Prevalence of long COVID and emotional exhaustion among European healthcare workers with effort–reward imbalance as a potential mediator

Abstract Aim Frontline healthcare workers (HCWs) experienced high occupational exposure to COVID-19 infection and may subsequently develop long as a sequela. The World Health Organization (WHO) estimates that 10–20% of infected individuals experience persistent symptoms consistent with long COVID. This study aimed to estimate the prevalence of long COVID among European HCWs and to assess the association between long COVID and emotional exhaustion (EE), examining effort–reward imbalance (ERI) as a potential mediator. Subject and methods A multinational cross-sectional survey was conducted between June and September 2023 among HCWs who were actively employed during the COVID-19 pandemic and had a prior COVID infection. Data were collected on sociodemographic and occupational characteristics, long COVID status (WHO criteria), ERI, and EE. Associations were evaluated using regression models, and mediation was assessed using regression-based decomposition of total, direct, and indirect effects. Results Among 691 HCWs from Spain, Romania, and Slovakia, 24% reported long COVID. Overall, 41% reported high EE, with the highest prevalence in Spain (52%). Long COVID was significantly associated with EE ( p < 0.001). Findings were consistent with an indirect association through ERI, accounting for 24% of the total association. Conclusion Long COVID was associated with increased EE among European HCWs. Addressing ERI through organizational- and policy-level interventions may help reduce EE and support workforce sustainability in the post-pandemic environment.