Coping strategies and mental health among remote hospital workers in the COVID-19 pandemic: A multicenteric cohort study from Pakistan

The COVID-19 pandemic and digital transformations have led to a significant expansion of remote work in healthcare settings. This longitudinal, multicenter study evaluated personal and organizational coping strategies employed by remote hospital staff (including doctors, nurses, engineers, and administrative personnel) in Lahore and Karachi, Pakistan. The study assessed the effectiveness of these strategies in maintaining mental health. Over a 12-month period, we surveyed approximately 800 participants across 5 hospitals in each city. Validated tools (the Patient Health Questionnaire-9 [PHQ-9] for depression and the Generalized Anxiety Disorder-7 for anxiety) were administered at baseline, 6 months, and 12 months. Additionally, the brief COPE inventory was used to assess coping mechanisms. Ethical approval and informed consent were obtained in accordance with the Declaration of Helsinki. Descriptive statistics were used to characterize demographic and mental health profiles, while multivariable mixed-effects models examined associations between coping strategies and symptom trajectories over time. At baseline, 30% of participants reported moderate-to-severe depressive symptoms. Common personal coping practices included family support, positive thinking, prayer, physical exercise, and mindfulness. Organizational strategies included flexible work schedules, IT assistance, and regular supervisor check-ins. Over time, regular physical activity, virtual social support, and effective time management were significantly associated with lower PHQ-9 and Generalized Anxiety Disorder-7 scores. In contrast, excessive news consumption and workaholism were linked to worse mental health outcomes. For instance, individuals who reported engaging in daily physical activity experienced a 20% reduction in depressive symptom trajectories (P < .01). In conclusion, both personal and organizational strategies were effective in mitigating stress. These findings highlight the importance of institutional policies that promote such coping mechanisms (such as structured support programs and balanced workloads) to sustain staff well-being in remote and hybrid work environments.