The use of mental health promotion strategies by nurses to reduce anxiety, stress, and depression during the COVID-19 outbreak: A prospective cohort study

To evaluate and compare nurses' depression, anxiety and stress symptoms at the beginning of the COVID-19 pandemic and after six months; to evaluate and compare the frequency of use of mental health promotion strategies during the same period; and to identify the relationship between the frequency of use of mental health promotion strategies, during the same period, with nurses’ depression, anxiety and stress symptoms. Data collection was carried out in two moments: at baseline and after six months. An online questionnaire was applied to nurses to assess the frequency of use of some mental health promotion strategies and their depression, anxiety, and stress symptoms (through the Depression Anxiety Stress Scales – short version (DASS-21)). The anxiety and stress symptoms significantly decreased over time. The physical activity increased, and a decrease was observed in the remote social contacts after six months. The stress, anxiety and depression scores were significantly lower in nurses who frequently or always used all strategies compared to participants who never or rarely used them, except for one strategy (rejecting information about COVID-19 from unreliable sources). Mental health promotion strategies, such as physical activity, relaxation activity, recreational activity, healthy diet, adequate water intake, breaks between work shifts, maintenance of remote social contacts, and verbalization of feelings/emotions, are crucial to reduce nurses’ stress, anxiety and depression symptoms during the COVID-19 outbreak. •Nurses' stress and anxiety symptoms decreased six months after the lockdown due to COVID-19.•Nurses increased the physical activity and reduced remote social contacts six months' after the lockdown due to COVID-19.•The use of mental health promotion strategies by nurses is important to reduce stress, anxiety, and depression symptoms.•Caring for nurses' mental health during the COVID-19 outbreak is a matter of public health concern.