Spatial analysis of depression and anxiety among frontline health workers during Nigeria’s COVID-19 pandemic: cross-sectional study

Background: The Coronavirus (COVID-19) pandemic caused considerable panic and anxiety among health workers in all countries of the world, including Nigeria. This study aimed to identify the spatial clustering for prevalence and factors associated with anxiety and depression among frontline health workers (FHWs) during COVID-19 in the 36 states of Nigeria. Methods: This was a cross-sectional study conducted in COVID-19 hospital treatment centres (one in each state) across 36 Nigerian states and Federal Capital Territory. A total of 3,353 FHWs were recruited using convenient sampling technique. The main outcomes were depression and anxiety symptoms examined using the Hospital Anxiety and Depression Scale (HADS) and categorised into binary. The sequential modelling approach in Multivariate logistic regression analysis was used to identify factors associated with anxiety and depression among FHWs. The spatial distribution of anxiety and depression across Nigerian states was examined, and prevalence and adjusted odds ratios (aORs) for mental health outcomes were visualized using ArcGIS Desktop 10.86, with graduated color symbols representing aORs adjusted for confounders. Results: FHWs in the Southeastern States of Anambra, Enugu, Abia, and Imo, experienced higher odds of depression and anxiety compared with other states. For anxiety alone, higher odds were observed among FHWs in Benue, Cross River, Ebonyi, and Edo states. Logistic regression analyses revealed higher odds for anxiety and depression among Nurses, while FHWs who have practiced for 1–6 years had significantly higher odds for depression (adjusted odds ratios (AOR) = 3.21, 95%CI: 1.90, 5.43 for 5–6 years; and AOR = 2.33, 95%CI: 1.27, 4.26 for 1–4 years). The odds for anxiety and depression were significantly lower among FHWs with a prior history of psychological distress compared to those without such a history. Conclusions: This study highlights significant spatial clustering of anxiety and depression among FHWs in Nigeria, with the highest burden in Southeastern states. Nurses and FHWs with fewer years of practice were particularly vulnerable, indicating the need for targeted mental health interventions. Those with a prior history of psychological distress had lower odds of experiencing anxiety and depression, suggesting potential resilience or coping mechanisms. These findings underscore the urgency for tailored mental health support and policy interventions to mitigate the psychological impact of future public health crises on healthcare workers.