ORIGINAL RESEARCH article
Front. Psychiatry
Sec. Public Mental Health
Volume 16 - 2025 | doi: 10.3389/fpsyt.2025.1610910
The non-linear association of physical fatigue with depression and anxiety among mental health professionals who recovered from COVID-19 infection: a national survey in China
Provisionally accepted
Yucheng Wang1*
Yiran Huang1Heli Sun1
Feng Yuan2
Pan Chen1
Zhaohui Su3
Teris Cheung4
Gabor Ungvari5
Lloyd Balbuena6Fengrong An2
Gang Wang2
Yutao Xiang1- 1University of Macau, Taipa, Macau Region, China
- 2Beijing Anding Hospital, Capital Medical University, Beijing, Beijing Municipality, China
- 3Southeast University, Nanjing, Jiangsu Province, China
- 4Hong Kong Polytechnic University, Kowloon, Hong Kong, SAR China
- 5University of Notre Dame Australia, Fremantle, Australia
- 6University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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Background: The COVID-19 pandemic took a toll on everyone’s health and mental health professionals were no exception. This study examined the trajectory of the relationship between levels of physical fatigue and each of depression and anxiety in mental health professionals (MHPs) recovering from COVID-19. Methods: A national survey of 9,858 MHPs who had recovered from COVID-19 was conducted between January and February 2023. The nine-item Patient Health Questionnaire (PHQ-9), the 7-item Generalized Anxiety Disorder (GAD-7) scale, and a numerical rating scale were used to measure depression, anxiety and physical fatigue, respectively. Logistic regression with restricted cubic spline (RCS) models were created to examine anxiety and depression. Results: The prevalence of depression and anxiety in MHPs who recovered from COVID-19 infection were 47.0% (95%CI: 46.0-48.0%) and 28.9% (95%CI: 28.0-29.8%) respectively. The prevalence of moderate to severe physical fatigue was 44.2% (95%CI: 43.2-45.2%). The RCS models revealed a significant nonlinear relationship between physical fatigue and both depression and anxiety, with an inflection point at a fatigue score of 4. Above this threshold, the risk of both conditions increased significantly. Participants with poor perceived health and lower socioeconomic status had a significantly greater increase in depression and anxiety when fatigue levels were higher.Conclusions: Moderate to severe physical fatigue associated with depression and anxiety in MHPs recovering from COVID-19. Interventions aimed at alleviating fatigue may play a critical role in improving mental health outcomes in this vulnerable population.
Keywords: COVID-19, physical fatigue, Depression, Anxiety, Mental health professionals, nonlinear association
Received: 13 Apr 2025; Accepted: 28 Jul 2025.
Copyright: © 2025 Wang, Huang, Sun, Yuan, Chen, Su, Cheung, Ungvari, Balbuena, An, Wang and Xiang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Yucheng Wang, University of Macau, Taipa, 999078, Macau Region, China
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