psychiatry A Razi Hospital La Manouba La Manouba Tunisia

Faculty of Health and Social Work University of Applied Sciences Emden Leer Emden Germany

Faculty of Law Education and Humanities Universidad Europea de Madrid Villaviciosa de Odón Spain

Faculty of Medical Sciences University of San Carlos of Guatemala Guatemala City Guatemala

Faculty of Medicine São Paulo State University Botucatu Brazil

Hospital La Paz Institute for Health Research Madrid Spain

Icahn School of Medicine at Mount Sinai New York NY USA

Institute for Development Research Advocacy and Applied Care Beirut Lebanon

Institute of Health Sciences Universidad de O'Higgins Rancagua Chile

Interdisciplinary Center for Health Studies Department of Public Health School of Medicine Faculty of Medicine Universidad de Valparaiso Valparaiso Chile

King Abdullah International Medical Research Center King Saud Bin Abdulaziz University for Health Sciences Riyadh Saudi Arabia

Mailman School of Public Health Department of Epidemiology Columbia University New York NY USA

Medical School of Tunis University of Tunis El Manar Tunis Tunisia

National Institute of Health Named After Academician S Avdalbekyan Yerevan Armenia

National Institute of Psychiatry Ramón de la Fuente Muñiz Mexico City Mexico

New York State Psychiatric Institute New York NY USA

Parnassia Psychiatric Institute Parnassia Groep The Hague The Netherlands

Question Driven Design and Analysis Group New York NY USA

School of Behavioral and Brain Sciences Ponce Research Institute Ponce Health Sciences University Ponce Puerto Rico

School of Public Health University of Chile Santiago Chile

University Hospital Federal University of Rio Grande Rio Grande Brazil

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