Family Practice, 2025, 42, cmad094 https://doi.org/10.1093/fampra/cmad094 Epidemiology Prevalence and correlates of alcohol use, mental disorders, and awareness and utilization of support services among healthcare professionals in West Rand District, Gauteng, South Africa: a cross-sectional study Charlotte Mc Magh*, , Oluwafojimi Fadahun , Joel Msafiri Francis Department of Family Medicine and Primary Care, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa *Corresponding author: Department of Family Medicine and Primary Care, Division of Family Medicine, 4th Floor, Philip V Tobias Health Sciences Building, 29 Princess of Wales Terrace, Parktown, Johannesburg 2193, South Africa. Email: charlotte@rapt.co.za Introduction: Healthcare professionals (workers) are at an increased risk for developing mental and alcohol use disorders (risky drinking) due to increased psychological distress, long working hours, medical litigation, role conflict, and verbal/physical violence from colleagues and patients. Psychological well-being in healthcare workers is crucial to provide the best quality of care to patients. Current data are limited regarding alcohol abuse (risky drinking) rates and mental health condition among healthcare professionals in South Africa. Objectives: To describe the prevalence and correlates of alcohol use disorder (risky drinking), depression, anxiety, suicidality, and covid anxiety during the coronavirus pandemic in healthcare professionals in West Rand District, Johannesburg, South Africa. Methods: We carried out a cross-sectional study on a sample of healthcare professionals including doctors, nurses, clinical associates, and dentists working in the West Rand District of Gauteng, South Africa, during Covid-19 pandemic. Participants were invited to complete a paper- based questionnaire addressing sociodemographic questions, a set of measures for alcohol use disorder (AUDIT-C), depression (PHQ-2), anxiety (GAD-7), suicidality (PSS-3), covid anxiety (CAS), and awareness and utilization of support services. Results: A total of 330 healthcare professionals (60.9% nurses, 33% doctors, 5.5% other) participated. Females comprised the majority of study participants with 78.8%, and 48.2% of the participants were in the age band 35–64 years. Overall, 20.9% of the healthcare professionals reported risky alcohol use. Females were 73% less likely to report risky alcohol use (AOR = 0.27;95% CI: 0.13–0.54). Prevalence of probable depression was 13.6% and female professionals were 5 times more likely to be classified as having probable depression (AOR = 4.86;95% CI: 1.08–21.90). The grouped prevalence of anxiety ranging from mild to severe was reported at 47.3%, female professionals were 3 times more likely to be classified as having anxiety disorder (AOR = 2.78;95% CI: 1.39–5.57). Furthermore, races other than African had higher rates of anx- iety (AOR = 2.54; 95% CI: 1.00–6.42). The prevalence of suicide symptoms was 7.9% and that of covid dysfunctional anxiety 4.8%. Only 5% of participants were involved in an employee wellness program, with 60% expressing interest in joining one. Conclusion: Alcohol use (risky drinking) and mental disorders were common among healthcare professionals in West Rand District, Johannesburg, South Africa. There is overall poor awareness and use of support structures highlighting urgent need for interventions. Future studies could also explore in-depth the drivers of mental disorders and lack of utilization of the available service and strategies to deliver alcohol and mental disorder screening, brief intervention, and referral to treatment. Key words: anxiety, healthcare professionals, risky drinking, South Africa, suicide symptoms Introduction Alcohol is a psychotropic substance able to affect mental pro- cesses such as effect and/or cognition and has dependence producing properties. Alcohol use is part of multiple social, religious and cultural practices due to its perceived ability to provide pleasure. Heavy alcohol use, however, is associated with greater risk for developing multiple medical conditions as well as mental disorders.1 During 2018, a global status report on alcohol and health estimated that 3 million alcohol related deaths occurred glo- bally every year.2 Moreover during 2019, Statistica reported that South Africans consumed just under 10 L of alcohol per capita, making it the third most leading country in terms of alcohol consumption in Africa.3 In 2019, 1 in every 8 people, or 970 million people globally was found to have a mental disorder, depression and anxiety as commonest.4 These num- bers are thought to have increased by 25% during the first year of the coronavirus disease 2019 (Covid-19) pandemic according to the World Health Organisation (WHO).5 There is a complex interplay of internal and external fac- tors which eventually contribute to the use of alcohol and/or development of mental disorders. External factors include en- vironment, family, religion, job status, and in many societies considered a cultural norm.6 Internal factors include genetics and psychological conditions such as other substance related disorders, antisocial personality disorder, mood disorders, and anxiety disorders.6 Healthcare professionals are highly vulnerable to developing risky alcohol use and mental disorders. They are exposed to long working hours, high workloads, concerns © The Author(s) 2023. Published by Oxford University Press. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/ by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited. https://orcid.org/0000-0001-8901-4326 https://orcid.org/0000-0001-8901-4326 https://orcid.org/0000-0003-3872-535X https://orcid.org/0000-0003-3872-535X https://orcid.org/0000-0003-1902-2683 https://orcid.org/0000-0003-1902-2683 mailto:charlotte@rapt.co.za https://creativecommons.org/licenses/by/4.0/ https://creativecommons.org/licenses/by/4.0/ 2 Epidemiology of alcohol use, mental disorders among healthcare professionals over medical errors and/or litigation, role conflict, emo- tional labour, and verbal and/or physical abuse.7 Additional stressors include lack of resources, personnel and critical facilities. Lastly exposure to dangerous pathogens such as Covid-19 can further exacerbate and strain healthcare pro- fessionals’ psychological state. Healthcare professionals are at the frontline when diagnosing, treating, and caring for pa- tients with Covid-19. The ever-increasing numbers of cases depleted personal protective equipment, overwhelming work- load, lack of clear guidelines and medication as well as fear of contracting or spreading the virus, have all contributed to the mental burden.8 During the coronavirus pandemic multiple studies con- ducted on healthcare professionals found alarmingly high rates of risky drinking. Problem drinking amongst healthcare professionals were reported in an American study (as high as 42.6%),9 a British study (7%)10 an Ethiopian study (40.2%),11 and a Kenyan study (43.9%).12 A rapid scoping review con- ducted in 2020 researched the mental health of healthcare professionals during the Covid-19 outbreak in South Africa and found prevalence of rates of depression (8.9%–50.4%) and anxiety (10.4%–44.6%).13 Both harmful alcohol use and abovementioned mental dis- orders can affect a healthcare professionals standard of care and overall safety to the patient.14 Risky drinking has been associated with reduced productivity and performance in the workplace due to cognitive impairment and ill health.15 Workplaces that encourage and support mental health are more likely to improve healthcare professionals’ quality of life, decrease absenteeism, increase productivity, and benefit from associated economic gains.16 Preventative mental health interventions or health promotion programmes are ways in which to reduce the risk of mental health problems within the workplace. There is a lack of research on mental health in healthcare professionals working in South Africa particularly in primary care settings. Therefore, the aim of this study was to deter- mine the prevalence and correlates of alcohol use and mental disorders including covid anxiety amongst healthcare profes- sionals in West Rand District, Gauteng, South Africa. And in addition, assess the healthcare professionals’ awareness and utilization of support services. Methods Study design and setting This study was a quantitative cross-sectional study. The re- search was conducted at 3 randomly selected Government Hospitals and Community Healthcare Centres (CHC) located in the West Rand District, Gauteng, South Africa. The 3 hos- pitals were Dr Yusuf Dadoo (District), Carletonville (District) and Leratong (Regional). The 3 Community HealthCare Centres were Bekkersdal West, Khutsong, and Mohlakeng. Recruitment was done by the investigator at each site. Participants were approached in their respective clinical work areas. The data were collected from June 2021 to March 2022. Study population The inclusion criteria for participants included doctors (in- terns, community service, medical officers, registrars, and spe- cialists), nurses (nursing professionals, nursing assistants, and professional nurses), clinical associates, and dentists. Since it was a survey on healthcare professionals, a positive response to participation was taken as an implied consent. Participants also had to be currently employed on the West Rand and aged 18 or older. Those who did not fulfil above criteria were ex- cluded from the study. Sample size and sampling According to the West Rand Health Council Area healthcare professionals totalled 2,747.17 Ideally, we would have wanted to include as many healthcare professionals as possible working in the West Rand District. However, having assumed that we could not access all healthcare professionals we cal- culated a sample size by using OpenEpi.18 Moreover, we as- sumed that 6% of healthcare professionals would have had an alcohol use disorder,19 using a population size of 2,747 healthcare workers with a precision of 3% and design effect of 2%. The minimal sample size was 443 healthcare profes- sionals with a confidence interval of 95%. Data collection procedures Recruitment of participants Permission was obtained from the various heads of units to grant access to their facilities and to meet potential study participants. Recruitment was done by the investigator at each site. Study information was provided to all eligible participants who were then invited to partake in a paper-based self-administered questionnaire. Participants were provided with paper-based self-administered questionnaire that comprised of 7 sections with a total of 33 questions. The survey looked at sociodemographic data such as gender, age, marital status, religion, race, profession, work setting, and employment duration. Each collection site was provided a secure area to drop off surveys once completed. The investigator would then collect the surveys after a few days. Study variables Outcomes (dependent variables) Harmful alcohol use was measured by applying the 3-item question screening tool namely alcohol use disorder identification test (AUDIT-C). It is a shorter and modified version of the10 question AUDIT instrument. Studies have validated the use of the AUDIT-C for screening risky drinking and active abuse.20 The AUDIT-C measures alcohol misuse based on 3 questions about drinking Key messages • Risky alcohol use is common among male healthcare professionals. • Mental disorders were common among female healthcare professionals. • Awareness and utilization of support services was overall poor. • There is a need for alcohol and mental disorders interventions. Family Practice, 2025, Vol. 42, No. 2 3 habits. The scores are interpreted differently in males than in females. A score of 4 or more in males suggest alcohol misuse, while a score of 3 or more in females suggest the same. Depression was measured using the patient health questionnaire-2 (PHQ-2). The full 9-item PHQ-9 question- naire is a validated tool created by Kroenke et al.21 to as- sist in screening, diagnosing, and monitoring depression. The shorter version PHQ-2 is a 2-item questionnaire comprising of the first 2 questions from the PHQ-9,22 its main purpose is to screen for depression. A PHQ2 score can range from 0 to 6, if the score is equal to 3 or greater, major depression dis- order is likely.22 The generalized anxiety disorder-7 (GAD-7) tool was used to screen for generalized anxiety disorder. It is a val- idated diagnostic tool for generalized anxiety.23 Each ques- tion is rated from zero to 3 with a maximum score of 21. A score of 10 and above indicates moderate symptom severity with possible clinically significant condition requiring further workup.23,24 A score of 15 and more is considered a severe symptom severity and warrants active treatment.23,24 The 3-item Patient Safety Scale-3 (PSS-3) is a validated, short and efficient tool used to screen for suicidality and idea- tion.25 The first 2 questions were based on thoughts experi- enced over the past 2 weeks and the last questions based on past experiences over a lifetime. Each question has 3 options to choose from: No, Yes, and refused to answer. A positive screening is found if ‘Yes’ was selected in question 2 or 3.25 The 5-item CAS questionnaire (CAS) was used to screen for anxiety related to Covid-19. It is a recently developed brief mental health screener for Covid-19-related anxiety, with 90% sensitivity and 85% specificity.8 Each question has 5 op- tions to choose from, participants with a score of 9 and above are classified as having dysfunctional anxiety associated with the Covid-19 pandemic.8 The final part of the survey assessed the awareness of and utilization by healthcare professionals of organizations avail- able for counselling on alcohol use and mental disorders. Multiple support services were provided, and healthcare professionals were asked to select the ones they had person- ally used in the past. Participants were asked if they were in- volved in any employee wellness program (EWP), interested in joining, and what types of services they would prefer. Exposures (independent variables) The study exposures included sociodemographic information such as job title, work environment, gender, race, religion, and marital status. Data management and analysis The survey data were entered into a secure software platform called Research Electronic Data Capture (REDCap). Only the investigator and the supervisors had access to the data. Prior to analysis we recorded the scores used to assess the main out- comes (alcohol use and mental disorders). We then computed descriptive statistics to summarize the sociodemographic information from the participants. Bivariate analysis (using chi-square or Fisher’s exact test) was used to determine the association between alcohol use, alcohol use disorders, mental disorders with the correlates. Furthermore, multivariable logistic regression was performed to determine the factors associated with alcohol use, alcohol use disorders, and mental disorders. From previous studies, age and sex were included in the multivariable models as a priori confounders of alcohol use, alcohol use disorder, and mental disorders.12,26–29 Other factors were entered in the multivariable models if they had a P value <0.20 in bivariate analysis (Supplementary Tables 1–4). We report the findings of multivariable analysis as adjusted odds ratios and corres- ponding 95% CI. In the final models, a P value of <0.05 was considered statistically significant. Results A total of 500 surveys were disseminated with 330 surveys having been completed, this translates to 66% response rate. Sociodemographic characteristics of the study participants Most of the participants were predominantly female (78.8%) with 48.2% of healthcare professionals aged between 35 and 64 years. The predominant religion was Christianity (87.3%) with mostly African healthcare professionals par- taking (87.0%) in the study. Regarding healthcare profession 60.9% were nurses followed by doctors (33.0%), and 40.6% of the participants had been employed for a duration of more than 10 years. Additionally work setting varied amongst healthcare professionals with 36.1% working in wards and 35.8% working in the outpatient department and casualty (Table 1). Prevalence and factors associated with alcohol use disorder (risky drinking) The overall prevalence of alcohol use disorder (AUD) amongst participants was (20.9%, P value <0.001). The AUD was highly prevalent amongst male healthcare professionals (42.0%, P value <0.001) when compared with females (15.4%, P value <0.001) (Table 2). In multivariable analysis (Table 3), only sex was associated with AUD and that females were less likely to report risky drinking (AOR = 0.27, 95% CI: 0.13–0.54). Prevalence and factors associated with depression Regarding depression the overall prevalence for probable de- pression was 13.6% (P value <0.001), with females having markedly higher rates of probable depression (16.5%, P value <0.001) compared with males (2.9%, P value <0.001) (Table 2). In the multivariable analysis (Table 4) being female was significantly associated with increased odds of being clas- sified as having probable depression (AOR = 4.86,95% CI: 1.08–21.90). Prevalence and factors associated with anxiety disorder The general prevalence of mild to severe anxiety was 47.3% (n = 156): mild anxiety 30.6% (n = 101); moderate anxiety 10% (n = 33); and severe anxiety 6.7% (n = 22). As presented in Table 2, females were found to have higher prevalence of anxiety than males (50.8% versus 34.8%, P value <0.001). In the multivariable analysis (Table 4) females were significantly associated with increased odds of anxiety (AOR = 2.78, 95% CI: 1.39–5.57). Furthermore, races other than African had higher percentages of anxiety (AOR = 2.54, 95% CI: 1.00– 6.42) (Table 5). http://academic.oup.com/fampra/article-lookup/doi/10.1093/fampra/cmad094#supplementary-data 4 Epidemiology of alcohol use, mental disorders among healthcare professionals Prevalence and factors associated with suicide symptoms As presented in Table 2, the participants’ overall suicidal symptoms prevalence was 7.9% with females having higher prevalence than males (9.2% versus 2.9%, P value <0.001). In multivariable analysis (Table 6), being widowed/divorced was significantly associated with reporting suicidal symptoms (AOR = 6.88, 95% CI: 1.37–34.55). Prevalence of Covid-19 dysfunctional anxiety and correlates The overall prevalence of Covid-19 dysfunctional anxiety was generally low amongst healthcare professionals (4.8%, P value <0.001) with no males having reported Covid-19 dys- functional anxiety (Table 2). On bivariate analysis (Table 7), anxiety disorder (P < 0.001), probable depression (P = 0.031), and sex, being female (P = 0.034) were associated with Covid- 19 dysfunctional anxiety. In multivariable analysis, none of the factors were associated with Covid-19 dysfunctional anxiety. Utilization and awareness of wellness services Table 8 shows that there was low utilization of all the different helplines listed: Alcoholics Anonymous (AA) only 1.5% (n = 5); Alcoholics Anonymous for group of young people (Alteen) 1.5% n = 5; South African Depression and Anxiety Group (SADAG) 2.4% (n = 8); Depression and Mental Helpline (DMH) (n = 9); and lastly the Suicidal Crisis Helpline (SCH) only 0.6% (n = 2). The counselling service most used by healthcare professionals was psychology with 21.2% (n = 70). Most of the healthcare professionals 91.8% (n = 303) were not involved in EWP however 59.7% (n = 197) reported interest in joining one. Additionally, when asked what spe- cific services were required, healthcare professionals reported as follows: 47% (n = 155) wellness events, 43.6% (n = 144) services, and 44.8% (n = 148) resources. Discussion These results reveal that healthcare professionals working in the West Rand have high levels of reported alcohol use dis- order, anxiety, depression, and suicidality. Females were found to have much higher rates of anxiety, depression, suicidality, and Covid-19 anxiety. Males however had higher reported rates of alcohol use. Overall, there was poor utilization of support services in general with few healthcare professionals involved in EWP. Strengths/limitations This is the first study conducted on healthcare professionals on the West Rand District, Gauteng province, South Africa to assess alcohol use disorder and a variety of mental health outcomes. This study provides important information on the prevalence and correlates of alcohol use disorder and mental health conditions among healthcare professionals. Our study was neither without limitations nor could the caus- ation be inferred due to the nature of a cross-sectional study. Unfortunately, we were unable to meet our calculated sample size of 443 with only 330 completed surveys. Possible reasons for nonparticipation at recruitment included lack of time and being uninterested in research. This selection bias could lead to underestimation of the outcomes if those with alcohol use disorder (risky drinking) and mental disorders refrained to take part. Self-administered questionnaires were used for this study which relied on self-report measures, this may have caused recall bias. There can also be a tendency for healthcare Table 1. General characteristics of healthcare professionals in West Rand District, Johannesburg, South Africa, 2021–2022. Characteristic Categories n % Sex Male 69 20.9 Female 260 78.8 Missing 1 0.3 Total 330 100.0 Age (years) 23–34 years 119 36.1 35–64 years 159 48.2 Missing 52 15.8 Total 330 100.0 Marital status Single 125 37.9 Married/with partner 180 54.5 Widowed/divorced 24 7.3 Missing 1 0.3 Total 330 100.0 Religion Christian 288 87.3 Other 32 9.7 Missing 10 3.0 Total 330 100.0 0.0 Race Black/African 287 87.0 Coloured 6 1.8 Indian/Asian 12 3.6 White 17 5.2 Prefer not to disclose 4 1.2 Missing 4 1.2 Total 330 100.0 Race—binary Black 287 87.0 Others 39 11.8 Missing 4 1.2 Total 330 100.0 Profession Medicine 109 33.0 Nursing 201 60.9 Other 18 5.5 Missing 2 0.6 Total 330 100.0 Work setting Wards 119 36.1 OPD and causality 118 35.8 Other 73 22.1 Missing 20 6.1 Total 330 100.0 Employment duration <4 years 92 27.9 4–10 years 94 28.5 >10 years 134 40.6 Missing 10 3.0 Total 330 100.0 OPD, outpatient department. Family Practice, 2025, Vol. 42, No. 2 5 professionals to under report harmful alcohol use/mental illness/suicidal ideation to be seen as safe and responsible due to the nature of their position thus social desirability bias may have occurred. To reduce the risk of response bias, surveys were anonymous, questions were short and clear and shorter screening tools for alcohol use disorder and depression. Interpretation This cross-sectional study found that during the Covid-19 pandemic 20.9% of West rand healthcare professionals re- ported harmful alcohol use. Our findings vary from similar studies conducted in other countries during Covid-19 time- line. Our rate is much lower than healthcare professionals working in Kenya (43.9%) and United States of America (42.6%)9,12 and much higher than those in Italy (9.1%) and United Kingdom (7%).10,26 A possible reason for the discrep- ancy in alcohol prevalence rates could be due to the varied alcohol control policies across different countries and access to mental health services. The high rate of harmful alcohol use found on the West Rand is a cause for concern especially in the male popula- tion. In our study being female was associated with decreased odds of harmful alcohol use, these findings are consistent with studies conducted in Kenya and Italy during the Covid- 19 pandemic.12,26 These gender differences may be explained by strict cultural beliefs, values, and traditional gender roles that may prevent females from developing harmful substance abuse.30 Regarding depression 45 (13.6%) participants screened positive for probable depression. In contrast, Lai et al.31 con- ducted research at 34 hospitals in China and found much higher rates of depression (50%). A systematic review titled ‘Global prevalence and burden of depressive and anxiety disorders in 204 countries and territories in 2020 due to the Covid-19 pandemic’ found higher rates of depression as com- pared with our population (24.3%).32 In our study females had higher chances of developing depression [AOR = 4.86; 95% CI: 1.08–21.90]. Naidoo et al. researched depression in healthcare professionals working in Kwa-Zulu Natal prior to the Covid-19 pandemic and similarly found an association be- tween being female and having depression [OR 3.85, 95% CI: 1.21–12.22].33 A recent systematic review which researched the prevalence of major depressive disorder in the general population also reported females as more affected with de- pression than males.34 These differences may be attributed Table 2. Prevalence of alcohol use disorder, depression, anxiety, suicide, COVID dysfunctional anxiety among healthcare professionals in West Rand District, Johannesburg, South Africa 2021–2022. Characteristic Categories Sex P value Male Female Total n % n % n % Alcohol use disorder (AUDIT-C) No risky drinking 38 55.1 218 83.8 256 77.6 <0.001 Risky drinking 29 42.0 40 15.4 69 20.9 Missing 2 2.9 2 0.8 5 1.5 Total 69 100.0 260 100.0 330 100.0 Depression No depression 64 92.8 210 80.8 274 83.0 <0.001 Probable depression 2 2.9 43 16.5 45 13.6 Missing 3 4.3 7 2.7 11 3.3 Total 69 100.0 260 100.0 330 100.0 Anxiety No anxiety 44 63.8 120 46.2 164 49.7 <0.001 Mild anxiety 19 27.5 82 31.5 101 30.6 Moderate anxiety 4 5.8 29 11.2 33 10.0 Severe anxiety 1 1.4 21 8.1 22 6.7 Missing 1 1.4 8 3.1 10 3.0 Total 69 100.0 260 100.0 330 100.0 Anxiety (binary) No anxiety disorder 44 63.8 120 46.2 164 49.7 <0.001 Anxiety disorder 24 34.8 132 50.8 156 47.3 Missing 1 1.4 8 3.1 10 3.0 Total 69 100.0 260 100.0 330 100.0 Suicide symptoms No suicide symptoms 63 91.3 224 86.2 287 87.0 <0.001 Suicide symptoms 2 2.9 24 9.2 26 7.9 Missing 4 5.8 12 4.6 17 5.2 Total 69 100.0 260 100.0 330 100.0 COVID dysfunctional anxiety No dysfunctional anxiety 68 98.6 240 92.3 308 93.3 <0.001 Dysfunctional anxiety 0 0.0 16 6.2 16 4.8 Missing 1 1.4 4 1.5 6 1.8 Total 69 100 260 100.0 330 100.0 The bolded P-value is statistically significant. 6 Epidemiology of alcohol use, mental disorders among healthcare professionals to prescribed gender roles, added stressors of balancing do- mestic and professional roles, empathetic tendencies, margin- alization by male colleagues and the likelihood of social and economic consequences of the Covid-19 pandemic.33,34 Many respondents 47.3% (n = 101) in our study reported some form of anxiety. Robertson et al. conducted a systematic review of global literature surrounding mental health of healthcare professionals and found anxiety rates ranged any- where from 10.4% to 44.6%.13 Differences in study popula- tion, screening tools and study sites may be causes of the wide range of prevalence rates.13 In our study being female was as- sociated with increased odds of having anxiety [AOR = 2.78, Table 3. Factors associated with alcohol use disorder among healthcare professionals in West Rand District, Johannesburg, South Africa, 2021–2022. Characteristic Categories Adjusted OR 95% CI Sex Male 1 Female 0.27*** 0.13–0.54 Age (years) 23–34 1 35–64 0.52 0.26–1.02 Marital status Single 1 Married/with partner 0.76 0.38–1.49 Widowed/di- vorced 0.38 0.08–1.92 Religion Christian 1 Other 0.87 0.23–3.22 Race Black 1 Others 0.42 0.12–1.49 Probable depres- sion No 1 Yes 1.45 0.58–3.60 COVID dysfunc- tional anxiety No 1 Yes 0.80 0.16–4.00 ***P < 0.001. The bolded P-value is statistically significant. Table 4. Factors associated with probable depression among healthcare professionals in West Rand District, Johannesburg, South Africa, 2021–2022. Characteristic Categories Adjusted OR 95% CI Sex Male 1 Female 4.86* 1.08–21.90 Age (years) 23–34 1 35–64 1.34 0.60–3.03 Marital status Single 1 Married/with partner 0.97 0.44–2.14 Widowed/di- vorced 0.66 0.16–2.80 Religion Christian 1 Other 0.65 0.17–2.41 Race Black 1 Others 2.36 0.79–7.05 Alcohol use dis- order No 1 Yes 1.44 0.58–3.58 COVID dysfunc- tional anxiety No 1 Yes 2.59 0.72–9.29 *P < 0.05. The bolded P-value is statistically significant. Table 5. Factors associated with anxiety disorder among healthcare professionals in West Rand District, Johannesburg, South Africa, 2021–2022. Characteristic Categories Adjusted OR 95% CI Sex Male 1 Female 2.78** 1.39–5.57 Age (years) 23–34 1 35–64 0.90 0.51–1.60 Marital sta- tus Single 1 Married/with partner 0.77 0.44–1.36 Widowed/di- vorced 1.23 0.47–3.26 Religion Christian 1 Other 1.20 0.43–3.35 Race Black 1 Others 2.54* 1.00–6.42 Alcohol use disorder No 1 Yes 1.60 0.83–3.08 *P < 0.05. **P < 0.01. The bolded P-value is statistically significant. Table 6. Factors associated with suicide symptoms among healthcare professionals in West Rand District, Johannesburg, South Africa, 2021–2022. Characteristic Categories Adjusted OR 95% CI Sex Male 1 Female 7.88 0.98–63.19 Age (years) 23–34 1 35–64 0.36 0.13–1.03 Marital sta- tus Single 1 Married/with partner 2.55 0.83–7.88 Widowed/di- vorced 6.88* 1.37–34.55 Religion Christian 1 Other 2.69 0.52–13.91 Race Black 1 Others 0.16 0.02–1.14 Alcohol use disorder No risky drinking 1 Risky drink- ing 1.32 0.42–4.13 *P < 0.05. The bolded P-value is statistically significant. Family Practice, 2025, Vol. 42, No. 2 7 95% CI: 1.39–5.57]. A systematic review assessing mental health problems in healthcare professionals since Covid-19 found similar results to our study.35 They found that female workers, nurses, frontline healthcare workers, younger med- ical staff members and workers in higher infection areas ex- perienced the highest level of psychological distress.35 Pre-Covid-19 studies showed consistently that both nurses and physicians were at a higher risk for suicide as compared with other employed people.36,37 Our study found higher rates of suicidal ideation (7.9%) as compared with the findings of 4.2% by Mortier et al. which was con- ducted at a large multicentre, in a prospective cohort study of Spanish healthcare workers (HCWs) active during the Covid-19 pandemic.38 The higher rate in our study could be due to South Africa as a developing country with limited resources, insufficient workforce, poor supervision/guide- lines, and high job expectations. Rahman and Plummer found that females are at a higher risk of suicidal behav- iour than males during the Covid-19 pandemic, this was true for our study whereby female healthcare professionals had higher suicidal prevalence than male health profes- sionals (9.2% versus 2.9%, P value <0.001) and suicide symptoms were significantly higher among those divorced/ widowed.39 Alarmingly there was overall poor utilization of help- line services besides psychology (21.2%, n = 70) amongst healthcare professionals considering the high rates of harmful alcohol use, depression, anxiety, and suicidality. A majority of healthcare professionals were not involved in any EWP 91.8% (n = 303) whereas oddly more than half 59.7% (n = 197) reported interest in joining one. When asked which services they would be interested in receiving from an EWP healthcare professionals reported health services, creating wellness events, and providing resources. Nikunlaakso et al. conducted a scoping review looking at interventions to reduce the risk of mental health problems in health workplaces.40 Their study revealed that there is a scarcity in the evidence that interventions reduce the risk of work-related mental health problems.40 However, psychological communication training and coaching, mental relaxation, muscle stressing, and emotional orientated care interventions were reported to have a positive effect and showed promising results.40 Generalizability Our sample was comprised mostly of nurses followed by doc- tors, a good representation as the latter makes up the largest group of healthcare providers in South Africa. The findings of this study could be extended in other settings in South Africa. Conclusions and recommendations It is evident that harmful alcohol use, probable depression, anxiety, and suicidality are significant problems amongst healthcare professionals on the West Rand. Overall, there is poor utilization of support services but large interest in joining an EWP. There is a need to create and pilot, targeted interven- tions amongst healthcare professionals to improve awareness and utilization of the existing alcohol use and mental health services. Our recommendations include increasing awareness of the availability of alcohol use and mental health wellness programs/psychological services and to strengthen/create EWPs. Lastly there is also a need for integration of screening, brief interventions, and referral for treatment of alcohol use Table 7. Findings of the factors associated with COVID dysfunctional anxiety at bivariate analysis among healthcare professionals in West Rand District Johannesburg, South Africa, 2021–2022. Characteristic Categories COVID dysfunctional anxiety P value No Yes Total n % n % n Sex Male 68 100.0 0 0.0 68 0.034 Female 240 93.8 16 6.3 256 Total 308 95.1 16 4.9 324 Age (years) 23–34 112 94.1 7 5.9 119 0.795 35–64 147 94.8 8 5.2 155 Total 259 94.5 15 5.5 274 Marital sta- tus Single 116 95.1 6 4.9 122 0.191 Married/with partner 171 96.1 7 3.9 178 Widowed/di- vorced 21 87.5 3 12.5 24 Total 308 95.1 16 4.9 324 Religion Christian 269 94.7 15 5.3 284 0.183 Other 32 100.0 0 0.0 32 Total 301 95.3 15 4.7 316 Race Black 267 94.7 15 5.3 282 0.459 Others 38 97.4 1 2.6 39 Total 305 95.0 16 5.0 321 Cadre Medicine 106 97.2 3 2.8 109 0.422 Nursing 183 93.8 12 6.2 195 Other 17 94.4 1 5.6 18 Total 306 95.0 16 5.0 322 Working sta- tion Wards 110 94.0 7 6.0 117 0.853 OPD and causality 109 94.8 6 5.2 115 Other 70 95.9 3 4.1 73 Total 289 94.8 16 5.2 305 Employment duration <4 years 89 96.7 3 3.3 92 0.626 4–10 years 88 94.6 5 5.4 93 >10 years 123 93.9 8 6.1 131 Total 300 94.9 16 5.1 316 Alcohol use disorder No 238 94.4 14 5.6 252 0.369 Yes 67 97.1 2 2.9 69 Total 305 95.0 16 5.0 321 Probable de- pression No 259 96.3 10 3.7 269 0.031 Yes 40 88.9 5 11.1 45 Total 299 95.2 15 4.8 314 Suicide symp- toms No 270 95.4 13 4.6 283 0.126 Yes 23 88.5 3 11.5 26 Total 293 94.8 16 5.2 309 Anxiety dis- order No 161 99.4 1 0.6 162 <0.001 Yes 139 90.3 15 9.7 154 Total 300 94.9 16 5.1 316 The bolded P-value is statistically significant. 8 Epidemiology of alcohol use, mental disorders among healthcare professionals and mental disorders in EWPs. Future studies could also ex- plore in-depth the drivers of mental disorders and lack of utilization of the available service and strategies to deliver al- cohol and mental disorder screening, brief intervention, and referral to treatment. Acknowledgements We thank all the participating healthcare professionals on the West Rand for their collaboration. The research findings have been presented at the second annual West Rand Health District Research Conference. Table 8. Utilization of wellness services among healthcare professionals in West Rand District Johannesburg, South Africa 2021–2022. Characteristic Categories Sex P value Male Female Total n % n % n % Alcoholic Anonymous South Africa National Helpline (AA) No 68 98.6 249 95.8 317 96.1 <0.001 Yes 0 0.0 5 1.9 5 1.5 1 1.4 6 2.3 8 2.4 Total 69 100.0 260 100.0 330 100.0 Alteen (group for young people with alcohol problems) No 66 95.7 247 95.0 313 94.8 <0.001 Yes 1 1.4 4 1.5 5 1.5 2 2.9 9 3.5 12 3.6 Total 69 100.0 260 100.0 330 100.0 SADAG No 66 95.7 244 93.8 310 93.9 <0.001 Yes 1 1.4 7 2.7 8 2.4 2 2.9 9 3.5 12 3.6 Total 69 100.0 260 100.0 330 100.0 Depression and Mental Health Help line No 67 97.1 241 92.7 308 93.3 <0.001 Yes 2 2.9 7 2.7 9 2.7 0 0.0 12 4.6 13 3.9 Total 69 100.0 260 100.0 330 100.0 Suicide Crises line No 66 95.7 244 93.8 310 93.9 0.001 Yes 1 1.4 1 0.4 2 0.6 2 2.9 15 5.8 18 5.5 Total 69 100.0 260 100.0 330 100.0 Psychologist No 57 82.6 189 72.7 246 74.5 <0.001 Yes 11 15.9 59 22.7 70 21.2 1 1.4 12 4.6 14 4.2 Total 69 100.0 260 100.0 330 100.0 Are you currently involved in an employee wellness program? No 63 91.3 240 92.3 303 91.8 <0.001 Yes 4 5.8 12 4.6 16 4.8 2 2.9 8 3.1 11 3.3 Total 69 100.0 260 100.0 330 100.0 Would you be interested in joining an employee wellness program if provided No 31 44.9 78 30.0 109 33.0 0.001 Yes 33 47.8 164 63.1 197 59.7 5 7.2 18 6.9 24 7.3 Total 69 100.0 260 100.0 330 100.0 Wellness events (e.g. walking, nutrition, resilience programs) No 3 4.3 9 3.5 12 3.6 0.270 Yes 25 36.2 130 50.0 155 47.0 41 59.4 121 46.5 163 49.4 Total 69 100.0 260 100.0 330 100.0 Services (e.g. screening, health coaching) No 3 4.3 18 6.9 21 6.4 0.483 Yes 26 37.7 118 45.4 144 43.6 40 58.0 124 47.7 165 50.0 Total 69 100.0 260 100.0 330 100.0 Resources (e.g. online assessments, learning modules, training programs) No 5 7.2 19 7.3 24 7.3 0.406 Yes 25 36.2 123 47.3 148 44.8 39 56.5 118 45.4 158 47.9 Total 69 100.0 260 100.0 330 100.0 Family Practice, 2025, Vol. 42, No. 2 9 Supplementary material Supplementary material is available at Family Practice online. Funding This work was self-funded by investigating researcher. Conflict of interest None declared. Ethical approval The study was approved by the Ethics Committee (HREC) of the University of the Witwatersrand, Johannesburg (Ref no. M2102101), the West Rand District clinical manager and head of units at each of the various facilities. The Ethics committee waived the requirement of written informed con- sent for participation. As part of a distress measure, parti- cipants were provided details on different support services/ helplines in order to assist with any alcohol or mental health- related issues. No financial remuneration was offered to the participants. Our study procedures were in keeping with the 1964 Helsinki Declaration. No consent form was needed as completing the self-administered questionnaire voluntarily implied consent. Participating healthcare professionals com- pleted the survey/questionnaire completely anonymously. 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J Psychiatr Res. 2022:152:57–69. https://pubmed.ncbi.nlm.nih.gov/33052921/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7090843/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7090843/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8348388/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8348388/ https://pubmed.ncbi.nlm.nih.gov/33052921/ https://pubmed.ncbi.nlm.nih.gov/33052921/ https://pubmed.ncbi.nlm.nih.gov/34634250/ Prevalence and correlates of alcohol use, mental disorders, and awareness and utilization of support services among healthcare professionals in West Rand District, Gauteng, South Africa: a cross-sectional study Introduction Methods Study design and setting Study population Sample size and sampling Data collection procedures Recruitment of participants Permission was obtained from the various heads of units to grant access to their facilities and to meet potential study participants. Recruitment was done by the investigator at each site. Study information was provided to all Study variables Outcomes (dependent variables) Harmful alcohol use was measured by applying the 3-item question screening tool namely alcohol use disorder identification test (AUDIT-C). It is a shorter and modified version of the10 question AUDIT instrument. Studies have Exposures (independent variables) The study exposures included sociodemographic information such as job title, work environment, gender, race, religion, and marital status. Data management and analysis Results Sociodemographic characteristics of the study participants Prevalence and factors associated with alcohol use disorder (risky drinking) Prevalence and factors associated with depression Prevalence and factors associated with anxiety disorder Prevalence and factors associated with suicide symptoms Prevalence of Covid-19 dysfunctional anxiety and correlates Utilization and awareness of wellness services Discussion Strengths/limitations Interpretation Generalizability Conclusions and recommendations Acknowledgements References