2.1. Study Design and Sample

A cross sectional survey was conducted, including 389 accessible HCWs during the COVID-19 pandemic in the governmental and private hospitals and primary health care centers in Saudi Arabia.

Tools used to assess mental and psychological health were the Arabic versions of the Patient Health Questionnaire-9 (PHQ-9) scale and the Generalized Anxiety Disorder 7-item (GAD-7) scale [16]. The PHQ-9 is the depression module, which scores each of the nine DSM-IV criteria as “0” (not at all) to “3” (nearly every day) [17]. It has been validated for use in primary care [18] and used to monitor the severity of depression. The total score of PHQ-9 ranges from 0 to 27; scores “0–4” mean no depression, scores “5–9” mean mild depression, scores “10–14” mean moderate depression, scores “15–19” mean moderately severe depression, and scores “20–27” mean severe depression. The GAD-7 is the anxiety module and scores of 5, 10, and 15 are taken as the cut-off points for mild, moderate, and severe anxiety, respectively [19,20].

The data were collected using a pre-structured online questionnaire developed by the researchers after an intensive literature review and expert consultation as a panel of 3 consultants reviewed the items independently. Any discrepancy regarding any item was resolved by consensus at first, then by voting. After agreeing on the final questionnaire format, it was raised online using social media platforms and sent to all accessible staff using a snowball sampling method. The survey remained on the social media platforms from May till mid July 2020. The questionnaire included HCW’s personal data, academic position, qualification, years of experience, chronic health problems, and setting. The amount of contact with COVID-19 cases and history of getting COVID-19 infection were also considered.

Before starting the survey, the participants were informed about the aims of the study and the protection of personal data. They were asked to confirm their informed consent to participate. The study was conducted in accordance with the Declaration of Helsinki, and it was approved by the King Khalid University Research Ethics Committee (Approval Number: ECM#2020-237-HAPO-06-B-001) and the Research Ethical Committee at General Directorate of Health Affairs, Aseer Region, Saudia Arabia.

A pilot study of 20 HCWs was done to assess PHQ-9 and GAD-7 applicability and reliability. Both tools showed α-Cronbach’s of 0.85 and 0.77, respectively.