Mental health of general practitioners and family medicine specialists two years into the COVID-19 pandemic

Marija Zafirovska ^1,2* Jelena Danilenko ³ Aleksandar Zafirovski ^1,2,4 Kristien Coteur ⁵ Heidrun Lingner ⁶ Cristián Andrés Frigolett ⁷ Milena Cojić ⁸ Mustafa Kursat Sahin ⁹ Carmen Iliana Busneag ^10,11,12 Nicola Buono ¹³ Aleksander Stepanović ^14,15 Christine Brütting ¹⁶ Lyubomir Kirilov Kirov ^17,18 Zaim Jatić ¹⁹ Liljana Ramasaco ²⁰ Monika Brovč ²¹ Vanja Lazic ^22,23,24 ERJONA ABAZAJ ²⁵ Ljubin Šukriev ¹

• ¹ Association of general practice/family medicine of South-East Europe (AGP/FM SEE), Skopje, North Macedonia
• ² Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
• ³ Department of Family Medicine, Riga Stradins University, Riga, Latvia
• ⁴ General Hospital Jesenice, Jesenice, Slovenia
• ⁵ Department of Public Health and Primary Care, Faculty of Medicine, KU Leuven, Leuven, Brussels, Belgium
• ⁶ Center for Public Health Care, Hannover Medical School, Hannover, Germany
• ⁷ Doctoral School of Biomedical Sciences, KU Leuven, Leuven, Belgium
• ⁸ Primary Health Care Center Podgorica, Podgorica, Montenegro
• ⁹ Department of Family Medicine, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Türkiye
• ¹⁰ Spiru Haret University, Bucharest, Bucharest, Romania
• ¹¹ Medical Department, National Romanian Television, Bucharest, Romania
• ¹² Individual Medical Office of Family Medicine "dr. Busneag Carmen", Bucharest, Romania
• ¹³ National Society of Medical Education in General Practice (SNAMID), Caserta, Campania, Italy
• ¹⁴ Department of Family Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
• ¹⁵ Primary Healthcare of Gorenjska, Public Medical Center in Škofja Loka, Škofja Loka, Slovenia
• ¹⁶ Institute for General Medicine, Faculty of Medicine, University of Halle-Wittenberg, Halle (Saale), Germany
• ¹⁷ General medicine, Faculty of medicine, Sofia university, Sofia, Bulgaria
• ¹⁸ National Association of General Practitioners in Bulgaria, Sofia, Bulgaria
• ¹⁹ Public Institution Health Centre of Sarajevo Canton, Sarajevo, Bosnia and Herzegovina
• ²⁰ Nursing Department, Faculty of Technical Medical Sciences, University “Aleksander Xhuvani”, Elbasan, Albania
• ²¹ National Institute for Public Health, Ljubljana, Slovenia
• ²² Association of Teachers in General Practice/Family Medicine, Zagreb, Croatia
• ²³ Health Center Zagreb, Zagreb, Croatia
• ²⁴ European General Practice Research Network, Zagreb, Croatia
• ²⁵ Department of National Reference Laboratories, Institute of Public Health, Tirana, Albania

The COVID-19 pandemic has significantly impacted general medical practice by altering work structures and increasing teamwork while also adversely affecting the mental health of general practitioners and family medicine specialists. This study assesses depression, anxiety, and fear levels among general practitioners and family medicine specialists in Europe two years after the COVID-19 pandemic's onset, and it explores influencing factors.This observational cross-sectional study included participants from thirteen European countries. Data was collected from May to August 2022 with an anonymous online survey incorporating validated questionnaires for depression (PHQ-9), anxiety (GAD-7), and fear of COVID-19 (FCV-19S). Data analysis involved descriptive statistics, correlation tests, and linear regression.A total of 1,723 participants completed the survey. Findings indicated an overall mild to moderate levels of anxiety (GAD-7: 5.4±4.76) and depression (PHQ-9: 6.33±5.43), and moderate fear of COVID-19 (FCV-19: 12.84±5.29). Key determinants of anxiety, fear, and depression included country, at-risk status, patient non-compliance, and mental health history. Sex influenced anxiety and fear, losing co-workers to COVID-19 influenced anxiety and depression, while losing relatives or friends influenced fear.Two years into the pandemic, European general practitioners and family medicine specialists showed mild to moderate levels of anxiety, depression, and fear. Country, at-risk status, mental health history, and work-related challenges significantly affected mental health. Crucial interventions are needed to support healthcare workers during pandemics, focusing on protective measures, stable work environments, and coping strategies for anxiety and depression.