{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T06:36:38Z","timestamp":1778740598328,"version":"3.51.4"},"reference-count":69,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,9,17]],"date-time":"2025-09-17T00:00:00Z","timestamp":1758067200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>The COVID-19 pandemic increased psychological distress among health care workers (HCWs). Those with informal caregiving responsibilities (ICs) may be especially vulnerable, but data remain limited.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In a multicenter online survey conducted across four time points (T1\u2013T4: 2020\u20132022) within the German healthcare system, HCWs with ICs were compared to those without (comparison group, CG). Psychological distress was assessed using validated measures of anxiety (Generalized Anxiety Disorder\/GAD-2) and depression (Patient Health Questionnaire\/PHQ-2). Group differences were analyzed using non-parametric Mann\u2013Whitney U and chi-square tests. Longitudinal logistic regression analyses examined the impact of IC on psychological distress, controlling for sociodemographic, occupational, and psychological factors. A moderation analysis tested whether fear of infecting relatives influenced the salutogenic effect of optimism. All analyses were performed with multiply imputed data and a retrospective sample size justification was conducted.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>ICs were more likely to be female, older, work in occupations other than medicine, work part-time, have children, and have more than 6\u202fyears of work experience. While ICs showed significantly higher PHQ-4 anxiety and depression than CG at T1 and T2, no significant differences could be shown for the other time points. IC emerged as a significant risk factor for increased psychological distress longitudinally, even after controlling for confounders. The protective effect of optimism was moderated by fear of infecting relatives at T1.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>HCWs with informal caregiving duties represent a vulnerable subgroup with increased psychological distress, especially during the early pandemic. This group may benefit from targeted support (e.g., flexible schedules, protective equipment, psychological interventions). Limitations include lack of pre-pandemic data and reliance on self-report. Findings underscore the importance of acknowledging and addressing overlapping care burdens in future health crises.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpubh.2025.1559518","type":"journal-article","created":{"date-parts":[[2025,9,17]],"date-time":"2025-09-17T14:08:47Z","timestamp":1758118127000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["The impact of informal caregiving on the mental health of health care workers during the COVID-19 pandemic\u2014cross-sectional and longitudinal results from the VOICE study"],"prefix":"10.3389","volume":"13","author":[{"given":"Gloria-Beatrice","family":"Wintermann","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anne 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