Of the 264 health professionals recruited, 78.8% were female, 73.8% were white and 70.1% were between 30 and 49 years old. Regarding profession, 47.7% of the sample consisted of nursing technicians, 53.4% had less than five years of occupation, 56.3% worked up to 40 hours a week and 31.6% worked in two or more places. During the period of the COVID-19 pandemic, 21.2% said they had a family member who had lost their job, 65% had not received psychological guidance at work and 24.1% had not been tested for COVID-19. Among the professionals tested, 19.8% had positive results. In addition, 24.2% of professionals had chronic diseases (diabetes, hypertension or asthma) and 63.9% had already suffered a traumatic event in their lives (Table 1).

Table 1

Variable	n	%
Sociodemographic characteristics
Gender
Female	208	78.8
Male	56	21.2
Age*
20 to 29 years	50	19.7
30 to 39 years	93	36.6
40 to 49 years	85	33.5
50 years or more	26	10.2
Skin Color*
White	194	73.8
Black	24	9.1
Brown	45	17.1
Marital Status*
Married/living with a partner	177	67.3
Single	72	27.4
Divorced/widowed	14	5.3
Responsibility for family income
No	181	68.6
Yes	83	31.4
Occupational characteristics
Profession
Nursing technician	126	47.7
Nurse	67	25.4
Doctor	28	10.6
Radiology technician	24	9.1
Physiotherapist	19	7.2
Years of working in the current position
Less than 5 years	141	53.4
From 5 to 10 years	35	13.3
More than 10 years	88	33.3
Weekly working hours*
Up to 30 hours per week	87	33.1
Up to 40 hours per week	148	56.3
More than 40 hours per week	28	10.6
How many places do you work*
One	180	68.4
Two or more	83	31.6
Variables related to the COVID-19 pandemic
Having a family member who lost their job during the pandemic
No	208	78.8
Yes	56	21.2
Having received psychological counseling at work during the pandemic*
No	165	65.0
Yes	89	35.0
Having been tested for COVID-19*
No	63	24.1
Yes	198	75.9
Having been diagnosed with COVID-19 (n = 194)
No	158	80.2
Yes	39	19.8
Prior risk
Chronic diseases (diabetes, hypertension, or asthma)
No	200	75.8
Yes	64	24.2
Having suffered a traumatic life event*
No	93	36.1
Yes	165	63.9
Mental Health Assessment
Anxiety*
No	192	73.8
Yes	68	26.2
Depression*
No	177	67.6
Yes	85	32.4

Note: *Missing value.

Since the beginning of the COVID-19 pandemic, several countries have been concerned about the working conditions of their health professionals. Some countries already had protocols for these situations, due to previous epidemics. However, other countries, such as Brazil, did not have previous studies that investigated the psychological characteristics of health professionals exposed to an event such as an endemic/pandemic. The uncertain scenario of the pandemic in Brazil and the rapid increase in cases and deaths from COVID-19 could contribute to the emergence of psychological symptoms. In this study, the prevalence of depression and anxiety in health professionals was 32.4% and 26.2%, respectively. These prevalences were higher than those found in other studies that also used the GAD-7 and PHQ-9 scales (Naser et al., 2020; Rossi et al., 2020; Zhu et al., 2020), and a prevalence combined with a systematic review carried out with 13 studies (Pappa et al., 2020). However, our results on the prevalence of anxiety and depression are lower than those found by other studies that also used the same scales (AlAteeq et al., 2020; Gu et al., 2022; Lai et al., 2020).

Some of the characteristics of these studies may have contributed to the differences in prevalence. For example, a Chinese study found a prevalence of depression and anxiety of 50.4% and 44.6%, respectively, in approximately 60.5% of professionals working in Wuhan and 41.5% on the frontlines of COVID-19, in the initial period of the pandemic (i.e. January and February 2020) (Lai et al., 2020). This may have overestimated the prevalence in this population, given that, during this period, China found an increase in cases and hospitalizations due to the disease, and studies are still being conducted to understand the mechanism and etiology of SARS-CoV-2. Meanwhile, a study in Jordan, which found a prevalence of 21.2% and 11.3% for depression and anxiety, respectively, described a profile of health professionals, where 48.2% were doctors and only 53.1% were directly involved in the COVID-19 pandemic (Naser et al., 2020). These differences in prevalence can be explained by the different cutoff points adopted, cultural differences between countries, and the pandemic situation.

It is important to mention that the literature related to psychosocial care in an emergency context highlights that the first months after the event are essential for emergency preventive actions, considering that in this period individuals may present common (Fundação Oswaldo Cruz, 2020). However, the different phases of the pandemic may have increased the period of these responses; at a time when European countries, for example, were experiencing a decrease in COVID-19 cases and deaths, Brazil reached its peak. The anxiety and depressive symptoms found in this study from August to December 2020 represent a period in which the region faced an increase in the number of cases and deaths (Ministério da Saúde, 2021), but they had already been on alert since March 2020 with the initiation of COVID-19 prevention measures. Although it was not possible to identify whether these symptoms were classified as common reactions or were already chronic, it is important to understand that there are other factors related to these symptoms.

Regarding these associated factors, professionals aged 50 years or older had lower anxiety scores than their younger counterparts. This result is similar to that found in other studies during the COVID-19 pandemic (AlAteeq et al., 2020; Naser et al., 2020). However, only 10.2% of the professionals in our study were over 50 years old, which may have led to underestimating the anxiety scores of these participants; age was not associated with depressive symptoms, demonstrating that the sample size may not be the only explanation. Length of work experience may have contributed to the lower anxiety scores of professionals aged > 50 years.

Single and divorced/widowed health professionals had lower anxiety scores. It is possible that in the context of the COVID-19 pandemic, the fear of transmitting the virus to family members may have contributed to this result, as concern for the family is greater in individuals who are married or live with a partner. During the SARS epidemic of 2003, exposure to the virus and the possibility of infecting friends and family were risk factors for developing psychological symptoms (Wong et al., 2005).

In this study, other points that indicated that concern for the family may be related to psychological symptoms during the pandemic period were the association between depression and having a family member who lost their job, and the association between anxiety and being responsible for family income. A study conducted with US citizens during the COVID-19 pandemic showed that greater job insecurity was associated with an increase in depressive symptoms (Wilson et al., 2020). Another study in southern Brazil showed that participants who experienced economic losses during the COVID-19 pandemic were 1.4 times more likely to be at risk of anxiety and depression (Duarte et al., 2020). If concern for family and financial conditions are added, the professional may feel even more overwhelmed during this stressful period. These results are consistent with guidelines related to the pandemic, which state that concerns for the family can cause the onset of psychological symptoms (Ayanian, 2020).

Regarding profession, most of the sample in this study comprised nursing technicians who had higher depression scores. A higher proportion of nursing technicians may have overestimated the association in this study. However, these results are consistent with those of previous studies (Dal’Bosco et al., 2020; Wong et al., 2005). Previously, during the SARS epidemic, nurses and health aides had higher levels of distress than physicians (Wong et al., 2005), which may have been caused by increased contact with patients. A Brazilian study conducted among nursing professionals during the COVID-19 pandemic showed that technicians had a higher prevalence of anxiety (Dal’Bosco et al., 2020).

In this study, 35% of the professionals reported having received psychological guidance at work (brochures, online materials, or books), and these participants had lower scores for depression and anxiety. These results can be compared with those of a Chinese study (Kang et al., 2020) in which health professionals with severe mental disorders accessed fewer psychological materials and resources available in the media. Additionally, professionals with mild symptoms expressed interest in accessing psychological counseling materials (Kang et al., 2020). It is important to mention that these results demonstrate the importance of offering psychological guidance materials to health professionals, whether in person or digitally, as a method of promoting workers' mental health.

Approximately 75.9% of the health professionals were tested for COVID-19 and these professionals had higher depression and anxiety scores than those who were not tested. This result may be related to the fear of becoming infected because performing the test can demonstrate real proximity to the virus. However, there was no significant difference when the professionals were diagnosed with COVID-19. One possible explanation may be related to the sample size, which may have underestimated the association. In addition, professionals who were diagnosed with COVID-19 had already returned from the isolation period and probably felt calmer because they had already recovered, whereas those who tested negative continued to face an unpredictable prognosis.

Finally, one of the variables that was most associated with psychological outcomes in our study population was having experienced a traumatic event in life. This finding is consistent with the scientific literature, where the prevalence of exposure to a traumatic event in life ranged from 40% to 60% in previous studies (Breslau, 1991; Kessler, 1995; Norris, 1992; Resnick et al., 1993). In this study, 63.9% of health professionals reported having suffered some traumatic event in their lives. An American study demonstrated that acute stress events were associated with depression; individuals who experienced traumatic life events had higher depression scores than those who did not experience a traumatic life event (Muscatell et al., 2009). In the context of the COVID-19 pandemic, health professionals face challenges related to life and death more frequently and intensely, and having already suffered a traumatic event may have further aggravated their symptoms.

Working conditions play a crucial role in individuals' quality of life and mental health and may work either as protective or risk factors (International Labour Organization & World Health Organization, 2022). The constant fear caused by the pandemic and concerns about financial conditions added to the lack of adequate protective equipment and relationship problems with coworkers. According to the guidelines and recommendations for mental health at work, it is necessary to prevent exposure to mental health risks, promote mental health and well-being, and support those who already have a mental health condition (International Labour Organization & World Health Organization, 2022). A lack of support can interfere with the professional capacity of the worker, who alone is prone to greater illness and worse service delivery. Among all the factors associated with mental health outcomes in this study, few were related to individual characteristics (e.g., age), demonstrating that mental health promotion, prevention, and support services can achieve important results.

This study should be interpreted in light of its design limitations, as it is not possible to determine whether symptoms were absent prior to exposure to the pandemic; therefore, the results are subject to reverse causality. In addition, there may have been a sampling bias, as 47.7% of the professionals were nursing technicians. However, these professionals comprise a large proportion of health professionals who work on the frontlines in different parts of the country. Furthermore, this study was conducted in person during a period of difficult access and stress for the professionals. It is necessary to highlight the importance of this study, which is one of the first to investigate the mental health of Brazilian health workers during the COVID-19 pandemic. This study contributes to the most diverse areas of psychological science, mainly those that transition through the psychology of emergencies, workers' mental health, and collective mental health, providing scientific evidence about the population studied and the period itself.

This study identified a high prevalence of anxiety and depression among health professionals working in hospitals. One of the most relevant findings of this study was that receiving psychological guidance at work was a protective factor against anxiety and depression. Considering the unprecedented pandemic in Brazil, these results can aid the development of interventions and care protocols for Brazilian professionals after the pandemic period. Considering that health workers face major challenges inherent to their profession, continuous actions to support and prevent mental health problems are essential to improve the working conditions and quality of life of these professionals.