Open Access

ARTICLE

From Workplace Uncertainty to Social Burden: Nurses’ Psychological Distress during COVID-19 in Taiwan

Lissette Aviles¹, Shao-Jun Sun^2,3, Catherine Clarissa^1,4, Yun-Hsuan Shih², Bih-Shya Gau^2,5,6, Lu-Yen Anny Chen^7,*
1 Nursing Studies, School of Health in Social Science, University of Edinburgh, Edinburgh, UK
2 Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
3 National Taiwan University Hospital Union, Taipei, Taiwan
4 Scottish Collaboration for Public Health Research and Policy (SCPHRP), School of Health in Social Science, University of Edinburgh, Edinburgh, UK
5 School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan
6 Second Degree Bachelor of Science in Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan
7 Institute of Clinical Nursing, College of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan
* Corresponding Author: Lu-Yen Anny Chen. Email:
(This article belongs to the Special Issue: Exploring the Psychological Impact of Disasters and Emergency Events)

International Journal of Mental Health Promotion https://doi.org/10.32604/ijmhp.2026.086458

Received 31 May 2026; Accepted 02 August 2026; Published online 18 August 2026

Abstract

Background: Less is known about how the pattern of distress and related stressors differed across pandemic policy phases. Study’s purpose: This study examines whether nurses’ psychological burden differed across two independent survey waves. Methods: A repeated cross-sectional online survey recruited registered nurses through professional networks using snowball sampling. Wave 1 was conducted from January to June 2021, with 92.0% responding on or after 15 May; Wave 2 was conducted from September 2022 to May 2023. The questionnaire assessed preparedness, workplace and social experiences, and distress using the Impact of Event Scale-Revised (IES-R). Verified “Do not know” responses were treated as missing. Group comparisons, correlations, and multivariable linear regression with HC3 standard errors were performed. Results: The sample included 2500 nurses (2021: n = 2227; 2022–2023: n = 273). The later sample reported greater preparedness and personal protective equipment (PPE) confidence, less infection-related worry, and lower total and subscale IES-R scores (mean total-score difference = −9.82; Cohen’s d = −0.66). In 2021 bivariate analyses, workplace transfer and treatment of suspected cases and direct COVID-19 care, but not workplace screening, were associated with higher overall IES-R scores. No workplace-exposure variable was associated with overall IES-R score in 2022–2023. In the fully adjusted complete-case model (N = 2379), the later wave remained associated with lower total IES-R scores (B = −3.88, 95% CI [−5.83, −1.94], p < 0.001). Infection-related worry, concealment of COVID-19 care work, family or friend avoidance, and discrimination were associated with higher distress, whereas PPE confidence was associated with lower distress. Direct COVID-19 care was not independently associated with distress. Conclusions: Distress was lower in the later sample, but infection-related worry and social stressors remained important. Support should combine early preparedness and safety measures with longer-term interventions addressing infection-related worry, stigma, and relational consequences.

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Keywords

COVID-19; distress; nurse; workplace preparedness; social stressors

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