The 2019 coronavirus disease (COVID-19) is a viral zoonosis caused by the SARS-CoV-2 coronavirus [1]. COVID-19 spread rapidly worldwide, resulting in an unprecedented global health crisis [1][2]. According to the World Health Organization (WHO), more than 600 million confirmed cases and over 6 million deaths were reported worldwide by 2023 [3]. Although the number of cases in Africa was relatively lower than in other regions, the often-fragile health systems faced significant challenges [3].

In Mali, the first case of COVID-19 was confirmed in March 2020 [4]. Since then, the country has recorded thousands of cases and hundreds of deaths, placing considerable strain on health infrastructures and health professionals [5]. Healthcare workers on the front line of COVID-19 face not only the risk of infection but also increased workloads, challenging working conditions, and significant psychological stress [6][7].

Numerous studies around the world have highlighted the adverse effects of the pandemic on the mental health of health professionals. For example, research in China found that over 50% of healthcare workers showed symptoms of depression, anxiety, or post-traumatic stress during the pandemic [8]. Similarly, a survey in Italy showed that health professionals were twice as likely to suffer from high psychological stress compared with the general population [9]. These findings underscored the vital importance of healthcare workers’ mental well-being to ensure quality patient care.

In response to this COVID-19 mental health crisis, several initiatives have been launched globally to support the mental health of health professionals [8][9]. For example, the “Stay Well” program in the UK offered psychological support services to health professionals [10]. Additionally, telehealth applications such as Headspace and Calm were provided free of charge to healthcare workers in several countries to assist them in managing stress and anxiety [10].

However, limited data exist on the impact of the pandemic on the mental health of health professionals in West Africa, particularly in Mali. This is pertinent as although some research has been conducted in other African regions, francophone West Africa is of particular interest due to its unique socio-cultural and economic challenges, limited mental health resources, and the relative isolation of its healthcare workforce [11]. This study aimed to fill this gap by assessing the mental well-being of Malian healthcare workers engaged in the fight against COVID-19. By identifying levels of stress, anxiety, and depression among these professionals, we hoped to provide essential insights for developing effective psychological support interventions and enhancing the working conditions of these front-line heroes.

Among the 218 health workers surveyed, 55.0% were male. The participants’ average age was 31.8 years ± 7.9 years. Most of the participants were between 20 and 29 years old, accounting for 47.2% (103/218) of the participants. Health technicians and nurses were the most common health professionals, representing 28.4% of the participants. Table 1summarizes the socio-demographic characteristics of the participants.

Table 1. Socio-demographic characteristics.

The majority of the healthcare workers surveyed were male, and most fell within the 20-29 age bracket, indicating a relatively young population of professionals. The high proportion of health technicians and nurses highlights the significance of these professions in the healthcare system of a low-resource context, particularly during the COVID-19 pandemic. This is especially important in Mali and most of Sub-Saharan Africa, where primary health care and responding to pandemic emergencies are often nurse-led [17]-[19].

The vaccination status of health workers showed that 61.5% had received COVID-19 vaccines, which is relatively encouraging but still leaves room for improvement. Factors like vaccine access, safety perceptions, and trust in health authorities may have influenced this vaccine uptake rate. However, we did not find a statistically significant association between vaccination status and participants’ perceived well-being. The reported workload, with 50.9% of staff working more than 72 hours a week, is alarming and can significantly impact the mental and physical health of health professionals. This mirrors situations in other contexts where long working hours during the pandemic were associated with increased stress and deteriorating mental health [20][21].

The findings also indicated high distress levels among healthcare workers. Although 53.2% of workers reported generally coping with stress, a third of the participants (31.2%) reported poor well-being, and a significant minority (3.7%) perceived life as constantly under threat. Anxiety and depression levels, measured by the GAD-7 and PHQ-9 scales, are concerning, with 59.2% and 58.8% of participants, respectively, showing symptoms ranging from mild to severe. These results align with international studies documenting the pandemic’s severe psychological impact on health professionals [22]-[25].

The IES-R assessment revealed that nearly all participants (98.2%) had post-traumatic stress symptoms of varying intensity, and 6.4% were diagnosed with post-traumatic stress disorder. These results are particularly concerning as they demonstrate the significant traumatic impact the pandemic has had on healthcare workers. Similar studies in other countries have also found a high rate of PTSD symptoms among health professionals [26]-[28], emphasizing the need for specific psychological support programs.

The study’s findings emphasize the need for urgent action to support the mental health of health professionals. Essential initiatives include psychological support programs, improved working conditions, and reduced workloads. Health authorities should also promote and facilitate access to vaccination to increase coverage rates among healthcare workers.

Programs like “Stay Well” in the UK and telehealth applications such as “Headspace” and “Calm” can serve as models for similar interventions in Mali. Developing communication strategies to address vaccination-related concerns and building vaccine confidence is also crucial.

This study’s sample consists of volunteer health workers, which may introduce a selection bias. Volunteer participants may have distinct characteristics, such as a greater interest in mental health, compared to those who did not participate.

Participants’ responses may be influenced by the desire to present a positive image of themselves, which could lead to under-reporting or overestimation of certain aspects of their stress, anxiety, or depression.

Working conditions and available resources vary significantly between different healthcare facilities and regions, affecting the comparability of results and limiting the generalizability of conclusions to other environments.

This study did not measure certain factors that may influence the mental health of healthcare workers, such as family support, facility resources, or public health policies. The absence of these variables may limit a complete understanding of the determinants of health professionals’ mental health.

Beyond the cross-sectional nature of the study and the risk of reporting bias associated with face-to-face interviews are also important limitations of this work.

This study highlights the significant impact of the COVID-19 pandemic on the mental health of healthcare workers in Mali. The results emphasize the need for targeted interventions to improve the psychological well-being of healthcare workers, including psychological support programs, better workload management, and increased promotion of vaccination.

We express our deep gratitude to all the staff at Hôpital du Mali, Centre Hospitalier Universitaire du Point G, and Hôpital Dermatologique de Bamako for their exemplary collaboration. We would also like to extend our warmest thanks to all the staff of the Department of Psychiatry for their warm welcome and invaluable advice. Author Idiatou Diallo was supported by the Fogarty International Center and the National Institute of Mental Health (NIMH) of the National Institutes of Health (NIH) under Award Number D43 TW010543. We also acknowledge the use of the Hemingway Editor, which assisted in enhancing the clarity and readability of this article.

COVID-19: Coronavirus Disease 2019

FMOS: Faculty of Medicine and Odontostomatology

GAD-7: Generalized Anxiety Disorder-7

IES-R: Impact of Event Scale—Revised

PTS: Post-Traumatic Stress

PHQ-9: Patient Health Questionnaire-9

USA: United States of America

USTTB: University of Sciences, Techniques and Technologies of Bamako