Psychological distress among nurses before and after COVID-19 vaccines: A repeated cross-sectional study

Background Extensive research conducted during the COVID-19 pandemic has consistently found significant levels of anxiety, perceived stress and depression among healthcare workers, particularly among nurses. Nevertheless, the effect of COVID-19 vaccine availability on the psychological distress of healthcare workforce remains unexplored. Objective To compare levels of anxiety, perceived stress and depression among Spanish nurses immediately before and after the full COVID-19 vaccination protocol which was conducted in Spain throughout 2021. Methods We employed a repeated cross-sectional design recruiting 439 and 410 Spanish registered nurses at the first (pre-vaccination) and second (post-vaccination) timepoints respectively. Data on psychological distress were collected via online surveys using the Perceived Stress Scale (PSS) and the Hospital Anxiety and Depression Scale (HADS). Results After vaccination nurses showed lower perceived stress and depression with a small effect size, but anxiety was not reduced. The magnitude of these effects was very small. Although in both timepoints psychological distress was higher in women, the initial differences between frontline and non-frontline professionals tended to disappear. Over the period studied, the proportion of nurses receiving psychiatric or psychological care increased from 7.7% to 20.4%, and half of those using psychotropic drugs had started treatment in the preceding year. Conclusions The psychological distress of nurses continued being a relevant problem even after COVID-19 vaccines became available. Policymakers and health systems must ensure adequate psychological support for nurses and a supportive work environment to improve their long-term resilience and well-being, regardless of the existence of effective vaccines.