Background and Objectives: The COVID-19 pandemic has negatively impacted the health care system. Front-line health care workers (HCWs) are at a higher risk of mental health adverse outcomes. The aim of this study was to evaluate the frequency of the symptoms of depression and anxiety and associated demographic and occupational factors among front-line HCWs in Latvia. Materials and Methods: A cross-sectional quantitative study was performed in a population of HCWs during the first wave of the COVID-19 pandemic in Latvia. The participants were interviewed between 28 April 2020 and 2 June 2020. Answers from 864 HCWs were obtained. The participants reported their demographics, work-related information, contacts with COVID-19-positive patients and completed two standardised questionnaires that assessed the symptoms of anxiety (GAD-7) and depression (PHQ-9). The gathered data were analysed by a chi-squared test and binary logistic regression. The data analysis was performed using SPSS v25. Results: A total of 209 (24.8%) participants had depression symptoms and 145 (17.2%) had anxiety symptoms. Health care workers older than 50 had a lower risk of both depression (OR 0.422 (95% CI, 0.262–0.680)) and anxiety (OR 0.468 (95% CI, 0.270–0.813)). General practitioners had more frequent symptoms of depression and anxiety than participants who worked at hospitals (32.8% (n = 63) versus 19.4% (n = 73) and 27.1% (n = 52) versus 10.3% (n = 39), respectively (p = 0.037; p < 0.000)). Working more than 48 h during the week was associated with a higher risk of depression (OR 2.222 (95% CI, 1.315–3.753)) and anxiety (OR 2.416 (95% CI, 1.272–4.586)). Conclusions: The vulnerability of the health care system before the COVID-19 pandemic led to significant mental health adverse outcomes of HCWs during the COVID-19 pandemic in Latvia. A further cohort study is needed to evaluate the dynamics of mental health and other predisposing factors of HCWs.

Background and Objectives: Oxidative stress has been identified as a key process involved in different diseases, particularly depression. Selenium (Se) protects against oxidative stress, one of the pathogenic mechanisms involved in affective disorders. Selenium is incorporated into antioxidant selenoproteins, such as selenoprotein P, which acts as the main selenium-transport protein in plasma and as an extracellular oxidant defense mechanism. This study aimed to determine whether lower selenium and selenoprotein P levels correlate with high levels of depression and anxiety symptoms. Materials and Methods: The research design was a quantitative cross-sectional study among employed fourth-year medical students at Riga Stradins University in Latvia. The respondents were selected using convenience samples. The symptoms of anxiety were assessed using the Generalized Anxiety Disorder-7 (GAD-7) scale, and the symptoms of depression were assessed using the Patient Health Questionnaire-9 (PHQ-9) scale. Results: A total of 32 respondents participated; 90.6% (n = 29) were female. A significant association was found between selenoprotein P and symptoms of depression (p = 0.006), as well as between selenoprotein P and symptoms of anxiety (p = 0.012). The median selenium level was not significantly lower (p = 0.214) in the study group compared to the control group. Conclusions: There is a statistically significant correlation between selenoprotein P and symptoms of depression and anxiety, and there is a tendency for students with symptoms of depression and anxiety to have lower selenium levels. However, alternative unrecognized oxidative stress mechanisms involved in the development of symptoms of depression and anxiety, involving selenium and selenoprotein P pathways, may exist. Consequently, further research assessing possible alternative pathways and the effect size is required.

The prevalence of depression and anxiety among healthcare workers (HCWs) during the COVID-19 pandemic is high. The aim of the study is to identify the importance of self-esteem and occupational factors in association with the incidence of depression and anxiety among HCWs through a longitudinal cohort study during the COVID-19 pandemic in Latvia. Participants received seven questionnaires during the COVID-19 pandemic on demographic parameters, work-related information, and contact with COVID-19 patients, and three standardized questionnaires that evaluated symptoms of anxiety (GAD-7), depression (PHQ-9), and self-esteem (Rosenberg’s self-esteem scale). The Generalized Linear Mixed Model (GLMM) was used to identify factors associated with the incidence of depression and anxiety among HCWs. A total of 322 participants were included in the data analysis for depression and 352 for anxiety. HCWs with low self-esteem were 83% more likely to experience depression and 76% more likely to experience anxiety. Working at a general practitioner practice is associated with twice the risk of developing depression and anxiety. A 31% increase in the odds of depression is observed among HCWs with direct contact with COVID-19 patients. The organizational and government levels must look for opportunities to facilitate the mental health of HCWs to ensure better-quality healthcare.

Introduction. On 11 March 2020, the Covid-19 pandemic was declared worldwide. From the very beginning of the pandemic, it was clear that the mental health of medical personnel, and therefore the functioning of the healthcare system, would be significantly negatively affected. Early studies conducted during the initial stages of the pandemic were cross-sectional in design, with researchers expressing concern that the state of mental health might deteriorate over time. Given that the Latvian healthcare system was already facing several risks before the pandemic, it is important to assess the mental health dynamics of Latvian healthcare workers during the pandemic and identify factors associated with changes in mental health indicators – sociodemographic, work environment, and personality factors, with special attention to the role of self-esteem. Objective. The aim of the Thesis is to determine the prevalence of depression and generalised anxiety symptoms in the population of Latvian healthcare workers during the Covid-19 emergency situation, its changes in dynamics and related factors. Materials and Methods. The study design consists of a quantitative cross-sectional survey with a follow-up of participants over 7 rounds of data collection (T0–T6). The first round (T0) occurred from 28 April to 2 June 2020. The second round (T1) occurred 3 months after T0 (July–September 2020), T2 – 6 months after T0 (October–December 2020), T3 – 10 months after T0 (March 2021), T4 – 13 months after T0 (June 2021), T5 – 16 months after T0 (September 2021), and T6 – 19 months after T0 (December 2021). The participants were selected by convenience sampling – a non-probability sampling approach, representing persons from various healthcare institutions: general practitioners’ practices, State Emergency Medical Services, Rīga Stradiņš University’s Institute of Stomatology, and level III–V hospitals. Physicians, physician assistants, nurses, and other healthcare workers were invited to participate. Data collection for the first round was conducted in both paper and electronic formats, with subsequent rounds conducted electronically. Follow-up was only conducted with respondents who participated in the initial cross-sectional survey and provided their contact information to confirm their willingness to participate in further research via electronic surveys. No new participants were added in the study. The study was conducted using a self-administered questionnaire, which included questions on sociodemographic status, work environment, and personality factors, a depression symptom survey, a generalised anxiety symptom survey, and a self-esteem survey. Descriptive statistical methods such as medians, interquartile ranges, frequency calculations, proportions, and cross-tabulation analysis were used. The chi-square test was applied to determine differences. Odds ratios (OR) and 95 % confidence intervals were calculated using binary logistic regression analysis. Incidence and survival were calculated using Kaplan-Meier survival functions. A Generalised Linear Mixed Model was used to identify factors related to the chances of developing new cases of clinically significant depression and generalised anxiety. Data analysis was performed using the statistical software BM SPSS version 29 and Jamovi version 4.1. The results are described according to STROBE guidelines. Results. The data analysis included 844 respondents from the first round of the study. At the beginning of the Covid-19 state of emergency in Latvia, the prevalence of clinically significant depressive symptoms in the study sample was 24.9 % (n = 208), and the prevalence of clinically significant generalised anxiety symptoms was 17.3 % (n = 145). After adjustment for socio-demographic and occupational factors, younger age, postgraduate aducation, working in general practice, and a greater number of working hours were associated with higher odds of clinically significant depressive symptoms. Among personality factors, lower self-esteem, unpleasant emotions in the workplace, and the absence of a hobby were associated with higher odds of depressive symptoms. Regarding generalised anxiety symptoms, younger age, female gender, longer work experience, work in general practice and the State Emergency Medical Service, and working more hours were associated with higher odds of having clinically significant anxiety symptoms. Lower self-esteem and unpleasant emotions in the workplace were also associated with higher odds of generalised anxiety symptoms. An increase in the prevalence of clinically significant depressive and generalised anxiety symptoms was observed with Covid-19 infection incidence rates. The increase in prevalence compared to baseline was evident six months after the first state of emergency (p < 0.001). During the data collection period, the prevalence of depressive and generalised anxiety symptoms did not return to baseline levels. The 19-month cumulative incidence of clinically significant depressive symptoms in the sample was 48.0 %. The 19-month cumulative incidence of clinically significant generalised anxiety symptoms was 43.0 %. Older age was associated with a lower risk of developing depressive symptoms. Participants with a postgraduate education had a 30.0 % lower risk of developing depressive symptoms. Working in general practice was associated with an 89 % increased risk while working in Stomatology was associated with a 43.0 % reduced risk compared to working in a hospital or State Emergency Medical Service. Male participants had a 25 % lower risk of developing depressive symptoms than females. Those with low self-esteem had an 82 % higher risk of developing clinically significant depressive symptoms than those with high self-esteem and a 61.0 % higher risk than those with medium self-esteem. Participants who experienced more positive...

Ievads. 2020. gada 11. martā pasaulē tika izsludināta Covid-19 pandēmija. Jau pandēmijas sākumā bija redzams, ka medicīnas personāla psihiskā veselība, tātad arī veselības aprūpes sistēmas funkcionēšana, tiek būtiski negatīvi ietekmēta. Pandēmijas sākumposmā publicētie pētījumi bija šķērsgriezuma dizaina, un pētnieki atzīmēja bažas, ka psihiskās veselības stāvoklis dinamikā varētu pasliktināties. Ņemot vērā, ka Latvijas veselības aprūpes sistēma jau pirms pandēmijas bija pakļauta vairākiem riskiem, ir svarīgi izvērtēt Latvijas medicīnas personāla psihiskās veselības dinamiku pandēmijas laikā un noteikt ar psihiskās veselības rādītāju izmaiņām saistītos faktorus – sociāldemogrāfiskos, darba vides un personību raksturojošos, īpašu vērību pievēršot pašcieņas nozīmei. Darba mērķis ir noteikt depresijas un ģeneralizētas trauksmes simptomu biežumu Latvijas medicīnas personāla populācijā Covid-19 ārkārtējās situācijas laikā, tā izmaiņas dinamikā un saistītos faktorus. Materiāli un metodes. Pētījuma uzbūvi veido kvantitatīvs šķērsgriezuma apsekojums ar turpmāku iekļauto personu sekojumu laikā septiņās datu ievākšanas kārtās (T0–T6). Pirmā datu ievākšanas kārta (T0) notika laikā no 2020. gada 28. aprīļa līdz 2020. gada 2. jūnijam. Otrā datu ievākšanas kārta jeb T1 notika trīs mēnešus pēc T0 (07.–09.2020.), T2 – sešus mēnešus pēc T0 (10.–12.2020.), T3 – 10 mēnešus pēc T0 (03.2021.), T4 – 13 mēnešus pēc T0 (06.2021.), T5 – 16 mēnešus pēc T0 (09.2021.) un T6 – 19 mēnešus pēc T0 (12.2021.). Pētījumā izmantota personu izdevīguma izlase. Izlases veidošanā pārstāvētas dažādas ārstniecības iestādes: ģimenes ārsta prakses, Neatliekamās medicīniskās palīdzības dienests, SIA “RSU Stomatoloģijas institūts”, III–V līmeņa stacionāri. Dalībai pētījumā tika uzrunāti ārsti, ārstu palīgi, māsas un cits medicīnas personāls. Pirmās kārtas datu ievākšana notika divos formātos – papīra formātā un elektroniskā formātā, apsekojuma datu ievākšana notika elektroniskā formātā. Sekojums laikā tika veikts tikai tiem respondentiem, kuri piedalījās pirmajā šķērsgriezuma apsekojumā un bija norādījuši savu kontaktinformāciju kā apstiprinājumu dalībai tālākā pētījumā ar elektronisku aptauju palīdzību. Pētījuma gaitā jauni pētījuma dalībnieki netika iekļauti. Pētījums notika ar pašaizpildāmas anketas palīdzību, kurā iekļauti jautājumi par sociāldemogrāfisko stāvokli, darba vides un personību raksturojošiem faktoriem, depresijas simptomu aptauja, ģeneralizētas trauksmes simptomu aptauja un pašcieņas aptauja. No aprakstošās statistikas metodēm tika izmantota mediānas, starpkvartiļu ranga, biežuma aprēķināšana, proporciju un šķērstabulu analīze. Atšķirību noteikšanai tika izmantots hī kvadrāta tests. Izredžu attiecības (odds ratio) un 95 % ticamības intervāls tika noteikts ar binārās loģistiskās regresijas analīzi. Incidence un izdzīvotība tika noteikta ar Kaplana-Meijera izdzīvotības funkciju. Lai identificētu faktorus, kas saistīti ar izredzēm attīstīties jauniem klīniski nozīmīgas depresijas un ģeneralizētas trauksmes gadījumiem, tika lietots vispārinātais lineārais jauktais modelis. Pētījuma datu apstrādei tika izmantota statistikas datorprogrammas IBM SPSS 29. versija un Jamovi 4.1 versija. Rezultāti aprakstīti pēc STROBE vadlīnijām. Rezultāti. Datu analīzē tika iekļauti 844 respondenti no pirmās pētījuma kārtas. Covid- 19 ārkārtējās situācijas sākumā Latvijā klīniski nozīmīgu depresijas simptomu izplatība pētījuma izlasē ir 24,9 % (n = 208) un klīniski nozīmīgu ģeneralizētas trauksmes simptomu izplatība pētījuma izlasē ir 17,3 % (n = 145). Samērojot klīniski nozīmīgu depresijas simptomu izredžu attiecības pēc sociāldemogrāfiskajiem un darba vides faktoriem, jaunāks vecums, augstāks izglītības līmenis, darbs ģimenes ārsta praksē un lielāks darba stundu skaits ir saistīts ar lielākām klīniski nozīmīgu depresijas simptomu izredzēm. Samērojot klīniski nozīmīgu depresijas simptomu izredžu attiecības pēc personības faktoriem, lielākas klīniski nozīmīgu depresijas simptomu izredzes ir medicīnas personālam ar zemu...