Introduction

Since the beginning of the Covid-19 pandemic, healthcare workers (HCWs) have had to make many adjustments in their routines. In general, the HCWs who work in the hospitals, especially frontline teams, may be more susceptible to develop psychiatric problems (^{Lai et al., 2020}; ^{Pappa et al., 2020}) because of the proximity with patients. These professionals have to deal with the lack of individual protection equipment (^{Vancappel et al., 2021}), higher workload (^{Pappa et al., 2020}), fear of contaminating themselves and family members (^{Vancappel et al., 2021}), and consequently at higher risk of stress.

A Brazilian study identified nearly half of the participants (48.6%) had high levels of emotional exhaustion, and 29.4% had high levels of depersonalization during the Covid-19 pandemic (^{Medeiros et al., 2022}). The increased mental burden may encourage HCWs to find strategies, such as substance use (alcohol, illegal drug, prescription drug or not prescribed), that could help them to feel better as pointed out by ^{Wong et al. (2005)} during the SARS epidemic in 2003 and by ^{Voorspoels et al. (2021)} during Covid-19 pandemic in 2020. In Brazil, the use of psychiatric drugs among HCWs was already a concern due to the easy access (^{Minas et al., 2019}), exhausting workload, and the complexity of the profession (Barros et al., 2009). A previous study identified a self-medication prevalence of 24.2% among nursing workers from public hospitals in Rio de Janeiro (Brazil), of whom 46.7% consumed medications for the nervous system (psycholeptic, analgesics, and anesthetics) (Barros et al., 2009).

Although self-medication and the use of psychiatric drugs in HCWs are important topics, the lack of publications in Brazil is a challenge. Since the Covid-19 pandemic was an unprecedented scenario, this behavior may have increased. In this sense, this study aimed to describe the use of psychiatric drugs among hospital HCWs at some point in their lives and during the Covid-19 pandemic in extreme southern Brazil.

Methods

This was a cross-sectional study nested in a longitudinal study that investigated the mental health of HCWs during the Covid-19 pandemic, in two hospitals in the city of Rio Grande, extreme south of Brazil. Follow-up was carried out between August 2020 and September 2021, at three different times (August-December 2020; January-May 2021; June-September 2021) with the same healthcare workers. In the first stage, 264 professionals participated, followed by 191 and 147 professionals who participated in the second and third stages. The questionnaire was compound by five parts: sociodemographic characteristics, occupational characteristics, variables related to the Covid-19 pandemic, previous risk, use of psychiatric medications and mental health assessment.

For this work, we used the data of a convenience sample consisting of 147 HCWs (doctors, nurses, nursing technicians, radiology technicians, and physiotherapists) who participated in the third stage of the research collected between June and September 2021. The outcome was accessed through two questions included in the questionnaire: 1. Have you ever used any psychiatric drugs? (No/Yes); 2. Did you start to use psychiatric drugs (for the first time) during the Covid-19 pandemic? (No/Yes). Some characteristics related to the use of psychiatric medications were also investigated, such as frequency of medication use (continuous or sporadic); for why the drug was used (depression, anxiety, insomnia, and others); what psychiatric medications used (benzodiazepine, non-benzodiazepine, antidepressant, anticonvulsant, antipsychotic and others); presence of side effects (No/Yes); satisfaction with the use of the drug (No/Yes); and who prescribed this drug (No doctor prescribed me, neurologist, Psychiatrist/General Practitioner/other).

Statistical analysis was performed through univariate analysis of outcome frequencies and related characteristics, using Stata statistical software version 14.2 (StataCorp). This study was submitted and approved by the Research Ethics Committee of the Federal University of Rio Grande and by the National Research Ethics Commission under number 33018720.5.0000.5324.

Results

Of 147 tertiary care health professionals, 39.4% were nursing technicians, 23.1% were nurses, 12.9% were physicians, 14.9% were physical therapists, and 9.7% were radiology technicians. 74.8% were female and 10.9% worked more than 40 hours a week. 44.2% of HCWs reported that they had used psychiatric drugs at some point in their lives, of whom 40% used these drugs for the first time during the Covid-19 pandemic (17.7% of the whole study sample) (Figure 1).

Figure 1 The use of Psychiatric Drugs Among Hospital Healthcare Workers Before and During the Covid-19 Pandemic (n=147) 

Among professionals who claimed to have used psychiatric drugs during their lifetime, 54% used it sporadically, 76.6% had no side effects, and 82.8% were satisfied with the use of the drug. However, 43% stated that the medication was not prescribed by a doctor. Regarding the purpose of using the drug, 23.1% used it for symptoms of depression, 26.1% for -insomnia, and 50% said used for anxiety. The most commonly used drugs were -antidepressants (46.1%), and benzodiazepines (27.7%) (Table 1).

Discussion

The mental health of HCWs is an occupational problem because these professionals are exposed to a high level of work environment risk (^{Martins & Zeitoune, 2007}; ^{Ribeiro et al., 2020}). The possibility of being infected by a virus or bacteria is much greater in these professionals than in any other individual. In addition, the daily stress generated by work activities can cause psychological damage (^{Jones et al., 2018}; ^{Lai et al., 2020}; ^{McKay & Asmundson, 2020}; ^{Pappa et al., 2020}).

The HCWs in our study used psychiatric drugs for symptoms of depression, anxiety, and insomnia. Another study also described that these professionals suffer from posttraumatic stress disorder, drinking problems, and other behavior problems (^{Jones et al., 2018}). In this sense, the indiscriminate use of psychiatric medications by health professionals has become a concern, which can be understood by the stress generated by activities related to the profession, as well as the accessibility to these drugs (^{Bennett & O’Donovan, 2001}; ^{Minas et al., 2019}). In our study, at least 4 of 10 HCWs used psychiatric drugs at some point in their lives, and 43% were self-medicating. It is important to highlight that the use of these drugs should be prescribed by trained professionals and indicated consciously and appropriately, after the diagnosis of a mental disorder.

Self-medication with psychiatric drugs among HCWs reported by our study is consistent with the literature (^{Bennett & O’Donovan, 2001}; ^{Minas et al., 2019}) that points out about the facility of access, since many health professionals choose to use the drug only to relieve symptoms, often without a full diagnosis. The use of psychotropic drugs generates short and long-term mental changes, and the indiscriminate use can cause important damage, not only in the organism but also in the family, social and psychological sphere of the subject (^{American Psychiatric Association, 2014}). Despite that 76.7% of our sample reported that the use of the medication doesn’t cause any side effects, less noticeable symptoms such as lack of attention can occur, which could impair job performance.

Considering that these professionals are already exposed daily to small traumatic events in their routines, the Covid-19 pandemic may have only exacerbated existing problems. The stress derived from the pandemic may have contributed to the first use of psychiatric drugs in almost half of those who have had used such drugs at some point in life, representing 17.7% of the whole study sample. Since they work at hospitals, they are directly involved with the diagnosis and treatment of patients with Covid-19. The difference between this scenario from other previous situations is that the risk of being infected and the stress of the pandemic don’t stop when they come back home. This big event plus the daily routine can lead these professionals to use psychiatric drugs as a coping strategy, or just a way out of the scenario.

Just like in the Covid-19 pandemic, during the SARS epidemic in 2003, was found a correlation between the general level of suffering and substance use (alcohol and other drugs) as a coping strategy in HCWs (^{Wong et al., 2005}). In Belgium, a study (^{Voorspoels et al., 2021}) revealed that before the Covid-19 pandemic, 0.9% of HCWs reported having a problem with substance use (illegal drug use, use of a prescription drug or not prescribed), and during the first wave of the pandemic, the estimated frequency increased to 4.9%. Studies also revealed that the use of these substances (illegal drug use, use of a prescription drug or not prescribed) was related to emotional difficulties (^{Vancappel et al., 2021}) and that seeking help was not common among health professionals (^{Wong et al., 2005}), which can lead to the search for other coping strategies.

In general, the sale of psychoactive drugs in Brazil showed a marked increase between the first quarter of 2020 and 2021 (^{Alves et al., 2021}), which may be related to the Covid-19 pandemic. Antidepressants were the main drugs used by HCWs and were also the most sold in Brazil during this period. The medications most commonly used in the country were -bupropion, amitriptyline, escitalopram, and trazodone, with an increase in their sales of 137%, 41.5%, 37.9%, and 17.4%, respectively. About benzodiazepines, which appear as the second main drug category used in our study sample, there was a 120% increase in the sale of bromazepam in Brazil (^{Alves et al., 2021}).

This study has some limitations regarding design and sample size. However, considering that the studies about the use of psychiatric medications by health professionals in Brazil are limited, the results of our study call more attention of researchers as well as health services managers to the need for longitudinal studies and interventions related to this topic. The indiscriminate use of psychiatric drugs should be considered an important occupational problem among health professionals.