Factors associated with mental health outcomes across healthcare settings in Oman during COVID-19: Frontline versus non-frontline healthcare workers

Muna Alshekaili, Walid Hassan, Nazik Al Said, Fatima Al Sulaimani, Sathish Kumar Jayapal, Adhra Al-Mawali, Moon Fai Chan, Sangeetha Mahadevan, Samir Al-Adawi*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

92 Citations (Scopus)


Objective This study aims to assess and compare demographic and psychological factors and sleep status of frontline healthcare workers (HCWs) in relation to non-frontline HCWs. Design, settings, participants and outcomes This cross-sectional study was conducted from 8 April 2020 to 17 April 2020 using an online survey across varied healthcare settings in Oman accruing 1139 HCWs. The primary and secondary outcomes were mental health status and sociodemographic data, respectively. Mental health status was assessed using the Depression, Anxiety, and Stress Scale (DASS-21), and insomnia was evaluated by the Insomnia Severity Index. Samples were categorised into the frontline and non-frontline groups. χ 2 and t-Tests were used to compare groups by demographic data. The Mantel-Haenszel OR was used to compare groups by mental health outcomes adjusted by all sociodemographic factors. Results This study included 1139 HCWs working in Oman. While working during the pandemic period, a total of 368 (32.3%), 388 (34.1%), 271 (23.8%) and 211 (18.5%) respondents were reported to have depression, anxiety, stress and insomnia, respectively. HCWs in the frontline group were 1.5 times more likely to report anxiety (OR=1.557, p=0.004), stress (OR=1.506, p=0.016) and insomnia (OR=1.586, p=0.013) as compared with those in the non-frontline group. No significant differences in depression status were found between the frontline and non-frontline groups (p=0.201). Conclusions To our knowledge, this is the first study to explore the differential impacts of the COVID-19 pandemic on different grades of HCWs. This study suggests that frontline HCWs are disproportionally affected compared to non-frontline HCWs, with managing sleep-wake cycles and anxiety symptoms being highly endorsed among frontline HCWs. As psychosocial interventions are likely to be constrained owing to the pandemic, mental healthcare must first be directed to frontline HCWs.

Original languageEnglish
Article numbere042030
JournalBMJ Open
Issue number10
Publication statusPublished - Oct 10 2020


  • anxiety disorders
  • depression & mood disorders
  • public health
  • quality in health care

ASJC Scopus subject areas

  • Medicine(all)


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