{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,29]],"date-time":"2026-03-29T17:47:58Z","timestamp":1774806478814,"version":"3.50.1"},"reference-count":32,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T00:00:00Z","timestamp":1774396800000},"content-version":"unspecified","delay-in-days":24,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,3,3]]},"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>This study aims to estimate the prevalence and associated factors of anxiety, depression and stress symptoms among doctors working in hospitals with COVID-19 treatment units in the Anuradhapura district, Sri Lanka.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Cross-sectional descriptive study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study setting<\/jats:title>\n                    <jats:p>Hospitals with COVID-19 treatment units in Anuradhapura district, Sri Lanka.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methodology<\/jats:title>\n                    <jats:p>This study was conducted during the third wave of the pandemic in Sri Lanka in 2021. The study included all the doctors working in hospitals with COVID-19 treatment units in Anuradhapura. The Depression Anxiety and Stress Scale-21 was used to assess the prevalence of anxiety, depression and stress. Logistic regression analysis was performed to identify factors associated with anxiety, depression and stress symptoms.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Doctors working in hospitals with COVID treatment units in Anuradhapura, Sri Lanka.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interventions<\/jats:title>\n                    <jats:p>None.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main outcome measures<\/jats:title>\n                    <jats:p>Anxiety, depression and stress symptoms.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among the 385 participants, 52% (n=201) were male, with a mean age of 36.1 years (SD 7.2). The majority were married (76%, n=291). Nearly 50% had less than 5 years of work experience. Prevalence of anxiety, depression and stress was 38% (95% CI 32.8% to 42.7%), 34% (95% CI 30.1% to 39.8%)\u2009and 21% (95% CI 16.6% to 24.9%), respectively. Lack of professional fulfilment, excessive workload, lack of psychological support, being a junior staff member, inadequate guidance, lack of occupational safety equipment, working in a COVID unit, having young children, being quarantined during the pandemic and having a history of psychiatric illness were associated with anxiety, depression and stress symptoms.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This study revealed that nearly half of doctors working in hospitals with COVID-19 treatment units experienced symptoms of anxiety, depression or stress, which may have a negative impact on healthcare service delivery, particularly during crises such as the COVID-19 pandemic.<\/jats:p>\n                  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