Nurses’ mental health and COVID‐19 pandemic: Is there any approach?

The sudden and widespread outbreak of the novel coronavirus disease (COVID19) has caused many problems in all the sections of the societies (Liu et al., 2020). In the last few months, the increase in confirmed and suspected cases and deaths due to COVID19 in the world, and the imposition of more social restrictions in most countries has caused several psychological disorders among healthcare workers (HCWs) and the general population (Maroufi, 2021). Among HCWs, the frontline workers such as nurses and doctors who are involved directly in handling these patients are at greater risk than others (Spoorthy et al., 2020). With the rapid increase in the number of patients, doctors and nurses have to face enormous workload and highrisk infections, which may lead to mental health problems such as anxiety, depression (Liu et al., 2020) or insomnia (Walton et al., 2020). This psychological distress caused by acute infectious diseases may persist for a long time and even lead to posttraumatic stress disorder (PTSD) (Xiong et al., 2020). Investigations demonstrated that several factors have such adverse psychological consequences among HCWs, including excessive work hours, depletion of personal protection equipment, overenthusiastic media news, feeling insufficiently supported, lack of specific drugs and the infection rate among medical staff (Lai et al., 2020; Spoorthy et al., 2020). There are many similarities in psychological symptoms between the COVID19 pandemic and the SARS or Ebola outbreak among HCWs (Lai et al., 2020). Moreover, it has been reported that nurses have higher anxiety and depressive symptoms than doctors (Spoorthy et al., 2020). On the other hand, some strategies, including the Internet, telephone or applicationbased counselling or intervention, have been developed and administered by psychological health institutions to improve HCW’s mental health during the COVID19 pandemic (Lai et al., 2020). But the question is, along with counselling or interventions for nurses, doctors and medical staff, is there any approach that can be practical? We should first review the statistics of reports of psychological problems of health workers during the COVID19 pandemic. Many studies have been conducted during this time. In a study, 1,257 HCWs completed questioners. Results showed that 50.4% of the HCWs suffered from depression, 44.6% from anxiety, 34.0% from insomnia and 71.5% from distress (Spoorthy et al., 2020). In another investigation, using Zung's selfrating depression scale (SDS) and Zung's selfrating anxiety scale (SAS), doctors and nurses showed experiencing clinically significant depressive symptoms (Liang et al., 2020). Kang et al. (2020) reported that among 994 medical and nursing staff in Wuhan, 36.9% had subthreshold mental health disturbances, 34.4% had mild disturbances, 22.4% had moderate disturbances and 6.2% had severe disturbances (Kang et al., 2020). Xiong et al., (2020) reported the outcome of a crosssectional survey among 223 nurses. Results showed the prevalence of anxiety and depression symptoms were 40.8% and 26.4%, respectively. In addition, they reported that selfefficacy was negatively correlated with anxiety (r = −.161) (Xiong et al., 2020).

others (Spoorthy et al., 2020). With the rapid increase in the number of patients, doctors and nurses have to face enormous workload and high-risk infections, which may lead to mental health problems such as anxiety, depression  or insomnia (Walton et al., 2020). This psychological distress caused by acute infectious diseases may persist for a long time and even lead to post-traumatic stress disorder (PTSD) (Xiong et al., 2020).
Investigations demonstrated that several factors have such adverse psychological consequences among HCWs, including excessive work hours, depletion of personal protection equipment, over-enthusiastic media news, feeling insufficiently supported, lack of specific drugs and the infection rate among medical staff Spoorthy et al., 2020). There are many similarities in psychological symptoms between the COVID-19 pandemic and the SARS or Ebola outbreak among HCWs . Moreover, it has been reported that nurses have higher anxiety and depressive symptoms than doctors (Spoorthy et al., 2020). On the other hand, some strategies, including the Internet, telephone or applicationbased counselling or intervention, have been developed and administered by psychological health institutions to improve HCW's mental health during the COVID-19 pandemic . But the question is, along with counselling or interventions for nurses, doctors and medical staff, is there any approach that can be practical? We should first review the statistics of reports of psychological problems of health workers during the COVID-19 pandemic.
Many studies have been conducted during this time. In a study, 1,257 HCWs completed questioners. Results showed that 50.4% of the HCWs suffered from depression, 44.6% from anxiety, 34.0% from insomnia and 71.5% from distress (Spoorthy et al., 2020). In another investigation, using Zung's self-rating depression scale (SDS) and Zung's self-rating anxiety scale (SAS), doctors and nurses showed experiencing clinically significant depressive symptoms (Liang et al., 2020). Kang et al. (2020) reported that among 994 medical and nursing staff in Wuhan, 36.9% had subthreshold mental health disturbances, 34.4% had mild disturbances, 22.4% had moderate disturbances and 6.2% had severe disturbances . Xiong et al., (2020) reported the outcome of a cross-sectional survey among 223 nurses. Results showed the prevalence of anxiety and depression symptoms were 40.8% and 26.4%, respectively. In addition, they reported that self-efficacy was negatively correlated with anxiety (r = −.161) (Xiong et al., 2020).

| PHYS I C AL AC TIVIT Y
Studies focused on the psychological effects of the COVID-19 pandemic among HCWs. Some of which declared that health authorities should consider the conditions and methods to provide psychological support to both patients and HCWs. These methods may consist of using the Internet, telephone or web applications, to assess and monitor stress, depression and anxiety (Spoorthy et al., 2020). Increasing awareness, utilizing appropriate protective equipment or reducing work hours are suggested as practical approaches to improve HCW's mental health circumstances Lai et al., 2020;Liang et al., 2020;Liu et al., 2020;Walton et al., 2020;Xiong et al., 2020).
We want to look at this issue from another perspective. Previous studies, American Sports Medicine Association (ACSM) and World Health Organization (WHO) have suggested regular physical activity to eliminate inappropriate mental conditions. Regular exercise and physical activity can alter the prevention and treatment of anxiety and depression (Maroufi, 2021). Regular physical activity regulates brain-derived neurotrophic factor (BDNF), which increases cognitive function and the ability to face depression and anxiety . Studies showed that all types of exercise, such as aerobic, resistance or high-intensity training, effectively reduced psychological disorders (Maroufi, 2021). Randomized controlled studies have illustrated that exercise is associated with an anti-depressant effect (Martinsen, 2008). A meta-analysis reported that using the