Analysis of the prevalence and factors related to psychotropic drug consumption among healthcare professionals in hospital services during the pandemic

Abstract

Objective  To analyze the prevalence and factors related to psychotropic drug consumption among healthcare professionals in hospital services during the pandemic.

Methods  This is a cross-sectional, analytical study carried out with 244 professionals who worked in the Intensive Care Unit and COVID-19 wards, including physicians, nurses, nursing technicians, and physiotherapists. Data were collected through a questionnaire containing sociodemographic, occupational, and psychotropic drug use-related variables between September and December 2022. Descriptive statistics, Pearson’s Chi-square test and binary logistic regression were used in data analysis. A 95% confidence level and 5% significance level were adopted.

Results  The use of anxiolytics stood out (22.5%). The consumption of this and other substances investigated was prevalent among nursing technicians. The variables “expressing interest in seeking help or psychological treatment, but did not seek help” (OR: 5; 95% CI: 2.43-10.27, p < 0.001) and “expressing interest and seeking help” (OR: 16.4; 95% CI: 7.53-36.01, p < 0.001) were associated with psychotropic drug consumption among professionals. The variables “Catholic religion” (OR: 0.15; 95%CI: 0.04-0.57, p = .005), “Evangelical religion” (OR: 0.13; 95%CI: 0.03-0.59, p = 0.008) and “moderate degree of emotional demand” (OR: 0.35; 95%CI: 0.00-0.27, p < 0.001) were identified as protective factors.

Conclusion  There was a predominance of anxiolytic use, with emphasis on consumption among the group of nursing technicians. Factors associated with psychotropic drug consumption were expressing interest in seeking help or psychological treatment, but not seeking help, and expressing interest and seeking help, while Catholic and Evangelical religions and moderate level of emotional demand were identified as protective factors.

Keywords:
Psychotropic drugs; Health personnel; Ancillary services, hospital; Mental health; Occupational health; Pandemics

Resumo

Objetivo  Analisar a prevalência e fatores relacionados ao consumo de psicotrópicos entre profissionais de saúde de serviços hospitalares na pandemia.

Métodos  Estudo transversal, analítico realizado com 244 profissionais que exerceram suas funções nos setores da Unidade de Terapia Intensiva e enfermarias COVID-19, incluindo médicos, enfermeiros, técnicos de enfermagem e fisioterapeutas. Os dados foram coletados por meio de questionário contendo variáveis sociodemográficas, ocupacionais e relacionadas ao consumo de psicotrópicos, entre setembro e dezembro de 2022. Na análise dos dados foi utilizada estatística descritiva, teste Qui-quadrado de Pearson e Regressão Logística Binária. Adotou-se o nível de confiança de 95% e significância de 5%.

Resultados  Destacou-se o uso de ansiolíticos (22,5%). O consumo dessa e das demais substâncias investigadas foi prevalente entre os técnicos de enfermagem. As variáveis “manifestar interesse em buscar ajuda ou tratamento psicológico, mas não procuraram ajuda” (OR: 5; IC95%: 2,43-10,27, p < 0,001) e “manifestar interesse e procurar ajuda” (OR: 16,4; IC95%: 7,53-36,01, p < 0,001) apresentaram associação com o consumo de psicotrópicos entre os profissionais. As variáveis “religião católica” (OR: 0,15; IC95%: 0,04-0,57, p = ,005), “religião evangélica” (OR: 0,13; IC95%: 0,03-0,59, p = 0,008) e “grau de exigência emocional moderado” (OR: 0,35; IC95%: 0,00-0,27, p < 0,001) foram identificados como fatores de proteção.

Conclusão  Houve predomínio do uso de ansiolíticos, com destaque para o consumo entre o grupo de técnicos de enfermagem. Os fatores associados ao consumo de psicotrópicos foram: manifestar interesse em buscar ajuda ou tratamento psicológico, mas não procuraram ajuda e manifestar interesse e procurar ajuda. Enquanto que religião católica ou evangélica e grau de exigência emocional moderado foram identificadas como fatores de proteção.

Descritores:
Psicotrópicos; Pessoal de saúde; Serviços técnicos hospitalares; Saúde mental; Saúde ocupacional; Pandemias

Resumen

Objetivo  Analizar la prevalencia y los factores relacionados con el consumo de psicotrópicos entre profesionales de la salud de servicios hospitalarios durante la pandemia.

Métodos  Estudio transversal, analítico realizado con 244 profesionales que ejercieron sus funciones en los sectores de Unidad de Cuidados Intensivos y enfermerías de COVID-19, que incluyó médicos, enfermeros, técnicos de enfermería y fisioterapeutas. Los datos se recopilaron mediante un cuestionario con variables sociodemográficas, laborales y relacionadas con el consumo de psicotrópicos, entre septiembre y diciembre de 2022. En el análisis de los datos se utilizó estadística descriptiva, prueba χ² de Pearson y regresión logística binaria. Se adoptó un nivel de confianza de 95 % y de significación de 5 %.

Resultados  Se destacó el uso de ansiolíticos (22,5 %). El consumo de esta sustancia y de otras investigadas fue predominante entre los técnicos de enfermería. Las variables “manifestar interés en buscar ayuda o tratamiento psicológico, pero no buscar ayuda” (OR: 5; IC95%: 2,43-10,27, p < 0,001) y “manifestar interés y buscar ayuda” (OR: 16,4; IC95%: 7,53-36,01, p < 0,001) presentaron relación con el consumo de psicotrópicos entre los profesionales. Las variables “religión católica” (OR: 0,15; IC95%: 0,04-0,57, p = ,005), “religión evangélica” (OR: 0,13; IC95%: 0,03-0,59, p = 0,008) y “nivel de exigencia emocional moderado” (OR: 0,35; IC95%: 0,00-0,27, p < 0,001) fueron identificadas como factores de protección.

Conclusión  Hubo predominio del uso de ansiolíticos, con énfasis en el consumo dentro del grupo de técnicos de enfermería. Los factores asociados al consumo de psicotrópicos fueron: manifestar interés en buscar ayuda o tratamiento psicológico, pero no buscar ayuda y manifestar interés y buscar ayuda. Mientras que la religión católica o evangélica y el nivel de exigencia emocional moderado fueron identificados como factores de protección.

Descriptores:
Psicotrópicos; Personal de salud; Servicios técnicos en hospital; Salud mental; Salud Laboral; Pandemias

Introduction

Working during the COVID-19 pandemic required constant updating and adaptation by healthcare teams, which led to changes in routine, resulting in stressful working hours.(¹) Healthcare workers still face the distress of those under their supervision, deal closely with the end of life and dedicate most of their time to occupational activities.(²)

The hospital context stood out as an environment conducive to mental and occupational illness. When analyzing hospital health teams’ physical and mental health during the pandemic, symptoms of mental disorders related to situations of anxiety, depression, poor quality of sleep were identified, with emphasis on disorders such as insomnia, exhaustion, post-traumatic stress disorder (PTSD) and somatization.(³-⁵)

The aforementioned factors encourage the search for relief strategies that provide feelings of relaxation and reduction of symptoms of anxiety, depression, stress and improvement of sleep quality. Among them, the growing psychoactive substance (PAS) consumption, such as psychotropic medications, among health workers, stands out. These chemical substances act on the Central Nervous System, producing changes in behavior, mood and cognition, characterized by depressant, stimulant, hallucinogenic and/or antipsychotic actions.(⁶)

The group of healthcare professionals has a high prevalence of psychotropic drug use, as they have greater accessibility and the possibility of self-administration, since these substances are generally under their control.(⁷) This consumption is a complex, multidimensional and expressive phenomenon, being an important social political issue, given the potential for damage to health and the impacts on performance and productivity, as well as it can result in an increase in indicators of adverse events to patient safety and occupational accidents.(⁸)

The significant use of psychotropic drugs and other PASs in recent years appears to be a reflexive response by individuals to a new way of life suddenly imposed by the COVID-19 pandemic. Studies involving adverse events, such as the impacts of natural disasters, terrorist incidents and the Severe Acute Respiratory Syndrome (SARS) epidemic, have identified high rates of substance use, abuse and dependence, including harmful alcohol, tobacco, antidepressant and anxiolytic consumption.(⁹,¹⁰)

In this context, it can be inferred that the pandemic increased the risk of abuse of prescribed psychotropic medications or self-medication and other dependent behaviors, influencing the symptoms of mental disorders among healthcare professionals, with emphasis on more pronounced symptoms of anxiety, depression, stress and burnout, responsible for several work absences.(¹¹,¹²)

Specific and comprehensive surveys on the use of PASs by Brazilian healthcare workers during the pandemic are still in their infancy. Investigations reveal that the use of these substances is related to the conditions of work environments and that psychotropic medications, alcohol, tobacco and even illicit compounds (marijuana, amphetamines and inhalants) are consumed by this population.(¹³)

In Brazil, it is worth noting that healthcare professionals have faced complex challenges in dealing with COVID-19. In addition to changes in the functioning of hospitals, with increased working hours and exposure to occupational risks, these professionals have had to deal with a lack of training and human resources, inadequate remuneration, a shortage of Personal Protective Equipment (PPE), insufficient beds, inefficient management, among other difficulties inherent to the Brazilian Health System (In Portuguese, Sistema Único de Saúde - SUS).(¹⁴,¹⁵) Such challenges and difficulties can reverberate in workers’ psychological imbalance and be reflected in psychotropic drug consumption. However, it is necessary to analyze this relationship more rigorously and in greater depth.

A cross-sectional analytical study was conducted in all Brazilian regions with 12,086 healthcare professionals who worked in direct care for patients affected or not by COVID-19, at different levels of healthcare. For data analysis, 12,051 participants who responded about the use of hypnotics or sedatives were considered. As a result, the prevalence of use was 17.1%.(¹⁶)

Another comparative investigation involving 150 healthcare professionals from public and private sectors in two municipalities in Minas Gerais showed psychotropic drug consumption among participants, with emphasis on the use of benzodiazepines, associated with the female gender, work in the private sector, working in intensive care, self-reported dissatisfaction with mental health and having thought about giving up work activities during the pandemic.(¹⁷)

It is important to highlight the importance of investigating and elucidating the motivations that lead workers to adopt behaviors that are harmful to their health, such as the abuse of psychotropic drugs, especially in regions where research in this area is incipient. By identifying these factors, it is possible to propose alternatives for the treatment of those already affected by consumption as well as to develop strategies to prevent this behavior among professionals.

Given the above, the study aimed to analyze the prevalence and factors related to psychotropic drug consumption among healthcare professionals in hospital services during the pandemic.

Methods

This is a cross-sectional and analytical study, conducted in accordance with the STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) recommendations and carried out in two hospital centers, references in the management of COVID-19 cases, located in Teresina, Piauí. Throughout the pandemic, Teresina was the municipality that concentrated the main reference services for the treatment of COVID-19 cases, in addition to bringing together the largest number of healthcare professionals who worked during the pandemic.

The population of this research consisted of 661 healthcare professionals, including physicians, nurses, nursing technicians and physiotherapists. Those who worked in the Intensive Care Unit (ICU) and COVID-19 wards were included. Those who for some reason were away from their activities during the data collection stage were excluded.

For the representative sample, the technique for finite population by proportion was adopted, considering a 5% margin of error and a 95% confidence level. Therefore, the minimum sample obtained was 244 participants, selected through a simple random technique (draw).

In this study, independent variables were sociodemographic and occupational characteristics. The use of healthcare services during the pandemic period represented the outcome. The dependent variable was based on the following question: “During your work during the pandemic, in the ICU and COVID-19 ward sectors, did you consume any psychotropic substances?”. The answer to this question was dichotomized as yes or no.

Data collection took place between September and December 2022, using a questionnaire prepared by the authors, divided into: sociodemographic variables (sex, race/color, marital status, children, individual and family income); occupational variables (professional category, sector, working hours, shift, workload, types and degree of demand, PPE supply/availability, specialized support in mental health and need to seek psychological support); and questions related to psychotropic drug consumption (use, type - adopted to encompass concepts and classifications of the World Health Organization (WHO)(¹⁸)- antidepressant, anxiolytic, hypnotic/sedative, tranquilizer and opioid, factors that influence use, frequency, time of onset of consumption - before or after starting work in the COVID-19 sector, use for sleeping and whether there was an increase in this use after working in the COVID-19 sector).

The collected data were analyzed using the SPSS version 22.0. A descriptive analysis was performed using position measurements (mean and median) and variability (standard deviation, amplitude, minimum and maximum) for quantitative variables and absolute and relative frequency for categorical variables. To verify the association among qualitative variables, Pearson’s chi-square test with Yates correction was used. The variables that reached significant values in bivariate analysis tests were all inserted into the binary logistic regression using the enter method, measuring their Odds Ratios (OR). All analyses were performed at a 95% confidence level and a 5% significance level (p<0.05).

The research followed the assumptions contained in Resolution 466 of 2012 of the Brazilian National Health Council, and was initiated after approval by the Universidade Federal do Piauí Research Ethics Committee, under Opinion 5.637.817 and Certificate of Presentation of Ethical Consideration 60299022.8.0000.5214. Participants were informed about the objectives and implications of the research results for the scientific community, society in general and the health field, as well as their voluntary participation, which was formalized by signing the Informed Consent Form (ICF).

Results

The final sample of study participants consisted of 244 healthcare professionals who worked in the COVID-19 sectors. There was a prevalence of females (79.5% (n=194), brown race/color (57.8% (n=140), married (45.5% (n=111), with children (56.1% (n=137), Catholic religion (77.9% (n=190), with an average individual monthly income of R$5,657.82 and family income of R$8,158.27). Regarding occupational characterization, most professionals were nursing technicians (n=109; 44.7%), followed by nurses (n=82; 33.6%), physiotherapists (n=27; 11.0%) and physicians (n=26; 10.6%), who worked in the COVID-19 ICU (n=128; 52.5%), worked 36 hours per week (n=74; 30.7%), on the day shift (n=153; 62.7%) and considered the workload in the COVID-19 sector to be high (n=137; 56%). In relation to the types and degrees of demands of work routine in the COVID-19 sector, they pointed out a high degree of physical (n=175; 72.1%), mental/intellectual (n=180; 73.8%) and emotional (n=192; 78.7%) demand. In relation to PPE supply/availability and quality in the COVID-19 sector, they classified it as low or of average quality (n=118; 48.4%). Regarding the institution’s supply of specialized support for mental healthcare, they stated that it did not exist (n=123; 50.8%) and reported never having expressed interest in seeking help or psychological treatment during their time working in the COVID-19 sector (n=114; 47.1%). Concerning psychotropic drug consumption, 124 (50.8%) participants reported using some of the substances investigated, with the use of anxiolytics (n=55; 22.5%), antidepressants (n=38; 15.5%) and tranquilizers (n=18; 7.3%) prevailing, with nursing technicians (n=63; 25.8%) being the category that presented the highest consumption among all substances. Among the professionals, 79 (32.3%) stated that they started consuming these substances after starting work in the COVID-19 sector, 27 (11.0%) used them specifically to sleep and 16 (6.5%) reported an increase in use and dose after starting work in COVID-19 (Table 1).

Table 1
Characterization of psychotropic drug use by professional category of healthcare workers who worked on the front lines to combat the COVID-19 pandemic

Variable	Professional category
	Nursing technician	Nurse	Physiotherapist	Physician
	n(%)	n(%)	n(%)	n(%)
If you have used/are using any of these substances, in which category would you classify their purpose for pharmacological action?
Antidepressant
Yes	19(17.4)	11(13.4)	5(18.5)	3(11.5)
No	90(82.6)	71(86.6)	22(81.5)	23(88.5)
Anxiolytic
Yes	27(24.8)	17(20.7)	5(18.5)	6(23.1)
No	82(75.2)	65(79.3)	22(81.5)	20(76.9)
Tranquilizer
Yes	12(11.0)	4(4.9)	1(3.7)	1(3.8)
No	97(89.0)	78(95.1)	26(96.3)	25(96.2)
Opioids/opiates
Yes	0(0.0)	1(1.2)	1(3.7)	0(0.0)
No	109(100.0)	81(98.8)	26(96.3)	26(100.0)
Hypnotic/sedative
Yes	5(4.6)	2(2.4)	2(7.4)	2(7.7)
No	104(95.4)	80(97.6)	25(92.6)	24(92.3)
When did you start using this/these substances?
Before working in the COVID-19 sector	20(31.7)	15(42.8)	4(40.0)	6(50.0)
After starting my work in the COVID-19 sector	43(68.3)	20(57.2)	10(60.0)	6(50.0)
Do you use any of these substances specifically to sleep?
Yes	12(19.5)	11(31.4)	3(21.4)	1(8.3)
No	51(80.5)	24(68.6)	11(78.6)	11(91.7)
If you were already using any of these substances before the pandemic, was there an increase in use/dose after you started working in the COVID-19 sector?
Yes	5(25.0)	8(53.3)	1(25.0)	2(33.3)
No	15(75.0)	7(46.7)	3(75.0)	4(66.7)

A statistically significant association was observed between the use of these substances and three variables, such as religion (p=0.006), emotional demand (p=<0.001) and interest in seeking help or psychological treatment during the time spent working in the COVID-19 sector (p=<0.001), indicating that the use of substances is related to these factors (Table 2).

Table 2
Association between sociodemographic and occupational profiles and psychotropic substance consumption among healthcare workers who worked on the front lines to combat the COVID-19 pandemic

Variable	Psychotropic substance consumption				p-value
	No		Yes
	n(%)	Mean±SD	n(%)	Mean±SD
Sociodemographic data
Sex					0,349
Female	122(77.7)		72(82.8)
Male	35(22.3)		15(17.2)
Race/color					0,385
White	40(25.5)		16(18.4)
Black	25(15.9)		13(14.9)
Yellow	4(2.5)		5(5.7)
Brown	88(56.1)		53(60.9)
Marital status					0.077
Married	80(51.0)		31(35.6)
Divorced	6(3.8)		8(9.2)
Single	58(36.9)		39(44.8)
Stable union	13(8.3)		8(9.2)
Widowed	0(0.0)		1(1.1)
Have children					0.300
Yes	92(58.6)		45(51.7)
No	65(41.4)		42(48.3)
Religion					0,006
Catholic	126(80.3)		64(73.6)
Evangelical	28(17.8)		13(14.9)
Other	3(1.9)		10(11.5)
Individual income		5568.39±4959.34		5819.21±4484.38	0.991
Family income		8315.24±7498.89		7874.99±7903.82	0.432
Occupational data
Professional category					0.759
Nursing technician	67(42.7)		42(48.3)
Nurse	55(35.0)		27(31.0)
Physiotherapist	19(12.1)		8(9.2)
Physician	16(10.2)		10(11.5)
Sector					0.330
COVID-19 ICU	86(54.8)		42(48.3)
COVID-19 ward	71(45.2)		45(51.7)
Weekly working hours					0.544
24 hours/week	28(17.8)		17(19.5)
30 hours/week	39(24.8)		21(24.1)
36 hours/week	44(28.0)		31(35.6)
40 hours/week	19(12.1)		9(10.3)
More than 40 hours/week	27(17.2)		9(10.3)
Work shift					0.486
Daytime	98(62.4)		55(63.2)
Night time	20(12.7)		7(8.0)
Day/night time	39(24.8)		25(28.7)
Workload					0.965
High	87(55.4)		49(57.0)
Moderate	63(40.1)		33(38.4)
Low	7(4.5)		4(4.7)
Degree of physical demand					0.822
High	114(72.6)		62(71.3)
Moderate	43(27.4)		25(28.7)
Low	0(0.0)		0(0.0)
Degree of mental/intellectual demand					0.109
High	110(70.1)		70(80.5)
Moderate	43(27.4)		17(19.5)
Low	4(2.5)		0(0.0)
Degree of emotional demand					<0.001
High	112(71.3)		80(92.0)
Moderate	43(27.4)		3(3.4)
Low	2(1.3)		4(4.6)
Personal Protective Equipment (PPE)					0.699
Sufficient and good quality supply/availability	78(49.7)		39(44.8)
Low supply/availability and fair quality	74(47.1)		44(50.6)
Insufficient and poor quality supply/provision	5(3.2)		4(4.6)
Specialized support for mental healthcare					0.456
Yes, there is	80(51.0)		40(46.0)
No	77(49.0)		47(54.0)
Felt the need or sought psychological help and treatment					<0.001
Yes, I have expressed a desire, but I have not sought help	40(25.5)		30(34.5)
Yes, I have already expressed my concerns and sought help.	17(10.8)		42(48.3)
No, I never expressed a desire	100(63.7)		15(17.2)

• *Chi-square test at the 5% level; **OR (95% CI) - Odds Ratio at the 5% level.

The variables that presented statistically significant results were included in the logistic regression model. Concerning religion, people who called themselves evangelicals were 0.139 times less likely to use psychotropic substances when compared to people of other religions. Catholics were 0.152 times less likely to consume psychotropic substances when compared to people of other religions. Regarding emotional demands, healthcare professionals classified as moderate were 0.035 times less likely to consume psychotropic substances (Table 3). When assessing the interest in seeking help or psychological treatment, it was evident that among participants who expressed interest but did not seek help, they were five times more likely to use psychotropic substances. In turn, those who expressed interest and sought help were 16.47 times more likely to consume the aforementioned substances in relation to those who never expressed interest (Table 3).

Table 3
Logistic regression with religion, degree of emotional demand, need for help and psychological treatment, and psychotropic substance consumption among healthcare professionals working on the front lines to combat the COVID-19 pandemic

	B	p-value	OR(95%CI)
Religion
Catholic	-1.881	0.005	0.152(0.041-0.573)
Evangelical	-1.971	0.008	0.139(0.033-0.593)
Other			b
Degree of emotional demand
High	-1.030	0.241	0.357(0.064-1.997)
Moderate	-3.356	0.001	0.035(0.004-0.274)
Low			b
Felt the need or sought psychological help and treatment
Yes, I have expressed a desire, but I have not sought help	1.609	0.000	5.000(2.433-10.274)
Yes, I have expressed and sought help	2.802	0.000	16.471(7.533-36.012)
No, I have never expressed a desire			b

• *Wald test at the 5% level; **OR (95% CI) Odds Ratio at the 5% level.

Discussion

The findings indicate that participants were mostly female, married, with children, and had an average monthly income of R$5,657.82. The practice of the Catholic religion was prevalent. They worked 36 hours a week, on the day shift, and considered the workload in their sector to be high. There was a higher anxiolytic substance consumption, especially among the nursing technician category. There was an increase in consumption after joining the sector, and substances were used especially for sleep support.

The study of related factors showed that working in the COVID-19 sector demonstrated a high level of emotional demand, followed by mental/intellectual and physical demands. There was a low PPE supply, which was of average quality. Regarding specialized support for mental healthcare, more than half of the interviewees reported that this was not provided by the institution. Many also expressed no interest in seeking help.

Professionals who considered themselves Catholic were less likely to use psychotropic substances when compared to people of other religions. Participants with a moderate degree of emotional demand were less likely to use psychotropic substances. Participants who expressed interest but did not seek mental healthcare were five times more likely to use psychotropic substances.

The use of psychotropic drugs may be influenced by precarious working conditions. Healthcare workers routinely experience exhausting activities, excessive workloads and consequent work overload, in addition to professional devaluation. Furthermore, they may work in inadequate environments and be exposed to occupational risks that compromise their health and safety, in addition to other situations that favor mental illness/distress and compromised quality of life, making them vulnerable to the problematic use of these and other substances.(¹²,¹⁹)

Investigations into substance use by healthcare professionals are pertinent and justified, since one of the reasons that favors it is overwork, which was experienced by those who worked on the front lines of the fight against COVID-19, especially during the most critical moments when vaccination was not available or was restricted to only a few groups. These professionals faced work-related stress, isolation from their families, uncertainty about the future, and insufficient PPE supply.(²⁰)

A survey by the Federal Pharmacy Council revealed an increase in sales of psychotropic drugs among the general population.(²¹) In fact, Brazilian studies have identified hypnotic, sedative, antidepressant and anxiolytic consumption by healthcare professionals.(¹⁶,²²-²⁴) Data from international literature corroborated these findings, highlighting the increased benzodiazepine consumption among Spanish professionals, due to mental health problems and misuse of psychotropic medications associated with burnout in an American study.(²⁵,²⁶)

There is a disparity in the type of substance consumed. While participants in the study in question opted more for anxiolytics, data related to the dispensing of medicines in Brazilian capitals during the pandemic point to an increase in antidepressant (such as escitalopram and sertraline) and hypnotic (zolpidem) consumption.(²⁷) It is noteworthy that antidepressants were used to deal with psychological problems arising from work.(²⁸)As for anxiolytic consumption, this was also identified among nursing professionals at a Brazilian Emergency Care Unit and was associated with stress and income.(²⁴)

This study highlighted the support provided by sleep for the use of PASs; however, the high level of mental demands in working with COVID-19 was a relevant finding that may lead to psychological distress. Hence, a Brazilian study on healthcare professionals’ mental health revealed symptoms of anxiety in this population, such as inability to relax, fear of the worst happening and nervousness, which were moderately observed in 41.7%. In addition, 83.3% stated that the overall quality of their sleep was impaired and 75% had daytime sleepiness.(²⁹)

When assessing interest in seeking psychological help or treatment, it was found that participants who expressed interest but did not seek help were more likely to use psychotropic drugs. A study conducted in partnership between Portugal and Brazil indicates that in both countries the impact of substance use assumes similar severity indicators with significant psychological impacts, and the existence of a well-structured psychosocial support network offered in various settings is relevant.(³⁰) In this direction, a recent change in occupational risk management updates Regulatory Standard NR-01, in order to recommend psychological support programs, healthy leadership practices and the promotion of a balanced work environment.(³¹)

Another result was that those who expressed interest and sought help were more likely to consume psychotropic substances than those who never did. This data can contribute to discussions on actions to confront and manage pandemic situations. However, several actions and campaigns have been launched for this purpose. For instance, the WHO published a guide of actions for coping with stressful situations that are suitable for use among healthcare professionals in pandemic contexts.(³²) Therefore, it is necessary to implement and popularize such actions so that they reach healthcare professionals from the most diverse regions of Brazil, which may have been a gap in the management of the pandemic related to the care of the mental health of professionals who worked on the front line.

Despite the results presented above, important protective factors were observed to prevent mental illness and the misuse of PASs, such as belonging to a religion. The influence of religiosity and spirituality on the adoption of healthier lifestyle habits and on coping with adverse situations is well documented in literature.(³³)Amid evidence that faith can help prevent people from falling victim to substance abuse and help them recover from it, 73% of addiction treatment programs in the United States include spiritually-based approaches, the vast majority of which emphasize dependence on God or a Higher Power to stay sober.(³⁴) In Brazil, scholars point to practical guidelines for integrating religiosity and spirituality into the prevention and treatment of substance use in an ethical and evidence-based manner, based on a respectful, person-centered and interdisciplinary approach that does not impose religious beliefs or secular worldviews.(³⁵)

The findings therefore reinforce the need for discussions on the management of the mental health of healthcare professionals exposed to unexpected situations, the need to provide evidence-based coping actions that have positive outcomes in reducing symptoms and consequently reducing the misuse of PASs.

The urgent need to develop and implement clear, objective, and evidence-based actions to manage symptoms that lead to the misuse of psychotropic substances by healthcare professionals is also emphasized. The results presented in this research contribute to the advancement of knowledge regarding factors associated with the psychotropic substance consumption among healthcare professionals in hospital services during the COVID-19 pandemic, which can guide discussions and contribute to public policies aimed at psychological support and the promotion of well-being among healthcare professionals working in hospital settings to prevent the misuse of psychotropic substances, including various professional categories.

The role of institutional managers is emphasized in creating a work environment that prioritizes and ensures worker safety in terms of mental health, encouraging a culture of peace, mutual support and open dialogue about signs and symptoms of mental distress or illness among the team, free from any stigma or prejudice.

The study presented limitations inherent to the cross-sectional method, which does not allow for a more precise measurement of the phenomenon studied, since the factors assessed were measured at a single point in time. Another point is related to the data collection instrument used so that due to shame or fear, regarding questions related to the use of psychotropic drugs, participants may have chosen to indicate a more socially acceptable answer instead of expressing their opinion or behavior. However, data collected at a relevant time during the pandemic were analyzed, which allowed us to identify factors associated with the use of psychotropic drugs among these professionals.

As for practical implications, mental healthcare professionals, including nurses, can rely on evidence highlighted to direct assertive strategies to prevent psychological distress within the healthcare service, not only in times of pandemic, but as a guide for cultural change and as soon as sick professionals’ behavior towards their self-care and in the fight for dignified working conditions.

Conclusion

There was a predominance of anxiolytic use, with emphasis on consumption among the group of nursing technicians. The variables studied indicated that factors associated with psychotropic drug consumption among healthcare professionals were expressing an interest in seeking help or psychological treatment, but not seeking help, as well as expressing an interest and seeking help. Furthermore, declaring oneself to be Catholic or Evangelical and presenting a moderate degree of emotional demand were identified as protective factors. Psychotropic drug consumption by healthcare professionals is a problem that requires attention and further investigation. In order to contribute to a better understanding of the subject, future studies are recommended that adopt more robust methodologies that establish the cause-effect relationship of the consumption of these substances. Furthermore, knowing these professionals’ perception may provide a deeper understanding of the motivations related to work and the use of psychotropic drugs, which will support the development of intervention strategies that collaborate in the promotion of workers’ health and well-being.

Data availability

The authors did not make the data from this article available in repositories prior to submission.

Acknowledgements

To the Brazilian National Council for Scientific and Technological Development for supporting research, under Process 142311/2020-0.

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Edited by

• Associate Editor:
  Thiago da Silva Domingos (https://orcid.org/0000-0002-1421-7468) Escola Paulista de Enfermagem, Universidade Federal de São Paulo, São Paulo, SP, Brasil

Publication Dates

• Publication in this collection
  09 Jan 2026
• Date of issue
  2025

History

• Received
  20 Sept 2024
• Accepted
  05 May 2025