{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,21]],"date-time":"2026-03-21T04:39:40Z","timestamp":1774067980413,"version":"3.50.1"},"reference-count":45,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2022,5,5]],"date-time":"2022-05-05T00:00:00Z","timestamp":1651708800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100012775","name":"Royal Melbourne Hospital","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100012775","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Australian J Rural Health"],"published-print":{"date-parts":[[2022,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>The Australian COVID\u201019 Frontline Healthcare Workers study examined the prevalence and severity of mental health symptoms during the second wave of the COVID\u201019 pandemic. This substudy examined the differences in psychological well\u2010being between rural and metropolitan health care workers (HCWs).<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>A nationwide survey conducted between August and October 2020.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting and Participants<\/jats:title><jats:p>Australian HCWs were recruited through multiple strategies.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main outcome measures<\/jats:title><jats:p>Demographics, mental health outcomes (anxiety, depression, post\u2010traumatic stress disorder [PTSD] and burnout).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Complete responses were included from 7846 participants, with 1473 (18.8%) in regional or remote (\u2018rural\u2019) areas and 81.2% in metropolitan areas. Rural participants were older, more likely to work in allied health, nursing or in health administration, and had worked longer in their profession than metropolitan participants. Levels of resilience were similar (<jats:italic>p<\/jats:italic>\u00a0=\u20090.132), but there was significantly higher prevalence of pre\u2010COVID\u201019 pandemic mental illness in the rural workforce (<jats:italic>p<\/jats:italic>\u00a0&lt;\u20090.001). There were high levels of current mental health issues: moderate\u2013severe PTSD (rural 38.0%; metropolitan 41.0% <jats:italic>p<\/jats:italic>\u00a0=\u20090.031); high depersonalisation (rural 18.1%; metropolitan 20.7% <jats:italic>p<\/jats:italic>\u00a0=\u20090.047); and high emotional exhaustion (rural 46.5%; metropolitan 43.3% <jats:italic>p<\/jats:italic>\u00a0=\u20090.002). Among rural participants, mental health symptoms were associated with younger age, worry about being blamed if they contracted COVID\u201019, fear of transmitting COVID\u201019 to their family, experiencing worsening relationships and working in primary care or allied health.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Despite having low COVID\u201019 case numbers in rural Australian health services compared with metropolitan counterparts over the course of 2020, there were widespread mental health impacts on the workforce. Rural health services need specific and flexible training, education, work policies and practices that support psychological well\u2010being now in preparedness for ongoing or future crises.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ajr.12873","type":"journal-article","created":{"date-parts":[[2022,5,5]],"date-time":"2022-05-05T15:07:03Z","timestamp":1651763223000},"page":"683-696","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":24,"title":["Differences in psychosocial distress among rural and metropolitan health care workers during the <scp>COVID<\/scp>\u201019 pandemic"],"prefix":"10.1111","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9362-5189","authenticated-orcid":false,"given":"Rachel","family":"Tham","sequence":"first","affiliation":[{"name":"Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health The University of Melbourne  Melbourne Victoria Australia"},{"name":"La Trobe Rural Health School La Trobe University  Bendigo Victoria Australia"},{"name":"Mary MacKillop Institute for Health Research Australian Catholic University  Melbourne Victoria Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amy","family":"Pascoe","sequence":"additional","affiliation":[{"name":"Department of Allergy, Immunology and Respiratory Medicine, Central Clinical School The Alfred Hospital, Monash University  Melbourne Victoria Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karen","family":"Willis","sequence":"additional","affiliation":[{"name":"College of Health and Biomedicine Victoria University  Melbourne Victoria Australia"},{"name":"Division of Critical Care and Investigative Services Royal Melbourne Hospital  Parkville Victoria Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Margaret","family":"Kay","sequence":"additional","affiliation":[{"name":"Primary Care Clinical Unit Royal Brisbane and Women's Hospital  Herston Queensland Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Natasha","family":"Smallwood","sequence":"additional","affiliation":[{"name":"Department of Allergy, Immunology and Respiratory Medicine, Central Clinical School The Alfred Hospital, Monash University  Melbourne Victoria Australia"},{"name":"Department of Respiratory Medicine The Alfred Hospital  Prahran Victoria Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2022,5,5]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-019-05376-x"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/JXX.0000000000000517"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcjq.2020.09.011"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.5694\/mja15.01044"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph18179263"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1056\/CAT.20.0378"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.2196\/24983"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1159\/000507639"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.5811\/westjem.2020.7.48684"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.17061\/phrp3132110"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1136\/gpsych-2021-100577"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.genhosppsych.2021.08.008"},{"key":"e_1_2_12_14_1","first-page":"18","article-title":"Moral distress and perceived community views are associated with mental health symptoms in frontline health workers during the COVID\u201019 pandemic","volume":"18","author":"Smallwood N","year":"2021","journal-title":"Int J Environ Res Public Health"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/resp.14143"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph16030314"},{"key":"e_1_2_12_17_1","volume-title":"Australian Institute of Health and Welfare (AIHW). 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