ABSTRACTBackground: European health care workers recently experienced serious challenges to their mental health. Following the extremely stressful experience of the COVID-19 pandemic, the war in Ukraine caused a humanitarian influx of refugees in need of social and healthcare. We aimed to explore: (1) how working with refugees has affected the mental well-being of health care workers in the context of the COVID-19 pandemic, and (2) the nature of health care workers' emotional strain related to the refugee situation and the war in Ukraine.Methods: We used a combination of quantitative regression analyses and qualitative content analysis to assess data collected by an online questionnaire in 2022. The study included 1121 health care workers from the Czech arm of the international HEROES Study.Results: Quantitative findings did not indicate that working with Ukrainian refugees was reliably associated with a greater occurrence of symptoms of depression, anxiety, distress, or burnout. Qualitative analysis revealed five categories of emotional strain: impacts on working conditions, emotional reactions to refugees and the war, comparisons with the COVID-19 pandemic, and coping strategies.Conclusions: This study highlights the resilience of health care workers but also points to the need for ongoing support to address the complex emotional challenges they face during health crises.

Although we did not find a significant association between working with refugees and mental health issues, health professionals encountered emotionally challenging situations.Emotionally challenging situations involved reactions to the war and refugees, worsening working conditions, and higher subjective strain than during the COVID-19 pandemic.When comparing health workers caring for with refugees and COVID-19 patients, we found differences in their mental health issues.

• Keywords
• COVID-19 pandemic, Migración, Migration, Russian-Ukrainian war, emotional strain, guerra ruso-ucraniana, malestar psicológico, pandemia de COVID-19, psychological distress,
• MeSH
• Adaptation, Psychological MeSH
• COVID-19 * psychology   epidemiology   MeSH
• Depression psychology   epidemiology   MeSH
• Adult MeSH
• Mental Health * MeSH
• Middle Aged MeSH
• Humans MeSH
• Pandemics MeSH
• Burnout, Professional * psychology   epidemiology   MeSH
• Surveys and Questionnaires MeSH
• Stress, Psychological * psychology   MeSH
• SARS-CoV-2 MeSH
• Refugees * psychology   MeSH
• Anxiety psychology   epidemiology   MeSH
• Health Personnel * psychology   statistics & numerical data   MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Geographicals
• Czech Republic epidemiology   MeSH
• Ukraine ethnology   MeSH

The COVID-19 pandemic placed significant psychological strain on healthcare workers. Our study tracked health care workers in the Czech Republic throughout the pandemic to examine the impact of stressors on psychological distress over time and explore gender differences in these associations. We studied health care workers from the Czech arm of the international COVID-19 HEROES Study who took part in all three waves of data collection in 2020, 2021 and 2022 (n = 264). We employed a path model to examine the relationships among six stressors (low trust in workplace, assignment of new tasks, prioritization of patients, experience of death due to COVID-19, experience of discrimination or violence, contact with COVID-19 patients), psychological distress (measured by General Health Questionnaire), and covariates (age, gender, occupation). We incorporated autoregressive paths and interactions to assess the longitudinal impact of stressors. Prior levels of distress predicted subsequent distress, with significant carry-over effects observed between each wave. Stressors had direct association to distress in the same wave of data collection (2020 and 2021), but not in subsequent waves, and stressors in 2022 did not have a significant direct effect to distress. Men reported lower distress in 2020 and 2021, but not in 2022. Furthermore, no significant interactions between stressors and gender were found. Age and occupation were not related to distress levels. There is a need for adaptable mental health support that addresses current stressors through targeted interventions, while also providing ongoing monitoring beyond crises, particularly for individuals with high distress levels.

• Keywords
• COVID-19, Distress, Health care worker, Occupational stressors, Pandemic,
• MeSH
• COVID-19 * psychology   epidemiology   MeSH
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Pandemics MeSH
• Occupational Stress psychology   MeSH
• Surveys and Questionnaires MeSH
• Psychological Distress * MeSH
• Stress, Psychological * epidemiology   MeSH
• SARS-CoV-2 MeSH
• Health Personnel * psychology   MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Geographicals
• Czech Republic epidemiology   MeSH