IntroductionHealth care professionals (HCPs) are essential to the functioning of the health system. During the COVID-19 pandemic, HCPs faced unprecedented challenges. They experienced extended periods of patient morbidity, elevated health risks due to exposure to an incurable disease, extended workloads, and insufficient resources [1-4]. Personal and societal disruptions affect HCPs’ ability to serve the public [3-5]. Multiple studies have confirmed the prevalence of stress, anxiety, depression, and emotional exhaustion among HCPs [6-9].
To alleviate HCPs’ emotional burden and thus enhance community resilience [10,11], we must understand the unique emotional impact of long-term emergencies on HCPs. Therefore, we designed a retrospective cohort with a matched comparison group study to compare the emotional impact of COVID-19 pandemic on HCPs versus non-HCPs. While it is reasonable to assume that HCPs experienced greater emotional impact than the general public due to their frontline exposure, the results are controversial. A meta-analysis found that the psychological burdens on HCPs and the general public were similar [12]. Phiri et al [13] revealed minimal differences in anxiety, depression, and posttraumatic stress disorder prevalence between HCPs and the general public. However, HCPs had higher rates of suicidal thoughts or self-harm, and the public experienced lower levels of well-being. A Dutch longitudinal study reported slightly better mental health among HCPs than non-HCPs during the pandemic’s first year [14]. A study among US-based HCPs found significantly higher distress levels than among non-HCPs, along with decreased proactive coping abilities [15].
Most studies on the pandemic’s impact are cross-sectional, failing to examine the changes in the pandemic’s impact over time. Existing longitudinal studies on HCPs have focused mostly on periods of 12 months or less [16-18], often including few measurement points and experiencing high participant attrition. Phiri et al [13] highlighted the need for longitudinal research on the long-term mental health impact of COVID-19 pandemic for better infrastructure to manage further emergencies.
Social media offers a pertinent data source for addressing many of the challenges of traditional longitudinal studies based on surveys. Social media–based health research has grown significantly in recent years [19], particularly in exploring the emotional impact of the COVID-19 pandemic [20]. Research has shown that different populations have exhibited unique emotional patterns throughout the pandemic [21]. Studies focusing on targeted groups, such as HCPs, have identified mental health challenges such as anxiety, depression, and emotional fatigue [22]. The evolution of emotions such as fear and anger was linked to pandemic waves, revealing dynamic emotional responses across time [23]. Tsao et al [24] identified 5 public health themes regarding the role of social media during the COVID-19 pandemic, arguing that social media can be crucial for coping with the pandemic. However, they also found that the studies faced methodological limitations, such as nonrepresentative sample sizes and selection bias.
To address the gaps described between HCPs and the general population throughout the pandemic, we analyze the emotions of a matched sample of HCPs and non-HCPs from a high-quality Twitter Panel dataset [25,26], selecting users who tweeted consistently throughout the study period from January 2019 to May 2022. The prepandemic period enables us to control for baseline differences.
The study aims to explore and compare the emotional responses of HCPs and non-HCPs during the COVID-19 pandemic, to investigate how emotional responses are linked to the pandemic’s evolution in the United States, and to assess whether the emotions experienced by HCPs can serve as an early indicator of pandemic progression. We hypothesized that HCPs would exhibit distinct emotional profiles compared with non-HCPs, with stronger correlations to pandemic metrics due to their frontline exposure and professional responsibilities.
DiscussionPrincipal FindingsWe analyzed emotions expressed by US HCPs and non-HCPs from January 2019 to May 2022. Given the increasing frequency of natural disasters, events such as the COVID-19 pandemic are likely to become more common, making it crucial to gain insights into the lessons learned for future prolonged emergencies [34]. Although this study did not measure mental health outcomes, the observed emotional patterns serve as meaningful proxies for participants’ mental health [35,36].
Our analysis revealed significant emotional turmoil in both groups during the COVID-19 pandemic. HCPs experienced notably higher fear levels, which is consistent with the findings by García-Fernández et al [37], who reported elevated fear in 58.5% of HCPs. Additionally, our study found that HCPs’ sadness levels remained above pre-COVID-19 levels during the final phase of the pandemic (Figure 2). Thus, similar to the patterns observed in posttraumatic stress disorder symptoms, after exposure to stress, negative emotions endure more strongly than before the stress-inducing event [38]. Given HCPs’ critical role during emergencies, systemic support is essential to maintain their capacity.
HCPs expressed higher levels of joy than non-HCPs did from the second COVID-19 outbreak phase onward. Muthuri et al [39] noted that happiness among HCPs reflects the meaning and value they find in their work. During the pandemic, this could be associated with a sense of purpose and fulfillment, as well as the appreciation they received from patients and families. This aligns with findings by McHugh et al [40], who highlighted that HCPs’ well-being during the pandemic was significantly enhanced by their sense of identity and purpose at work.
We found that HCPs exhibited lower levels of anger, surprise, and disgust than non-HCPs. There is limited literature on this issue. However, our results contrast with those of García-Fernández et al [37], who reported higher levels of anger among HCPs. Our findings could be related to the emotional regulation required for good practice in health care delivery [41]. Another reason may be the professional knowledge HCPs possess regarding stress-inducing events, moderating these feelings [42].
Personal resilience is the maintenance of quick recovery during or after stressor exposure [43]. Resilience reflects the adaptive capacity for change and is perceived as a core component of emergency response. During the COVID-19 pandemic, HCPs exhibited emotional recovery despite experiencing more distinct changes in emotional responses relative to non-HCPs. High levels of joy, along with low levels of anger, disgust, and surprise, indicate resilience among HCPs. Resilient HCPs ensure the continuity of health care services during emergencies and contribute to community resilience since their role broadens beyond the mere provision of medical treatment [10,11].
Our findings show that HCPs’ tweets with high emotion scores were often associated with professional topics across all emotions, which validates that emotional expression differences are work-related. The study supports the claim that HCPs’ professional identity extends beyond their workplace, influencing their social media interactions [44]. Fear in both HCPs and non-HCPs was associated with the progression of the pandemic. However, HCPs expressed additional concerns associated with their work environment, such as protective equipment, and the challenge of balancing professional commitment and personal safety. Our hashtag analysis supports this assumption, revealing that HCPs’ joyful tweets during the early stages of the pandemic focused primarily on professional topics, often using work-related terms such as “proud work.”
Comparison With Previous WorkComparing our findings with previous social media studies reveals both shared and distinct emotional response patterns. Consistent with our results, Saha et al [45] and Ashokkumar and Pennebaker [46] identified elevated levels of anxiety and sadness among non-HCPs early in the pandemic, while Guntuku et al [47] observed a similar trend in expressions of joy among this group. Ashokkumar and Pennebaker [46] also reported decreased anger during the pandemic. In contrast, our findings indicate nonsignificant changes in anger among non-HCPs across all phases, with a slight increase in the early phases, followed by a gradual decrease. This difference may be due to variations in the study populations and platforms.
Our HCPs’ findings align with those of the Twitter analysis by Agarwal et al [22], which reported initial emotional distress that gradually stabilized. Both studies observed emotional fluctuations: joy declined in phase 1, partially rebounded in phase 2, and stabilized by phases 3 and 4. Fear (in our study) and anxiety (in the study by Agarwal et al [22]) surged in phases 1 and 2 before a gradual decrease. Sadness in our data parallels the findings by Agarwal et al [22] on depression and loneliness, with an early rise followed by a partial decline, though without full recovery. Anger initially rose and then decreased, with our study showing a milder and statistically insignificant increase.
Strengths and LimitationsThis study has several strengths. The temporal scope extends from January 2019 to May 2022, capturing prepandemic, pandemic, and recovery phases. The comparative design between HCPs and non-HCPs enables the identification of occupation-specific emotional patterns. A participation-based inclusion criterion—requiring users to tweet at least once a month in more than 90% of the study months—ensured consistent user engagement and reduced noise from inactive accounts. The analysis incorporates multiple emotional dimensions rather than single affect measures and provides comprehensive emotional profiling. The large-scale social media dataset supports robust statistical analysis across pandemic phases.
Several limitations should be noted. First, the study analyzed a US sample and included only those HCPs and non-HCPs who use Twitter, excluding nonusers. Second, the nature of Twitter limits the depth of information compared with other sources, such as interviews. Third, it relies on emotions as proxies for mental health outcomes.
Future DirectionsSeveral studies have explored social media monitoring to detect or predict COVID-19 pandemic [41]. For example, Ockerman and Carrier [48] predicted COVID-19 case counts using Twitter images. Shen et al [49] reported that reports of symptoms and diagnoses of COVID-19 disease on social media significantly predicted daily case counts up to 14 days ahead of official statistics. Our findings suggest that analyses of HCP social media posts should yield more informative preliminary signals of emerging public health concerns than those of the general population.
Future research should examine cross-platform emotional patterns beyond Twitter to validate findings across social media environments. Integrating emotional data from social media with clinical mental health assessments could strengthen the validity for emotional proxies. The development of real-time monitoring systems for HCPs’ well-being could enable timely interventions during health emergencies.
ConclusionsLearning from the COVID-19 pandemic is essential for preparing for future prolonged emergencies. This study found that HCPs and non-HCPs experienced significant emotional turmoil during the COVID-19 pandemic. However, the emotional impact of the pandemic was more pronounced among HCPs than non-HCPs. This study highlights the resilience and professional identity of HCPs as reflected in social media. We propose that HCPs’ social media activity may serve as an indicator of emergency progression and a complementary source for assessing their well-being.