The relationship between the frequency of headaches associated with the personal protective equipment and its influencing factors is mediated by depression: A cross-sectional study

Background: To evaluate the factors affecting personal protective equipment (PPE) associated with headaches in healthcare workers during the first hit of coronavirus disease 2019 (COVID-19) outbreak in China in order to provide evidence for improving the prevention and treatment of PPE -associated headaches in frontline medical personnel. Methods: In this cross-sectional study, the baseline characteristics and the prevalence of the PPEassociated headaches among frontline healthcare workers at Wuhan Taikang Hospital were objectively evaluated by means of a questionnaire survey. We obtained predictors of PPEassociated headaches frequency by multiple regression analyses. The path analysis model was applied to determine the interrelationships between the variables related to PPE -associated headaches frequency. Results: Among the 520 participants, 436 (83.85 %) reported PPE -associated headaches during the anti -epidemic period. Compare with non -PPE -associated headache, age, PHQ-9 score >10, nurses, and PSQI>5were statistically significant found in participants with PPE -associated headaches. Multivariable linear regression showed that the occupation(nurse), pre-existing primary headache diagnosis, headache intensity and depression were risk factors for the frequency of PPE -associated headaches. The path analysis model observed that direct effects from occupation (nurse), preexisting primary headache diagnosis, headache intensity and depression on the frequency of PPE -associated headaches. Depression indirectly mediated the effects of headache intensity and sleep quality on headache frequency. (All P < 0.05) Conclusion: This study provided a path analysis model that illustrates the relationships between PPE -associated headaches frequency and its related factors among healthcare workers during the COVID-19 pandemic. It is crucial to the management of PPE -associated headaches to reduce its consequences for frontline healthcare workers.