Mental health patterns of physiotherapists in South Africa during COVID-19.

The study used a repeated cross-sectional design, meaning different people were surveyed at each time point, so individual trajectories cannot be confirmed and observed trends may reflect differences in who responded at each stage. Participants were recruited via convenience sampling and social media, so the samples may not represent all South African physiotherapists, and voluntary participation could attract those with stronger opinions or experiences. Important potential confounders such as vaccination status, personal infection history, and employment sector (private vs. public) were not measured, so it is unclear how these factors influenced the mental health outcomes. Self-reported measures of mental health may be influenced by stigma or cultural factors, potentially leading to underreporting of symptoms like depression. The sample sizes were unequal between frontline and non-frontline groups and across time periods, which can affect the stability of the statistical comparisons.

The authors declared no conflicts of interest. The study received ethical clearance from the Human Research Ethics Committee of the University of the Witwatersrand.

Do not interpret the declining depression scores as evidence that the pandemic became less psychologically damaging for physiotherapists. The authors suggest this may reflect underreporting due to stigma or a focus on physical symptoms, and the study design cannot confirm whether individuals actually improved over time.