The novel coronavirus disease 2019 (COVID-19) outbreak started in Wuhan, China and has become a serious public health problem that spread worldwide. It was declared as a “pandemic” by the World Health Organization (WHO) in March 2020 (1). Following this, restrictions began in education, social settings, business, and almost every other aspect of life within the framework of quarantine and isolation measures around the world (2, 3). The COVID-19 pandemic has affected every individual to some extent, and biopsychosocial problems have been experienced (4–7). Healthcare workers have been exposed to increased pressure and workload while they also fought in the frontlines during the pandemic period. These workers have faced many physical and psychiatric problems (8–10). Many studies have been conducted to compare different characteristics of healthcare workers to non-health workers during the COVID-19 pandemic. High rates of psychiatric problems such as depression, anxiety, insomnia, and obsessive-compulsive symptoms were found in previous studies (11–15). Similar effects for healthcare workers were observed in studies assessing the effects of past outbreaks (16, 17). In a study by Lu et al. involving 2,042 medical staff and 257 administrative staff, the Hamilton Anxiety and Depression Rating Scales were administered to the participants in February 2020 in China. The mean anxiety and depression scores were significantly higher in medical staff compared to administrative staff (15).

According to a study that included 927 healthcare workers (680 physicians and 247 nurses) in comparison to 1,255 non-health workers, healthcare workers had a higher prevalence of severe insomnia, anxiety, depression, and obsessive-compulsive symptoms than non-health workers in the COVID-19 pandemic period (14). In the same study, for healthcare workers, female sex, being at risk of contact with COVID-19 patients in hospitals, and having organic diseases were associated with anxiety risk. Female sex and having organic diseases were also associated with depression risk. Being at risk of contact with COVID-19 patients in hospitals and having organic diseases were risk factors for obsessive-compulsive symptoms (14). Differently, in a study conducted in Canada with a large sample, non-health workers were found more likely to have anxiety disorder and depression than healthcare workers during the pandemic. Individuals were asked about compulsive handwashing behaviors and worrying about dirt, germs, and viruses. Healthcare workers reported higher rates before and during the pandemic, while non-health workers reported higher rates only during the pandemic (18).

Two studies during the COVID-19 pandemic showed that obsessive-compulsive symptoms started to appear in individuals who did not have OCD (obsessive-compulsive disorder) before or those with OCD who had exacerbations. Fontenelle and Miguel (19) and Rivera and Carballea (20) concluded that the preventive measures recommended by WHO increase the cleaning and washing compulsions of individuals with OCD. In a study conducted with 6,041 participants in the general population, 60.3% of the participants stated that OCD symptoms started, and 53.8% of these participants developed handwashing compulsions (21). Although the increasing rates of depressive and obsessive-compulsive symptoms in healthcare workers in the COVID-19 pandemic are known, because of the high demand for healthcare labor worldwide and the continuation of the destructive effects of the pandemic, preventive and reformative interventions are not on the desired level yet. Studies where the long-term status of obsessive-compulsive and depressive symptoms that started in the first months of the COVID-19 pandemic was investigated were not encountered in the literature. The aim of this study was to investigate the obsessive-compulsive and depressive symptoms of healthcare workers in a case-control setting and reexamine the participants in terms of same symptoms 1 year later.

Table 1 includes the sociodemographic characteristics of the case and control groups and the results of the homogeneity tests between the groups. The mean age of the healthcare workers was 36.35 ± 5.90, 57.1% of them were male, and 75.5% were single. Additionally, 61.2% of them lived with their family, 85.7% had no family history of psychiatric illness, and 91.8% had no personal history of psychiatric illness. The mean age of the non-health workers was 37.11 ± 6.74, 55.3% of them were women, 83% were single, 91.5% were living with their families, and 89.4% had no history of psychiatric illness. There was no statistically significant difference between the two groups regarding their age, sex, marital status, living arrangements before the onset of the pandemic, personal history of psychiatric illness, or family history of psychiatric illness. The mean number of years of education in the case group was significantly higher than that in the control group. The rate of living alone during the pandemic period was significantly higher in the case group than in the control group (Table 1).

There was a statistically significant difference between the living arrangements of the case group before and after the pandemic, while there was no significant difference in the control group. According to the results of the Kruskal-Wallis test, 30.6% of the participants in the case group started to live alone during the pandemic, while they used to live with their family before the pandemic (Table 2).

The MOCI scores and the SCL-90 obsessive-compulsive subscale scores of the case group were significantly higher than those of the control group (Table 3).

In the assessments of the MOCI, HAM-D, and SCL-90 obsessive-compulsive subscale scores after 12 months, there was a statistically significant decrease in all three scale scores among the participants in the case group (Table 4).

The results of the study explain the obsessive-compulsive and depressive symptoms of healthcare workers during the COVID-19 pandemic. According to the results of the homogeneity test, there was no statistically significant difference between the case group including healthcare workers and the control group including non-health workers in terms of their age, sex, marital status, living arrangements before the pandemic, personal history of psychiatric illness, or family history of psychiatric illness. The mean duration of education among the healthcare workers (case group) was significantly longer than that in the non-health workers (control group). Since the healthcare workers in our study consisted of specialist doctors and nurses, it was expected that the education duration of the healthcare workers would be longer than that of the non-health workers. The rate of living alone during the pandemic was significantly higher in the case group than in the control group. It was found that 30.6% of the participants in the case group had left their families for isolation to protect them from exposure to the virus during the pandemic. In a study with a broad sample by Lu et al., 22% of medical staff and 14.4% of administrative staff answered yes to the statement “I feel lonely being isolated from my loved ones,” and the difference between the two groups was statistically significant (25).

Previous studies have reported that healthcare workers fighting COVID-19 are exposed to acute stress and therefore experience post-traumatic stress disorder and depression, and become mentally and physically weakened (29–31). Several studies on the mental health of healthcare workers during the COVID-19 pandemic revealed higher levels of stress, anxiety, depressive symptoms, and obsessive-compulsive symptoms (14, 32–34). Zhang et al. found that healthcare workers had a higher prevalence of severe insomnia, anxiety, depression, and obsessive-compulsive symptoms than non-health workers during the COVID-19 pandemic (14). In another study, the mean levels of anxiety and depression determined using the Hamilton Anxiety and Depression Rating Scales were significantly higher in medical staff compared to administrative staff (15). Unlike other studies, Mrklas et al. determined that non-health workers were more likely to have anxiety disorder and depression than healthcare workers. Individuals were asked about compulsive handwashing and worrying about dirt, germs, and viruses. Healthcare workers reported higher rates both before and during the pandemic, while non-health workers reported higher rates only during the pandemic (18). Consistent with this study, Wang et al. reported that early in the COVID-19 pandemic, the general public adopted handwashing after touching contaminated objects, washing their hands with soap, and always washing their hands after coughing, sneezing, or rubbing their nose as new habits (35). Based on our findings, the current effects of this public health problem experienced by healthcare professionals in the short and long term should be determined urgently. Intervention is needed to counteract these effects and rebuild the health of these individuals. The primary aim of such an intervention would be to support the mental health of healthcare professionals.

In this study, MOCI scores and SCL-90 obsessive-compulsive subscale scores were significantly higher in the case group than in the control group. There was no significant difference between the groups in terms of their scores in HAM-D and the other subscales of SCL-90. The higher obsessive-compulsive scale scores in the healthcare workers in this study can be explained by the fact that the study was conducted in the main pandemic hospital in a large city and a central region in Turkey. The fact that the novel coronavirus 2019 (SARS-CoV-2) is a newly encountered and poorly known virus, and there is a lack of adequate information about COVID-19, the participants working in the pandemic hospital were worried about their own health and that of their families, and their lack of social support may also have contributed to their high obsessive-compulsive scale scores.

In the assessments of MOCI, HAM-D, and SCL-90 obsessive-compulsive subscale scores after 12 months in our study, there was a statistically significant decrease in MOCI and SCL-90 obsessive-compulsive subscale scores and a significant increase in HAM-D scores. There are not enough longitudinal studies related to this subject in the literature. Loosen et al. assessed depressive and obsessive-compulsive symptoms in the United Kingdom for the general population two times, in April and August 2020 (36). They found an increase in obsessive-compulsive symptoms both at the beginning of the pandemic in April and in the following assessments in August. For depressive symptoms, there was an increase at the beginning of the pandemic, but in the second assessment, depressive symptoms had decreased. Previous studies also emphasized that they found the same increase in OC symptoms when these symptoms were only measured using pandemic-irrelevant items, suggesting that the observed increase in OC symptoms throughout the lockdown cannot be attributed to just adaptive protective behaviors during the pandemic (36, 37). In the study, depressive symptoms may have decreased due to adaptation development. The finding that obsessive-compulsive symptoms did not decrease can be explained by the early second evaluation in the aforementioned study. In our study, the second evaluation was made in July 2021. Exposure and response prevention are proven cognitive behavioral therapy interventions for obsessive-compulsive disorder (38). Due to the fact that the participants were working in a pandemic hospital, the prolongation of their exposure and the decrease in their possibility of avoidance may explain the decrease in the severity of their obsessive-compulsive symptoms over time. Likewise, the discovery of vaccines for COVID-19 and the fact that healthcare professionals in Turkey had started to be vaccinated may have contributed to the decrease in obsessive-compulsive symptoms.

Our results showed that healthcare workers were more likely to have obsessive-compulsive symptoms than non-health workers, as shown by their MOCI and SCL-90 obsessive-compulsive subscale scores in the early part of the pandemic in June 2020. When we assessed the healthcare workers after 12 months (July 2021), both MOCI and SCL-90 obsessive-compulsive subscale scores had decreased significantly. In contrast to these results, the HAM-D scores of the participants increased significantly. Our study contributes to the literature in terms of being a longitudinal follow-up study and showing that obsessive-compulsive symptoms decreased, and depressive symptoms increased in healthcare workers after 12 months during the pandemic period. Healthcare workers constitute a special group because they work in difficult conditions under high stress and danger in all periods and especially during periods of health crises such as epidemics or pandemics. In this context, experimental studies should be conducted with the participation of healthcare workers. The working conditions of healthcare workers should be improved, and they should be supported more by the state in social terms. Initiatives and research that will increase the psychological resilience of healthcare professionals should be planned.

The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author.

The studies involving humans were approved by Ethics Committee approval for the study was obtained from Diyarbakır Gazi Yaşargil Research and Training Hospital’s Non-Invasive Clinical Research Ethics Committee (Date: 28.04.2020, Number: 455). In line with the Declaration of Helsinki, the participants were given information about the study, and one of the researchers read the Informed Consent Form to the participants. The participants were included in the study after they gave verbal and written consent. The studies were conducted in accordance with the local legislation and institutional requirements. The participants provided their written informed consent to participate in this study. Written informed consent was obtained from the individual(s) for the publication of any potentially identifiable images or data included in this article.

BU: Conceptualization, Data curation, Funding acquisition, Investigation, Methodology, Project administration, Software, Writing – review & editing. SD: Conceptualization, Data curation, Formal analysis, Funding acquisition, Methodology, Validation, Writing – original draft.