{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,5]],"date-time":"2026-11-05T12:21:01Z","timestamp":1793881261900,"version":"4.7.0"},"reference-count":38,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2025,2,11]],"date-time":"2025-02-11T00:00:00Z","timestamp":1739232000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: The COVID-19 pandemic has posed unprecedented challenges to healthcare workers, leading to significant psychological distress, altered health-related behaviors, and reliance on various coping mechanisms. Understanding these impacts is critical for developing targeted interventions to support healthcare professionals. This study aimed to evaluate the psychological stressors, emotional responses, changes in healthy behaviors, and coping mechanisms employed by healthcare workers during the COVID-19 pandemic. The study further examined differences across demographic and professional groups and explored correlations between stressors, coping strategies, and emotional outcomes. Materials and Methods: A cross-sectional survey was conducted among 338 healthcare workers, including physicians and nurses, in urban and rural healthcare settings during the pandemic. Data were collected using validated instruments to measure emotional responses (anxiety and anger), lifestyle behaviors (dietary habits, sleep patterns, physical activity, and smoking), and coping strategies. Statistical analyses included descriptive, inferential, and correlation techniques to assess relationships between variables. Results: Fear of infecting family members (M = 3.36, SD = 0.86) and concerns about inadequate protective equipment (M = 2.80, SD = 0.95) were the most significant stressors, strongly associated with heightened anxiety and anger. Changes in healthy behaviors were observed: 69.2% maintained a healthy meal schedule, 56.5% reported disrupted sleep patterns, and only 39.6% engaged in regular physical activity. Among smokers (27.5%), 31.1% increased smoking as a maladaptive coping strategy, while 21.1% reduced smoking. Nurses predominantly relied on emotion-focused strategies, such as religious coping and venting, whereas physicians favored problem-focused strategies like planning and active coping. Social support emerged as a protective factor, mitigating stress and facilitating adaptive coping. Conclusions: The study revealed significant psychological and behavioral impacts on healthcare workers during the COVID-19 pandemic. Key stressors included the fear of infecting family members, concerns about inadequate protective measures, and the prolonged uncertainty of the pandemic, which contributed to heightened levels of anxiety and anger. Changes in healthy behaviors, such as disrupted sleep patterns, decreased physical activity, and increased reliance on maladaptive coping mechanisms, further underscored the multifaceted challenges faced by healthcare professionals. Although the acute phase of the pandemic has passed, the long-term consequences on the mental health and well-being of healthcare workers remain critical concerns. Further research is essential to develop effective strategies for monitoring, preventing, and addressing psychological distress among healthcare professionals, ensuring their preparedness for future public health crises.<\/jats:p>","DOI":"10.3390\/medicina61020311","type":"journal-article","created":{"date-parts":[[2025,2,11]],"date-time":"2025-02-11T11:01:08Z","timestamp":1739271668000},"page":"311","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Coping Strategies Among Healthcare Workers During the COVID-19 Pandemic: Emotional Responses, Challenges, and Adaptive Practices"],"prefix":"10.3390","volume":"61","author":[{"given":"Aida","family":"Puia","sequence":"first","affiliation":[{"name":"Department of Community Medicine, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sorina Rodica","family":"Pop","sequence":"additional","affiliation":[{"name":"Department of Community Medicine, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bianca Olivia Cojan","family":"Manzat","sequence":"additional","affiliation":[{"name":"Department of Community Medicine, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastian","family":"Pintea","sequence":"additional","affiliation":[{"name":"Department of Psychology, Babe\u0219-Bolyai University, 400084 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2638-9056","authenticated-orcid":false,"given":"Ion Cosmin","family":"Puia","sequence":"additional","affiliation":[{"name":"Regional Institute of Gastroenterology and Hepatology \u201cOctavian Fodor\u201d, 400394 Cluj-Napoca, Romania"},{"name":"Department of Surgery, \u201cIuliu Hatieganu\u201d University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9971-4975","authenticated-orcid":false,"given":"Mihaela","family":"Fadgyas-Stanculete","sequence":"additional","affiliation":[{"name":"Department of Neurosciences, Discipline of Psychiatry and Pediatric Psychiatry, \u201cIuliu Hatieganu\u201d University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,2,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1007\/s11920-020-01166-z","article-title":"The Psychological Impact of Epidemic and Pandemic Outbreaks on Healthcare Workers: Rapid Review of the Evidence","volume":"22","author":"Preti","year":"2020","journal-title":"Curr. Psychiatry Rep."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Billings, J., Ching, B.C.F., Gkofa, V., Greene, T., and Bloomfield, M. (2021). Experiences of Frontline Healthcare Workers and Their Views about Support during COVID-19 and Previous Pandemics: A Systematic Review and Qualitative Meta-Synthesis. BMC Health Serv. Res., 21.","DOI":"10.1186\/s12913-021-06917-z"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e2423316","DOI":"10.1001\/jamanetworkopen.2024.23316","article-title":"Physician Posttraumatic Stress Disorder During COVID-19: A Systematic Review and Meta-Analysis","volume":"7","author":"Kamra","year":"2024","journal-title":"JAMA Netw. Open"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Huang, J., Huang, Z.T., Sun, X.C., Chen, T.T., and Wu, X.T. (2024). Mental Health Status and Related Factors Influencing Healthcare Workers during the COVID-19 Pandemic: A Systematic Review and Meta-Analysis. PLoS ONE, 19.","DOI":"10.1371\/journal.pone.0289454"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"111102","DOI":"10.1016\/j.jpsychores.2022.111102","article-title":"Burnout among Hospital Staff during the COVID-19 Pandemic: Longitudinal Results from the International Cope-Corona Survey Study","volume":"164","author":"Blanch","year":"2023","journal-title":"J. Psychosom. Res."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"664","DOI":"10.5005\/jp-journals-10071-23518","article-title":"Burnout among Healthcare Workers during COVID-19 Pandemic in India: Results of a Questionnaire-Based Survey","volume":"24","author":"Khasne","year":"2020","journal-title":"Indian J. Crit. Care Med."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Kunno, J., Yubonpunt, P., Supawattanabodee, B., Sumanasrethakul, C., and Wiriyasirivaj, B. (2022). Knowledge, Attitudes, and Practices Related to the COVID-19 Pandemic among Pregnant Women in Bangkok, Thailand. BMC Pregnancy Childbirth, 22.","DOI":"10.1186\/s12884-022-04612-3"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Hwang, S., and Lee, J. (2023). The Influence of COVID-19-Related Resilience on Depression, Job Stress, Sleep Quality, and Burnout among Intensive Care Unit Nurses. Front. Psychol., 14.","DOI":"10.3389\/fpsyg.2023.1168243"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"317","DOI":"10.7326\/M20-1083","article-title":"Psychological Impact of the COVID-19 Pandemic on Health Care Workers in Singapore","volume":"173","author":"Tan","year":"2020","journal-title":"Ann. Intern. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"13953","DOI":"10.1007\/s12144-022-03562-5","article-title":"Healthy Lifestyle Changes and Mental Health of Healthcare Workers during the COVID-19 Pandemic in China","volume":"43","author":"Jin","year":"2022","journal-title":"Curr. Psychol."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Zheng, C., Huang, W.Y., Sheridan, S., Sit, C.H., Chen, X.K., and Wong, S.H. (2020). COVID-19 Pandemic Brings a Sedentary Lifestyle in Young Adults: A Cross-Sectional and Longitudinal Study. Int. J. Environ. Res. Public Health, 17.","DOI":"10.1101\/2020.05.22.20110825"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Shoja, E., Aghamohammadi, V., Bazyar, H., Moghaddam, H.R., Nasiri, K., Dashti, M.T., Choupani, A., Garaee, M., Aliasgharzadeh, S., and Asgari, A. (2020). COVID-19 Effects on the Workload of Iranian Healthcare Workers. BMC Public Health, 20.","DOI":"10.1186\/s12889-020-09743-w"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1186\/s12967-020-02399-5","article-title":"Eating Habits and Lifestyle Changes during COVID-19 Lockdown: An Italian Survey","volume":"18","author":"Renzo","year":"2020","journal-title":"J. Transl. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1186\/s13613-021-00900-x","article-title":"Mental Health Outcomes of ICU and Non-ICU Healthcare Workers during the COVID-19 Outbreak: A Cross-Sectional Study","volume":"11","author":"Wozniak","year":"2021","journal-title":"Ann. Intensive Care"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Lizarte Sim\u00f3n, E.J., Gij\u00f3n Puerta, J., Galv\u00e1n Malag\u00f3n, M.C., and Khaled Gij\u00f3n, M. (2024). Influence of Self-Efficacy, Anxiety and Psychological Well-Being on Academic Engagement During University Education. Educ. Sci., 14.","DOI":"10.3390\/educsci14121367"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"22799036241227891","DOI":"10.1177\/22799036241227891","article-title":"Perceived Stress and Anxiety among Medical Students at Helwan University: A Cross-Sectional Study","volume":"13","author":"Ebrahim","year":"2024","journal-title":"J. Public Health Res."},{"key":"ref_17","first-page":"111","article-title":"Coping Strategies and Dysfunctional Cognitions as Predictors of Irritable Bowel Syndrome Diagnosis","volume":"15","author":"Dumitrascu","year":"2015","journal-title":"J. Evid. Based Psychother."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"221","DOI":"10.52403\/ijshr.20210738","article-title":"Challenges of Women Healthcare Providers during the COVID-19 Pandemic in Aizawl City, Mizoram, India","volume":"6","author":"Lalrinzuala","year":"2021","journal-title":"Int. J. Sci. Healthc. Res."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Tahara, M., Mashizume, Y., and Takahashi, K. (2020). Coping Mechanisms: Exploring Strategies Utilized by Japanese Healthcare Workers to Reduce Stress and Improve Mental Health during the COVID-19 Pandemic. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18010131"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1207\/s15327558ijbm0401_6","article-title":"You Want to Measure Coping but Your Protocol\u2019s Too Long: Consider the Brief COPE","volume":"4","author":"Carver","year":"1997","journal-title":"Int. J. Behav. Med."},{"key":"ref_21","unstructured":"Spielberger, C.D., Gorsuch, R.L., Lushene, R.E., Vagg, P.R., and Jacobs, G.A. (1983). State-Trait Anxiety Inventory (STAI), Consulting Psychologists Press."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Spielberger, C.D. (1988). State-Trait Anger Expression Inventory (STAXI), Consulting Psychologists Press.","DOI":"10.1037\/t29496-000"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1159\/000513733","article-title":"What We Have Learned from Two Decades of Epidemics and Pandemics: A Systematic Review and Meta-Analysis of the Psychological Burden of Frontline Healthcare Workers","volume":"90","author":"Busch","year":"2021","journal-title":"Psychother. Psychosom."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Abur, A., Elkefi, S., Emhan, A., Mengenci, C., Bez, Y., and Asan, O. (2022). Anxiety, Burnout and Depression, Psychological Well-Being as Predictor of Healthcare Professionals\u2019 Turnover during the COVID-19 Pandemic: Study in a Pandemic Hospital. Healthcare, 10.","DOI":"10.3390\/healthcare10030525"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"101730","DOI":"10.1016\/j.jth.2023.101730","article-title":"Long-Term Effects of COVID-19 on Time Allocation, Travel Behavior, and Shopping Habits in the United States","volume":"34","author":"Shi","year":"2024","journal-title":"J. Transp. Health"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Collantoni, E., Saieva, A.M., Meregalli, V., Girotto, C., Carretta, G., Boemo, D.G., Bordignon, G., Capizzi, A., Contessa, C., and Nesoti, M.V. (2021). Psychological Distress, Fear of COVID-19, and Resilient Coping Abilities among Healthcare Workers in a Tertiary First-Line Hospital during the Coronavirus Pandemic. J. Clin. Med., 10.","DOI":"10.3390\/jcm10071465"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Huang, L., Lei, W., Xu, F., Liu, H., and Yu, L. (2020). Emotional Responses and Coping Strategies in Nurses and Nursing Students during the COVID-19 Outbreak: A Comparative Study. PLoS ONE, 15.","DOI":"10.1101\/2020.03.05.20031898"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"2329","DOI":"10.1111\/jonm.13395","article-title":"Healthcare Worker Resilience during the COVID-19 Pandemic: An Integrative Review","volume":"29","author":"Baskin","year":"2021","journal-title":"J. Nurs. Manag."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"102","DOI":"10.69569\/jip.2024.0056","article-title":"The moderation analysis of coping strategies in the relationship between anxiety and aggression among security personnel","volume":"2","author":"Baldovino","year":"2024","journal-title":"J. Interdiscip. Perspect."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Olivencia-Carri\u00f3n, M.A., Olivencia-Carri\u00f3n, M.D., Fern\u00e1ndez-Daza, M., Castro, G.P., and Jim\u00e9nez-Torres, M.G. (2023). Anxiety Levels and Coping Strategies to Deal with COVID-19: A Cross-Cultural Study among the Spanish and Latin American Healthcare Populations. Healthcare, 11.","DOI":"10.3390\/healthcare11060844"},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Zhao, Y., Ding, Y., Chekired, H., and Wu, Y. (2022). Student Adaptation to College and Coping in Relation to Adjustment during COVID-19: A Machine Learning Approach. PLoS ONE, 17.","DOI":"10.1371\/journal.pone.0279711"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"81","DOI":"10.55116\/IJIM.V1I1.23","article-title":"Islamic Religious Coping Strategy for Healthcare Workers in the COVID-19 Pandemic: A Literature Review","volume":"2","author":"Nopa","year":"2021","journal-title":"Int. J. Islam. Complement. Med."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Gambaro, E., Gramaglia, C., Marangon, D., Probo, M., Rudoni, M., and Zeppegno, P. (2023). Health Workers\u2019 Burnout and COVID-19 Pandemic: 1-Year After-Results from a Repeated Cross-Sectional Survey. Int. J. Environ. Res. Public Health, 20.","DOI":"10.3390\/ijerph20126087"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"23","DOI":"10.21037\/jhmhp-21-69","article-title":"Unique Stressors in a Global Pandemic: A Mixed Methods Study about Unique Causes of Distress among Healthcare Team Members during COVID-19","volume":"6","author":"Meese","year":"2022","journal-title":"J. Hosp. Manag. Health Policy"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"S154","DOI":"10.1093\/cid\/ciaa1684","article-title":"Coronavirus Disease 2019 (COVID-19) Seropositivity and Asymptomatic Rates in Healthcare Workers Are Associated with Job Function and Masking","volume":"73","author":"Sims","year":"2021","journal-title":"Clin. Infect. Dis."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"d\u2019Ettorre, G., Ceccarelli, G., Santinelli, L., Vassalini, P., Innocenti, G.P., Alessandri, F., Koukopoulos, A.E., Russo, A., d\u2019Ettorre, G., and Tarsitani, L. (2021). Post-Traumatic Stress Symptoms in Healthcare Workers Dealing with the COVID-19 Pandemic: A Systematic Review. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18020601"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1038\/s41398-022-01965-3","article-title":"Initial Findings on RESTORE for Healthcare Workers: An Internet-Delivered Intervention for COVID-19-Related Mental Health Symptoms","volume":"12","author":"Trottier","year":"2022","journal-title":"Transl. Psychiatry"},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Rotaru, T.-\u0218., Cojocaru, D., Cojocaru, \u0218., Alexinschi, O., Puia, A., and Oprea, L. (2024). Assessment of Physicians\u2019 Willingness to Work with Patients Not Yet Diagnosed with COVID-19 in a Romanian Sample. Healthcare, 12.","DOI":"10.3390\/healthcare12020161"}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/61\/2\/311\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T16:30:55Z","timestamp":1760027455000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/61\/2\/311"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2,11]]},"references-count":38,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2025,2]]}},"alternative-id":["medicina61020311"],"URL":"https:\/\/doi.org\/10.3390\/medicina61020311","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,2,11]]}}}