前言:新冠肺炎(COVID-19)自爆發以來迅速蔓延造成全球性的大流行，台灣於首波社區感染爆發期間，醫院工作的醫護人員面臨高度感染風險，可能引發心理健康困擾之衝擊。此研究旨在探討台灣於首波社區感染爆發前後期間，醫護人員的心理健康狀態及其相關影響因素。
方法: 本研究採長期追蹤設計，透過線上問卷調查南部某醫學中心之執業醫護人員，基線資料收集期間為2020年9月24日至11月21日，時值台灣尚未出現社區感染；後續追蹤調查於 2021年5月17日至6月17日台灣COVID-19三級警戒期間進行。研究工具包含：基本資料問卷、社會歧視問卷、心理健康問卷、恐懼問卷、睡眠問卷、創傷後壓力症候群問卷方式調查。研究變項涵蓋感知污名、抑鬱症狀、焦慮症狀、壓力、自我污名、失眠、PTSD與對COVID-19的恐懼。研究採用結構方程模式分析影響醫療人員心理健康結果之相關因素。
結果: 459 名受試者納入分析，各研究變項之間皆呈顯著正相關。在基準期評估中，對 COVID-19 的恐懼與失眠及 PTSD 症狀呈顯著正相關，而自我污名則與PTSD呈顯著負相關。然而，在後續追蹤評估中，自我污名與失眠之間轉為顯著正相關，顯示心理社會因素對醫護人員心理健康的影響隨疫情發展而有所變化。
結論:本研究確認在COVID-19疫情期間，醫護人員的失眠與創傷後壓力症候群(PTSD)症狀均與對疫情的恐懼呈顯著相關。此外，自我污名在不同階段對醫護人員的心理健康產生差異性影響。研究結果顯示，於傳染病大流行期間，應持續監測醫護人員的心理健康狀況，強化醫療機構的心理健康資源建設與整合性心理支持系統，並適時提供心理關懷與協助，以維護醫護人員的心理健康與工作穩定性。

Introduction:
COVID-19 caused a global pandemic due to rapid spread of virus and increasing mortality rate in the early stage of outbreak. Healthcare workers faced much pressure and psychological distress. This study explored potential factors associated with mental health problems among healthcare workers in hospitals before and after the first wave of community infection.
Methods:
This longitudinal study employed an online questionnaire to assess fear of COVID-19, depression, anxiety, stress, insomnia, and stigma. Participants were recruited from a tertiary medical center in southern Taiwan. Baseline data collection was conducted between September 24 and November 21, 2020, prior to the onset of community transmission in Taiwan, followed by a follow-up survey administered between May 17 and June 17, 2021, during the Level 3 COVID-19 alert. Structural equation modeling was utilized to examine factors associated with mental health outcomes among healthcare workers.
Results:
A total of 459 healthcare workers completed the questionnaire. All examined variables—including perceived stigma, depressive symptoms, anxiety symptoms, stress, self-stigma, post-traumatic stress disorder (PTSD), insomnia, and fear of COVID-19—were found to be positively and significantly correlated. Fear of COVID-19 demonstrated a positive association with both insomnia and PTSD symptoms. Interestingly, self-stigma was negatively associated with PTSD at baseline; however, at follow-up, self-stigma showed a positive association with insomnia.
Conclusion:
This study underscores that, during the COVID-19 pandemic, insomnia and PTSD symptoms were significantly associated with heightened fear of COVID-19. These findings highlight the critical importance of addressing the psychological distress experienced by healthcare workers in the context of emerging infectious disease outbreaks.

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