Identifying the Influencing Factors of Depressive Symptoms among Nurses in China by Machine Learning: A Multicentre Cross-Sectional Study

Background. Nurses' high workload can result in depressive symptoms. However, the research has underexplored the internal and external variables, such as organisational support, career identity, and burnout, which may predict depressive symptoms among Chinese nurses via machine learning (ML). Aim. To predict nurses' depressive symptoms and identify the relevant factors by machine learning (ML) algorithms. Methods. A self-administered smartphone questionnaire was delivered to nurses to evaluate their depressive symptoms;1,431 questionnaires and 28 internal and external features were collected. In the training set, the use of maximum relevance minimum redundancy ranked the features' importance. Five ML algorithms were used to establish models to identify nurses' depressive symptoms using different feature subsets, and the area under the curve (AUC) determined the optimal feature subset. Demographic characteristics were added to the optimal feature subset to establish the combined models. Each model's performance was evaluated using the test set. Results. The prevalence rate of depressive symptoms among Chinese nurses was 31.86%. The optimal feature subset comprised of sleep disturbance, chronic fatigue, physical fatigue, exhaustion, and perceived organisation support. The five models based on the optimal feature subset had good prediction performance on the test set (AUC: 0.871–0.895 and accuracy: 0.798–0.815). After adding the significant demographic characteristics, the performance of the five combined models slightly improved;the AUC and accuracy increased to 0.904 and 0.826 on the test set, respectively. The logistic regression analysis results showed the best and most stable performance while the univariate analysis results showed that external and internal personal features (AUC: 0.739–0.841) were more effective than demographic characteristics (AUC: 0.572–0.588) for predicting nurses' depressive symptoms. Conclusions. ML could effectively predict nurses' depressive symptoms. Interventions to manage physical fatigue, sleep disorders, burnout, and organisational support may prevent depressive symptoms.

Long-COVID and its Physical and Neurological Symptoms in Adults: A Systematic Review

This review was carried out with the objective to study patterns of neurological, psychological and other physical consequences of COVID-19 in the long term. The guidelines of PRISMA (Preferred Reporting Items for Systematic Reviews and Metaanalyses) had been followed;22 articles, published during January 2020 to September 2021, were selected. Original research, review articles, editorial and viewpoints were included. Google Scholar, Medline, and PubMed were searched through 2020 till 2021.Data collection in selected studies was performed mainly through the online survey, telephone survey, use of medical records, and patient interviews. This systematic review contains the studies conducted in the American, Asian and European countries. The major outcomes identified were the neurological, psychological, and other long-term chronic manifestations of COVID- 19. This review demonstrates that long-COVID has started to bring a huge wave of patients, the count of them being millions now, who can enter a phase of disability due to neurological damages if not treated during the early course of illness. Though more disabling than lethal, long-COVID patients with a neurological deficit is expected to overburden the healthcare system globally which is already been struggling to handle acute COVID-19 patients in this once-in-a-lifetime pandemic.Copyright © 2023 Lahore Medical And Dental College. All rights reserved.

The Very Long COVID: Persistence of Symptoms after 12-18 Months from the Onset of Infection and Hospitalization.

According to the World Health Organization's definition, long COVID is the persistence or development of new symptoms 3 months after the initial infection. Various conditions have been explored in studies with up to one-year follow-up but very few looked further. This prospective cohort study addresses the presence of a wide spectrum of symptoms in 121 patients hospitalized during the acute phase of COVID-19 infection, and the association between factors related to the acute phase of the disease and the presence of residual symptoms after one year or longer from hospitalization. The main results are as follows: (i) post-COVID symptoms persist in up to 60% of the patient population at a mean follow-up of 17 months; (ii) the most frequent symptoms are fatigue and dyspnea, but neuropsychological disturbances persist in about 30% of the patients (iii) when corrected for the duration of follow-up with a freedom-from-event analysis; only complete (2 doses) vaccination at the time of hospital admission remained independently associated with persistence of the major physical symptoms, while vaccination and previous neuropsychological symptoms remained independently associated with persistence of major neuropsychological symptoms.

Patients' lived experience and reflections on long COVID: an interpretive phenomenological analysis within an integrated adult primary care psychology NHS service.

BACKGROUND: Long Covid is an unknown illness which has been shown to affect sufferers regardless of mild initial COVID-19 or age. There is still a lot unknown about long COVID illness. There has been a call to understand this illness not only from a professional standpoint but also through the lived experience of patients. Patient reported outcomes through lived experience research is one such angle. To date, no research has explored the overall lived experiences and long COVID illness trajectory perspectives of the patients. This study aimed to gather patient reported outcomes of their long COVID through lived experience research. It recruited adult participants aged 18-years and over who had been referred to a primary care integrated psychology service. The study employed qualitative research using semi-structured interviews and Interpretive Phenomenological Analysis methodology. RESULTS: A total of eighteen participants completed the study. From their lived experiences, the participants uncovered the varied symptoms of long COVID. They also uncovered their lived progression of living with an unknown chronic illness. Common themes included uncertainty, mental and social impacts, and the processes of self-advocacy, mastering their symptoms, subjective recovery and future coping. CONCLUSION: This study uncovered the lived experience of long COVID in participants. The results from this study uncovered the lived subjective biopsychosocial experiences of long COVID chronic illness. Traditionally, patients receive care and recommendations from healthcare professionals. However, as long COVID is a new illness, this care model was limited. The participants in the current study described being left with a sense of uncertainty and role confusion. However, participants were able to realize their locus of control over their long COVID illness progression. This illustrates that patients have the resources to uncover the unknowns of this new illness which could inform clinical practice and further research. This suggests that that long COVID needs to be approached from a biopsychosocial perspective which emphasises patient involvement.

Resilience factors during the Coronavirus pandemic: Testing the main effect and stress buffering models of optimism and positive affect with mental and physical health.

This study investigates associations between resilience factors (optimism and positive affect) and self-rated health during the COVID-19 pandemic. Longitudinal data were collected (N = 292) across five assessments. Multilevel modeling tested main effects of the resilience factors and how they interacted with stress to predict health. Greater optimism and positive affect were prospectively associated with fewer depressive symptoms (ps < 0.01) and a lower burden of physical health symptoms (ps <0.01). Positive affect interacted with stress to predict depressive symptoms (p < 0.05), suggesting a stress buffering effect. These findings suggest that resilience factors may improve health during COVID-19.

Most Common Long COVID Physical Symptoms in Working Age Adults Who Experienced Mild COVID-19 Infection: A Scoping Review.

BACKGROUND: One-third of patients who recover from COVID-19 present with long COVID. Their symptoms are broad, affecting their physical functioning and, ultimately, their quality of life. Many of those individuals who develop long COVID, possibly from a mild COVID-19 infection, are in the 18-65 age group. This prolongation of malaise directly influences national workforce economies. OBJECTIVES: To summarise the commonly reported physical symptoms of long COVID in order to inform potential adjustments in healthcare for the employable population. METHODS: The Embase, CINAHL, Medline, SCOPUS, and WHO COVID-19 databases were searched. The study selection process was based on the PRISMA guidelines. The extracted data were synthesised and presented narratively. RESULTS: 7403 studies were accessed, comprising 60 cohort studies and 10 case series/studies, representing 289,213 patients who met our criteria. The most frequently reported physical symptoms were fatigue (92%), shortness of breath (SOB) (81.8%), muscle pain (43.6%), and joint pain (34.5%). CONCLUSIONS: The range of reported physical symptoms was broad and varied; the main ones being fatigue, breathlessness/SOB, and pain. Similarities observed between long COVID and other post-acute infection syndromes may help formulate protocols to manage and promote recovery for long COVID patients. Inconsistencies were evident, particularly with a lack of adherence to the standardised definitions of long COVID.

[Tiredness, fatigue and exhaustion: all the same or manifestations of a continuum?-Food for thought]. / Müdigkeit, Fatigue und Erschöpfung: Alles das Gleiche oder Ausprägungen eines Kontinuums? ­ Ein Diskussionsanstoß.

Owing to the COVID-19 pandemic and the associated post-COVID syndrome, the concept "fatigue" has gained significant importance. However, both the definition and the causes of fatigue differ depending on the disease pattern in question. Moreover, individuals who describe their symptoms in everyday clinical settings seem almost universally to use the terms tiredness, fatigue and exhaustion synonymously. In 2007, Olson described these three terms as being distinct states in her view, but that they can be placed in relation to each other on a continuum. Taking up this consideration, an overview of current research is provided. For this purpose, the published literature of the last 2 years was searched for the terms "tiredness", "fatigue" and "exhaustion". Some common diagnostic instruments can be found. However, the great variety of instruments used to capture the three terms is striking. Despite these different diagnostic and definition possibilities, different therapeutic measures can be derived for each of the three symptoms. It is crucial, especially with regard to further therapy, to separate the three terms tiredness, fatigue and exhaustion from each other and to consider each of them separately on the common continuum. This is the only way to establish both an accurate diagnosis and the successful individual therapy that goes along with it.

Family Conflict, Physical Symptoms, and Post Traumatic Stress among Sexual Minorities during the COVID Pandemic: A Moderated Mediation Model.

Sexual minorities experience health disparities compared to heterosexuals due to their stigmatized identies. The COVID- 19 pandemic has further exacerbated these disparities. Sexual minorities were surveyed about their experiences during the pandemic and asked about family conflict and minority stress as predictors of Post Traumatic Stress Symptoms (PTSS) and physical health symptoms, as well as psychological symptoms as a mediator of these relationships. We surveyed 435 sexual minorities who were recruited from Mechanical MTurk. Participants completed questionnaires that included demographics, PTSS in response to the pandemic, family conflict, minority stress, psychological symptoms, and physical health outcomes. Our findings support a moderated mediational model, explaining the relationships between family conflict, minority stress, PTSS and physical symptoms. Specifically, those participants who are high in minority stress are vulnerable to family conflict resulting in increased PTSS and physical symptoms. Psychological symptoms mediated these relationships.

IMPROVING COMMUNICATION ON MEDICAL WARD ROUNDS IN PATIENTS WITH LIMITED ENGLISH BY IMPLEMENTING MEDICAL COMMUNICATION CHARTS

Aim To improve communication on the medical ward round with patients with limited English through implementation of a medical communication chart. Introduction King’s College Hospital (KCH), London, is situated in Southwark in which 11% of households have no members that speak English as a first language, 4.1% of London’s population report they do not speak English well. Language barriers impair healthcare delivery including during daily ward rounds. This has been exacerbated by the need for PPE during the SARS-CoV2 pandemic. Effective communication between healthcare teams and patients is essential for high quality, patient-centred care. Communication tools commonly used include online, telephone and face-to-face translation services but these have limitations. Method Face-to-face patient questionnaires were conducted in the pre-QIP (baseline) group to assess communication on medical ward rounds. Medical communication charts were designed by adapting pre-existing aids commonly used by speech and language therapy. Charts were translated into commonly spoken languages among KCH inpatients. Patients with limited English were selected from both COVID-19 and non-Covid wards. Pre-intervention and post-intervention questionnaires were completed in three Plan–Do–Study–Act (PDSA) cycles. Results At baseline, patients agreed or strongly agreed that the ward round addressed physical symptoms (8/8), concerns or anxieties (7/8), ongoing needs (7/8). Only 2/8 doctors felt they could communicate effectively with patients. In PDSA 1, 4/5 patients reported high satisfaction in communicating physical symptoms, anxieties or concerns pre-intervention with 5/5 post-chart implementation. 5/5 patients reported high satisfaction in communicating ongoing needs pre-intervention but only 3/5 post-intervention. In PDSA 2, 2/5 patients reported increased satisfaction in communicating physical symptoms, concerns or anxieties with 4/4 doctors reporting improved satisfaction in communication in PDSA 2 and 2/3 doctors reporting higher satisfaction in communication in PDSA 3. Conclusion Medical communication charts can help in delivering high-quality, patient-centred care in multicultural and multilingual healthcare settings within the NHS.

Manifestation of Generalized Anxiety Disorder and Its Association With Somatic Symptoms Among Occupational and Physical Therapists During the COVID-19 Pandemic.

Purpose: The purpose of the study was to examine the level of generalized anxiety disorder among occupational and physical therapists during treatment sessions and its association with somatic symptoms during the COVID-19 pandemic. Methods: A descriptive cross-sectional design was used in this study. Data were collected during the month of April 2021, and the study included occupational and physical therapists who practiced during COVID-19 from March 2020 to March 2021. The generalized anxiety disorder scale (GAD-7) and a modified patient health questionnaire (mPHQ-15) were used to examine self-reported anxiety and somatic symptoms among the study participants. The independent t-test was used to determine differences between groups based on GAD-7 and mPHQ-15 results. Spearman's correlation test and chi-squared test were used to find the relationships between different variables such as anxiety and somatic symptoms. Results: The study (n = 98 participants) included 56 occupational and 42 physical therapists. An 84% response rate was achieved. GAD-7 final score was µ = 9.21 ± 5.63 with 27% reporting no anxiety, 14% mild, 38% moderate, and 21% severe. Independent t-tests on GAD-7 scores showed significant differences between therapist specializations [t(96) = -2.256; p = 0.026] and between therapists residing with or without their parents [t(96) = -2.536; p = 0.013]. The mPHQ-15 final score was µ = 9.52 ± 5.54 with 13% reporting no symptoms (n = 13), 20% mild (n = 20), 38% moderate (n = 37), and 29% severe (n = 28). GAD-7 and mPHQ-15 scores were moderately positively correlated [r(96) = 0.569; p <0.000]. The chi-squared test showed a significant association between GAD-7 levels of anxiety and mPHQ-15 levels of somatic symptoms [x2(9, N = 98) = 70.62 p <0.000]. Therapists reported that the quality (76%) and effectiveness (20%) of their rehabilitation services were negatively impacted by the COVID-19 pandemic. Conclusion: The majority of study participants experienced moderate to severe anxiety and associated somatic symptoms. During COVID-19, ongoing psychological counseling of healthcare professionals such as occupational and physical therapists is required to maintain positive mental health. Implications for practice are presented.

Psychosomatic Symptoms in Terminally Ill Cancer Patients and Its Relation With Using Complementary and Alternative Medicines: A Cross-Sectional Study in Southeast Iran.

Background: Cancer patients face various problems and complications, which they address through various complementary and alternative medicines (CAM). The aim of this study was to investigate the relationship between CAM and psychosomatic symptoms in terminally ill cancer patients. Methods: This cross-sectional study was performed on 221 terminally ill cancer patients (based on metastatic stage and according to the physicin diagnosis) in southeastern Iran. Convenience sampling was used to select terminally ill cancer patients. Using questionnaires like the demographic and clinical information questionnaire, Edmonton Symptom Assessment Scale (ESAS), Hospital Anxiety and Depression Scale (HADS), CAM questionnaire and satisfaction with the use of CAM, the researcher was able to compile a comprehensive picture of the population. Results: The mean age of the participants was 51.66 ± 13.34 years. The majority of the samples were female, married, educated, and unemployed. The mean score for the physical symptoms of the participants according to ESAS was 22.25 ± 17.57 which was less than the midpoint of the scale (the possible score of ESAS was 0-100). Only 2.7% (n = 6) and 0.9% (n = 2) of the participants had mild and moderate anxiety, respectively, and the other participants' anxiety levels were normal. Only 7.7% (n = 17) and 4.1% (n = 9) of the participants had mild and moderate depression, respectively, and the other participants' depression levels were normal. Last year, 87.3% of the participants used at least one type of CAM. Aside from prayer, 42.1% of the participants used at least one type of CAM in the last year. Prayer was used by 83.7% of the participants, medicinal plants by 35.8%, massage by 9.5%, dietary supplements by 3.6%, wet cupping by 3.2%, relaxation and meditation by 2.7%, dry cupping by 2.4%, and acupuncture by 0.5%. The common reason for using CAM was to reduce the stress and anxiety caused by cancer and to treat it. There were no significant differences in physical and psychological symptoms between the CAM-users and non-CAM users. Conclusion: Patients with cancer have a relatively low level of psychosomatic symptoms, and the primary reason for using CAM was to relieve stress and anxiety associated with cancer and treat it. However, psychosomatic symptoms were the same for CAM and non-CAM users. Because so many people with cancer use CAM, future studies should look into why and how CAM is used.

Day-to-day associations between nightly sleep and next-day well-being amid the COVID-19 pandemic in North America.

OBJECTIVE: Sleep may be especially important for maintaining health and well-being in daily life amid the stress of the coronavirus disease 2019 (COVID-19) pandemic. This preregistered study examined the associations of sleep quality, duration, and efficiency with next-day physical symptoms, affect, and stressors during the COVID-19 pandemic in North America, in addition to evaluating individual differences in COVID-19 threat as a moderator. METHOD: From mid-March to early August 2020, 1025 adults from Canada and the United States aged 18-91 reported COVID-19 threat at baseline and subsequently completed twice-daily diaries for one week about their sleep, negative affect, stressors, and physical symptoms. RESULTS: Within-persons, nights with better-than-usual sleep quality predicted lower next-day negative affect, physical symptoms, and stressor occurrence. Better-than-usual sleep efficiency and longer-than-usual sleep duration also predicted lower next-day physical symptoms. COVID-19 threat ratings moderated several of these associations, such that individuals with higher COVID-19 threat showed weaker within-person associations of sleep duration and efficiency with next-day well-being, compared to individuals with lower-to-moderate levels of COVID-19 threat. For the reversed direction of association, stressor occurrence predicted shorter-than-usual sleep that night, but no other links between daily well-being and subsequent sleep were observed. DISCUSSION: Sleep quality, efficiency, and duration were important predictors of daily health and well-being during the COVID-19 pandemic, but the protective associations between sleep and next-day well-being were attenuated among people with higher COVID-19 threat. These findings highlight the role of heightened stress contexts when considering the benefits of sleep on daily health and well-being.

Changes in Depressive Symptoms, Physical Symptoms, and Sleep-Wake Problems from before to during the COVID-19 Pandemic among Emerging Adults: Inequalities by Gender, Socioeconomic Position, and Race.

The impact of the COVID-19 pandemic on emerging adults is of global concern. We examine changes in depressive symptoms, physical symptoms, and sleep-wake problems from before to during the pandemic among college students, and examine inequalities by gender, socioeconomic status (SES), and race (N=263, 52% Black, 48% White, 53% female). As compared to pre-pandemic levels, increases were evident in depressive symptoms, physical symptoms, and sleep problems. Females had greater increases than males in depressive symptoms, sleep problems, and physical symptoms. Students from disadvantaged SES backgrounds had greater increases in physical symptoms. Among White students, those from disadvantaged backgrounds also had greater increases in sleep problems. Lastly, daytime sleepiness increased more among Black male than White male students. Overall, findings suggest notable shifts in sleep and health during the early phase of the pandemic among emerging adults, and that attention to inequality by gender, SES, and race is warranted.

Written benefit finding for improving psychological health during the Covid-19 pandemic first wave lockdown.

Objectives. Written benefit finding is known to improve psychological and physical health in a range of patient groups. Here, we tested the efficacy of written benefit finding, delivered online during the Covid-19 pandemic lockdown, on mood and physical symptoms. We also investigated perseverative thinking as a moderator of these effects. Design. A quantitative longitudinal design was employed. Main Outcome Measures. Participants (n = 91) completed self-report measures of anxiety, depression, stress and physical symptoms at baseline, and two weeks after being randomised to complete three consecutive days of writing about the positive thoughts and feelings they experienced during the pandemic (written benefit finding) or to unemotively describe the events of the previous day (control). State anxiety was measured immediately before and after writing. Perseverative thinking was measured at baseline. Results. Anxiety and depression symptoms decreased between baseline and the two week follow-up, but did not differ significantly between the two conditions. Perseverative thinking was negatively associated with changes in symptoms of anxiety, depression and stress, but did not moderate any writing effects. There was a significant reduction in state anxiety in the written benefit finding condition. Conclusions. Written benefit finding may be a useful intervention for short-term improvements in wellbeing.

Psychological reactions to COVID-19: Survey data assessing perceived susceptibility, distress, mindfulness, and preventive health behaviors.

The COVID-19 pandemic created a complex psychological environment for persons in America. A total of 450 USA MTurk workers completed measures of: (a) basic demographic characteristics; (b) health risk factors for COVID-19; (c) perceived susceptibility variables related to COVID-19; (d) COVID-19 preventive health behaviors; and (e) distress, physical symptoms, and quality of life measures. The surveys were completed between April 9, 2020 and April 18, 2020. This recruitment period corresponded to the first 2-3 weeks of lockdown in most of the USA. Follow-up surveys were completed by 151 of the USA participants between June 19, 2020 and July 11, 2020 (approximately 2 months after the first measurement). These data permit evaluation of relationships among demographic variables, COVID-19 stress and coping, COVID-19 preventive health behavior, and the role of mindfulness as a possible moderator of distress as well as a predictor of preventive health behavior. The availability of follow-up data permit longitudinal analyses that provide a stronger basis for causal inference.

Predicting personal protective equipment use, trauma symptoms, and physical symptoms in the USA during the early weeks of the COVID-19 lockdown (April 9-18, 2020).

The COVID-19 pandemic created a complex psychological environment for Americans. In this study, 450 MTurk workers completed measures of sociodemographic characteristics, perceived risk for COVID-19, general perceived vulnerability to disease, intolerance of uncertainty, and psychological flexibility. These variables were used to predict COVID-19 preventive health behaviors (PPE use), psychological distress, and physical symptoms. The surveys were completed between April 9, 2020 and April 18, 2020 which is a period that corresponded to the first 2-3 weeks of lockdown for most participants. A demographically diverse sample of participants was recruited. A substantial number of participants reported a reduction employment status and 69% were in self-isolation. Participants reported a high degree of perceived vulnerability to COVID-19. PPE mask wearing was variable: 16% "not at all," 20% "some of the time," 42% "a good part of the time," and 26 "most of the time." Using clinical cutoff on the post-trauma scale, 70% of the sample would be considered to have symptoms consistent with PTSD. Physical symptom reporting was also high. Intolerance of uncertainty and psychological inflexibility were significant predictors of psychological distress and physical symptoms. Psychological flexibility moderated the relationship between intolerance of uncertainty and psychological distress/physical symptoms. The relationship between intolerance of uncertainty and psychological distress/physical symptoms was stronger among participants with lower levels of psychological flexibility. These findings indicate psychological flexibility can reduce distress associated with COVID-19. Additionally, these results support the workability of the Unified Flexibility and Mindfulness Model as a framework for studying health behavior.

COVID-19 and Pretentious Psychological Well-Being of Students: A Threat to Educational Sustainability.

Since the outbreak of COVID-19, reaction quarantine, social distancing, and economic crises have posed a greater risk to physical and psychological health. Such derogatory mental health stigma is associated with adverse outcomes in the student population. The purpose of the current study is to provide a timely evaluation of the COVID-19 pandemic and its adverse effects on students' psychological well-being to sustain economic sustainability. A thorough review of the literature and current studies, significant emphasis of socio-demographic indicators, interpretation of physical symptoms, home quarantine activities, and COVID-19 unique stressors were extracted. Data were collected through electronic surveys from 640 university students at local and foreign universities. The findings revealed substantial adverse effects resulting in varying levels of stress, symptoms of depression, and specific discomfort in the case. Among COVID-19 stressors, financial instability, unpredictability toward future/career, and media exposure have been described as common factors that cause poor psychological well-being and weaken economic sustainability. COVID-19, quarantine, self-isolation, and onerous interventions primarily weaken university students' mental health. The emphasis on this vulnerable category, however, is substantially absent from the literature. This research addresses the urgent need to develop possible solutions and preventive measures to promote economic sustainability by ensuring students' psychological well-being.

Health-related quality of life of hospitalized COVID-19 survivors: An initial exploration in Nanning city, China.

Understanding the health-related quality of life (HrQoL) of hospitalized COVID-19 survivors is an emerging global challenge arising from the current pandemic. A qualitative study of the experiences of sixteen hospitalized COVID-19 survivors from Nanning City, China, was conducted using semi-structured telephone interviews in May 2020. These first-hand accounts were critically and empirically analysed to identify emerging health and social issues, and provide potential solutions to improve survivors' quality of life. This in-depth, qualitative study of HrQoL for hospitalized COVID-19 survivors provides the first empirical evidence and conceptual framework with eight dimensions (physical symptoms, anxiety, trauma, economic loss, place-based identity, self-stigma, health self-interventions, and changing lifestyle) for understanding the physiological, psychological, socio-economic and health behavioral aspects of their daily lives. We argue that local and global governments should provide integrated healthcare, social and digital infrastructure to support this vulnerable group. More comparative and multi-disciplinary studies in this area are needed to generate academic standards of assessing health-related quality of life and produce good practice guidelines for promoting urban resilience in response to public health disasters.

A multinational, multicentre study on the psychological outcomes and associated physical symptoms amongst healthcare workers during COVID-19 outbreak.

OBJECTIVE: Since the declaration of the coronavirus 2019 (COVID-19) outbreak as pandemic, there are reports on the increased prevalence of physical symptoms observed in the general population. We investigated the association between psychological outcomes and physical symptoms among healthcare workers. METHODS: Healthcare workers from 5 major hospitals, involved in the care for COVID-19 patients, in Singapore and India were invited to participate in a study by performing a self-administered questionnaire within the period of February 19 to April 17, 2020. Healthcare workers included doctors, nurses, allied healthcare workers, administrators, clerical staff and maintenance workers. This questionnaire collected information on demographics, medical history, symptom prevalence in the past month, Depression Anxiety Stress Scales (DASS-21) and the Impact of Events Scale-Revised (IES-R) instrument. The prevalence of physical symptoms displayed by healthcare workers and the associations between physical symptoms and psychological outcomes of depression, anxiety, stress, and post-traumatic stress disorder (PTSD) were evaluated. RESULTS: Out of the 906 healthcare workers who participated in the survey, 48 (5.3%) screened positive for moderate to very-severe depression, 79 (8.7%) for moderate to extremely-severe anxiety, 20 (2.2%) for moderate to extremely-severe stress, and 34 (3.8%) for moderate to severe levels of psychological distress. The commonest reported symptom was headache (32.3%), with a large number of participants (33.4%) reporting more than four symptoms. Participants who had experienced symptoms in the preceding month were more likely to be older, have pre-existing comorbidities and a positive screen for depression, anxiety, stress, and PTSD. After adjusting for age, gender and comorbidities, it was found that depression (OR 2.79, 95% CI 1.54-5.07, p = 0.001), anxiety (OR 2.18, 95% CI 1.36-3.48, p = 0.001), stress (OR 3.06, 95% CI 1.27-7.41, p = 0.13), and PTSD (OR 2.20, 95% CI 1.12-4.35, p = 0.023) remained significantly associated with the presence of physical symptoms experienced in the preceding month. Linear regression revealed that the presence of physical symptoms was associated with higher mean scores in the IES-R, DASS Anxiety, Stress and Depression subscales. CONCLUSIONS: Our study demonstrates a significant association between the prevalence of physical symptoms and psychological outcomes among healthcare workers during the COVID-19 outbreak. We postulate that this association may be bi-directional, and that timely psychological interventions for healthcare workers with physical symptoms should be considered once an infection has been excluded.