Anxiety, pandemic-related stress and resilience among physicians during the COVID-19 pandemic

Job burnout among Israeli healthcare workers during the first months of COVID-19 pandemic: The role of emotion regulation strategies and psychological distress

The current worldwide COVID-19 pandemic has elicited widespread concerns and stress. Arguably, healthcare workers are especially vulnerable to experience burnout during these times due to the nature of their work. Indeed, high prevalence of burnout was found among healthcare workers during the outbreak. However, the individual differences predicting burnout among healthcare workers during the pandemic have been understudied. The aim of the current study was, therefore, to identify risk and protective factors contributing to the severity of burnout among healthcare workers, above and beyond levels of current psychological distress. The survey was distributed online during the period April 13–28, 2020, approximately two months after the first COVID-19 case was identified in Israel. Ninety-eight healthcare workers completed an online survey administered cross-sectionally via the Qualtrics platform that included questionnaires assessing habitual emotion regulation strategies (i.e., trait worry, reappraisal, and suppression), psychological distress, COVID-19 related concerns, and burnout. A hierarchical linear regression analysis revealed that only trait worry and psychological distress were significant predictors of job burnout among healthcare workers. These findings highlight the role of maladaptive emotion regulation tendencies, specifically trait worry, in job burnout among healthcare workers. These findings have implications for both the assessment and treatment of healthcare workers. We discuss potential mechanisms and implications for practice.

Family Relationships Under Work From Home: Exploring the Role of Adaptive Processes

Work-from-home (WFH) influences both work and life, and further impacts family relationships. The current study explored the impacts of WFH on family relationships during the COVID-19 pandemic and identified effective adaptive processes for maintaining family relationships under WFH. Using the Vulnerability-Stress-Adaptation (VSA) model, the study examined the roles of adaptive processes (spending time with family members and balancing work and life) and demographic differences (gender, age, marital status, and education level) in the relation between WFH and family relationships. Path analysis results based on an online survey (N = 150) suggested that, overall, WFH improved family relationships through proper adaptive processes. WFH had a positive relation to time spent with family members, and this relation was especially salient for workers with lower education levels. While there was no statistically significant overall relation between WFH and work-life balance, older workers tended to engage in increased work-life balance during WFH. Both adaptive processes were positively related to family relationship quality. The findings advance the understanding of family relationships and WFH and provide practical recommendations to enhance family relationships under WFH.

How does fear of COVID-19 affect the mental well-being of waiters in Turkey

BACKGROUND

Empirical findings are needed to determine how the fear of COVID-19 might change in the context of different individuals.

OBJECTIVE

This study aims to determine the moderating role of fatalism and psychological resilience on the effect of fear of COVID-19 on general mental health.

METHODS

This study makes use of qualitative research methods that involved collecting data from 355 full-time waiters via questionnaires on online platforms.

RESULT

The collected data suggests that the fear of COVID-19 has a significant negative impact on mental well-being. Morever, the data gathered for this study also indicates that the fear of COVID-19 infection differs significantly according to the fatalistic belief and psychological resilience levels of the waiters.

CONCLUSIONS

Findings of this study indicate that the psychological effects of infectious diseases on individuals are not universal, but rather depend on the personal characteristics of individuals. It is hoped that the results of this study will contribute to the reduction of negative effects associated with the general anxiety of pandemic that individuals experience.

Investigating the relationships between resilience, autism-related quantitative traits, and mental health outcomes among adults during the COVID-19 pandemic

Resilience is a dynamic process through which people adjust to adversity and buffer anxiety and depression. The COVID-19 global pandemic has introduced a shared source of adversity for people across the world, with detrimental implications for mental health. Despite the pronounced vulnerability of autistic adults to anxiety and depression during the COVID-19 pandemic, relationships among autism-related quantitative traits, resilience, and mental health outcomes have not been examined. As such, we aimed to describe the relationships between these traits in a sample enriched in autism spectrum-related quantitative traits during the COVID-19 pandemic. We also aimed to investigate the impact of demographic and social factors on these relationships. Across three independent samples of adults, we assessed resilience factors, autism-related quantitative traits, anxiety symptoms, and depression symptoms during the COVID-19 pandemic. One sample (recruited via the Autism Spectrum Program of Excellence, n = 201) was enriched for autism traits while the other two (recruited via Amazon Mechanical Turk, n = 624 and Facebook, n = 929) drew from the general population. We found resilience factors and quantitative autism-related traits to be inversely related, regardless of the resilience measure used. Additionally, we found that resilience factors moderate the relationship between autism-related quantitative traits and depression symptoms such that resilience appears to be protective. Across the neurodiversity spectrum, resilience factors may be targets to improve mental health outcomes. This approach may be especially important during the ongoing COVID-19 pandemic and in its aftermath.

Psychosocial predictors of anxiety and depression in a sample of healthcare workers in Botswana during the COVID-19 pandemic: A multicenter cross-sectional study

Objectives:

This study aimed to investigate the psychological impact of the COVID-19 outbreak on healthcare workers across multiple hospitals in different districts in Botswana.

Methods:

We conducted a cross-sectional study in five public-funded hospitals from three districts in Botswana from 1 June 2020 to 30 October 2020. We used the neuroticism subscale of the 44-item Big Five Inventory, Patient Health Questionnaire, the Oslo 3-item Social Support Scale, the Anxiety Rating Scale, and the 14-item Resilience Scale to obtain data from 355 healthcare workers.

Results:

The participants’ mean age (standard deviation) was 33.77 (6.84) years. More females (207, 59%) responded than males (144, 41%). Anxiety and depression were experienced by 14% and 23% of the participants, respectively. After multiple regression analyses, neuroticism predicted depression (B = 0.22; p < 0.01) and anxiety disorder (B = 0.31; p < 0.01). Lower educational status (B = −0.13; p = 0.007) predicted anxiety and younger age (B = −0.10; p = 0.038) predicted depression, while resilience negatively correlated with both disorders.

Conclusion:

There is a need to develop and implement interventions targeted at these identified risk and protective factors that can be easily delivered to healthcare workers during this pandemic.

The impact of the COVID-19 pandemic on the mental health of medical staff considering the interplay of pandemic burden and psychosocial resources-A rapid systematic review

BACKGROUND

In times of the global corona pandemic health care workers (HCWs) fight the disease at the frontline of healthcare services and are confronted with an exacerbated load of pandemic burden. Psychosocial resources are thought to buffer adverse effects of pandemic stressors on mental health. This rapid review summarizes evidence on the specific interplay of pandemic burden and psychosocial resources with regard to the mental health of HCWs during the COVID-19 pandemic. The goal was to derive potential starting points for supportive interventions.

METHODS

We conducted a rapid systematic review following the recommendations of the Cochrane Rapid Reviews Methods Group. We searched 7 databases in February 2021 and included peer-reviewed quantitative studies, that reported related data on pandemic stressors, psychosocial resources, and mental health of HCWs.

RESULTS

46 reports were finally included in the review and reported data on all three outcomes at hand. Most studies (n = 41) applied a cross-sectional design. Our results suggest that there are several statistically significant pandemic risk factors for mental health problems in HCWs such as high risk and fear of infection, while resilience, active and emotion-focused coping strategies as well as social support can be considered beneficial when protecting different aspects of mental health in HCWs during the COVID-19 pandemic. Evidence for patterns of interaction between outcomes were found in the context of coping style when facing specific pandemic stressors.

CONCLUSIONS

Our results indicate that several psychosocial resources may play an important role in buffering adverse effects of pandemic burden on the mental health of HCWs in the context of the COVID-19 pandemic. Nevertheless, causal interpretations of mentioned associations are inadequate due to the overall low study quality and the dominance of cross-sectional study designs. Prospective longitudinal studies are required to elucidate the missing links.

Anxiety Linked to COVID-19: A Systematic Review Comparing Anxiety Rates in Different Populations

The COVID-19 pandemic has incited a rise in anxiety, with uncertainty regarding the specific impacts and risk factors across multiple populations. A qualitative systematic review was conducted to investigate the prevalence and associations of anxiety in different sample populations in relation to the COVID-19 pandemic. Four databases were utilised in the search (Medline, EMBASE, CINAHL, and PsycINFO). The review period commenced in April 2021 and was finalised on 5 July 2021. A total of 3537 studies were identified of which 87 were included in the review (sample size: 755,180). Healthcare workers had the highest prevalence of anxiety (36%), followed by university students (34.7%), the general population (34%), teachers (27.2%), parents (23.3%), pregnant women (19.5%), and police (8.79%). Risk factors such as being female, having pre-existing mental conditions, lower socioeconomic status, increased exposure to infection, and being younger all contributed to worsened anxiety. The review included studies published before July 2021; due to the ongoing nature of the COVID-19 pandemic, this may have excluded relevant papers. Restriction to only English papers and a sample size > 1000 may have also limited the range of papers included. These findings identify groups who are most vulnerable to developing anxiety in a pandemic and what specific risk factors are most common across multiple populations.

The Impact of COVID-19-Related Work Stress on the Mental Health of Primary Healthcare Workers: The Mediating Effects of Social Support and Resilience

Objective

The psychological condition of healthcare workers since the COVID-19 pandemic has attracted the attention of many studies. However, few have reported on psychosocial problems of primary healthcare workers in the COVID-19 pandemic. This study aimed to examine the mediating roles of social support and resilience in COVID-19-related work stress and symptoms of anxiety and depression.

Methods

A total of 840 primary healthcare workers in 17 community health centers in Guangzhou, China, were recruited from May to July 2021. Data on demographic characteristics, COVID-19-related work stress, social support, resilience, anxiety and depression were collected. A structural equation model was used for mediation analysis.

Results

More than half of participants reported mild or more severe (at least borderline abnormal) symptoms of anxiety (68.1%) and depression (55.6%). Social support and resilience mediate the association between COVID-19-related work stress and symptoms of anxiety and depression, respectively. Furthermore, the association between work stress and symptoms of anxiety and depression was also mediated by an accumulation of social support and resilience. The indirect effect of COVID-19-related work stress on anxiety and depression through resilience was much greater than other indirect effects.

Conclusion

Anxiety and depression were prevalent among primary healthcare workers. This study highlights the psychological impact of the COVID-19-related psychosocial work environment on primary healthcare workers. There is an urgent need to improve working conditions for primary healthcare workers in the COVID-19 and to implement intervention strategies aimed at increasing individual resilience alongside the establishment of external supportive work environments.

The Impact of Physicians' COVID-19 Pandemic Occupational Experiences on Mental Health

OBJECTIVE

To examine the association between a number of negative COVID-19 occupational experiences and probable anxiety, depression, and PTSD among physicians.

METHODS

Cross-sectional examination of longitudinal registry data consisting of physician personal and occupational well-being. Multivariable logistic regressions were performed to determine the association between negative COVID-19 experiences and outcomes.

RESULTS

Of the 620 eligible physicians, approximately half were female (49%), and 71% white with a mean age of 46.51 (SD = 13.28). A one-point increase in negative experience score was associated with a 23% increase in probable anxiety (OR = 1.23, 95% CI: 1.14-1.34), a 23% increase in probable depression (OR = 1.23, 95% CI: 1.13-1.33), and a 41% increase in probable PTSD (OR = 1.41, 95% CI: 1.30-1.52).

CONCLUSIONS

Negative pandemic experiences were strongly associated with adverse mental health outcomes while greater resilience was protective.

The impact of the prolonged COVID-19 pandemic on stress resilience and mental health: A critical review across waves

The global public health crisis caused by COVID-19 has lasted longer than many of us would have hoped and expected. With its high uncertainty and limited control, the COVID-19 pandemic has undoubtedly asked a lot from all of us. One important central question is: how resilient have we proved in face of the unprecedented and prolonged coronavirus pandemic? There is a vast and rapidly growing literature that has examined the impact of the pandemic on mental health both on the shorter (2020) and longer (2021) term. This not only concerns pandemic-related effects on resilience in the general population, but also how the pandemic has challenged stress resilience and mental health outcomes across more specific vulnerable population groups: patients with a psychiatric disorder, COVID-19 diagnosed patients, health care workers, children and adolescents, pregnant women, and elderly people. It is challenging to keep up to date with, and interpret, this rapidly increasing scientific literature. In this review, we provide a critical overview on how the COVID-19 pandemic has impacted mental health and how human stress resilience has been shaped by the pandemic on the shorter and longer term. The vast literature is dominated by a wealth of data which are, however, not always of the highest quality and heavily depend on online and self-report surveys. Nevertheless, it appears that we have proven surprisingly resilient over time, with fast recovery from COVID-19 measures. Still, vulnerable groups such as adolescents and health care personnel that have been severely impacted by the COVID-19 pandemic do exist. Large interindividual differences exist, and for future pandemics there is a clear need to comprehensively and integratively assess resilience from the start to provide personalized help and interventions tailored to the specific needs for vulnerable groups.

Mental Health Well-Being and Attitudes on Mental Health Disorders among Family Physicians during COVID-19 Pandemic: A Connection with Resilience and Healthy Lifestyle

Family physicians (FPs) are exposed to high amounts of stress, and could be susceptible to the development of mental health disorders (MHD), especially after the emergence of the COVID-19 pandemic. The aim of the current study was to assess MHD history, attitudes toward MHDs and stress-coping strategies in FPs. An additional goal was to estimate their comprehensive well-being and investigate connections with resilience and a healthy lifestyle. A total of 483 FPs submitted their responses via online survey. MHD attitudes were assessed with the according questionnaires, while burnout levels, healthy lifestyle, resilience, job and life satisfaction were estimated with validated scales. Results have shown that 32.5% of FPs disclosed positive MHD history, while 68.7% used professional help. Resilience and healthy lifestyle levels were significantly higher in MHD negative FPs (p < 0.001), while burnout levels were lower (p < 0.001). Moreover, healthy lifestyle (β = 0.03, p < 0.001) was an independent correlate of resilience, while healthy lifestyle (β = -0.35, p < 0.001, and resilience (β = -1.82, p < 0.001) were of burnout levels. Finally, resilience (OR = 0.387, p < 0.001) and healthy lifestyle (OR = 0.970, p = 0.021) were shown as independent predictors of positive MHD history status. Strong promotion and education of FP population regarding resilience and healthy lifestyle should be utilized in practice in order to alleviate the possibility of mental health disturbances and the according consequences.

Proximity to COVID-19 patients and role-specific mental health outcomes of healthcare professionals

BACKGROUND

Healthcare professionals (HCPs) experience extreme hardships and challenges during the time of COVID-19, due to their professional roles. At the same time, HCPs may experience a feeling of importance as contributing members of the community, which could enhance their well-being alongside COVID-19-work-related stressors.

AIMS

This cross-sectional study examined the relationship between HCPs' proximity to COVID-19 patients and role-specific fears of COVID-19 and sense of emotional, social and psychological well-being.

METHODS

Participants (N = 1,378) included: HCPs who treated COVID-19 patients (frontliners, n = 188), HCPs that did not work directly with COVID-19 patients (secondliners, n = 524), and a group of non-HCPs who served as the comparison group (n = 666). Participants completed the Depression and Anxiety Stress Scale-21; Fear of COVID-19 Scale; Fear of COVID-19 Familial Infection Scale; and the Mental Health Continuum Short-Form.

RESULTS

Results indicate that the comparison group reported higher levels of fear of COVID-19 compared to secondliners, while frontliners reported the highest levels of fear of infecting their families. Frontliners and secondliners HCPs reported significantly higher levels of social and psychological well-being compared to the non-HCP group.

CONCLUSIONS

This study indicates that there are role-specific mental health outcomes related to HCP's proximity to COVID-19 patients.

Left alone outside: A prospective observational cohort study on mental health outcomes among relatives of COVID-19 hospitalized patients

Hospitalization due to COVID-19 bears many psychological challenges. While focusing on infected patients, their relatives are being largely neglected. Here, we investigated the mental health implications of hospitalization among relatives, over a one-month course. A single center study was conducted to assess relatives of COVID-19 patients during the first month from their admission to the hospital, and elucidate risk and protective factors for mental health deterioration. Ninety-one relatives of the first patients to be hospitalized in Israel were contacted by phone and screened for anxiety, depression, and posttraumatic stress symptoms (PTSS) at three time points (25-72 hours, 7-18 days, and one month). We found that anxiety and depression decreased significantly during the first month from their admission. Risk factors for deteriorated mental health at one month included feelings of mental exhaustion, financial concerns, and social disconnection. Being an ultra-orthodox was a protective factor for anxiety and depression but not for PTSS. Our findings emphasize the importance of addressing the mental health status of close relatives and adjust support for the unique setting of COVID-19.

Sleep Difficulties Among COVID-19 Frontline Healthcare Workers

OBJECTIVE

To identify COVID-19 work-related stressors and experiences associated with sleep difficulties in HCW, and to assess the role of depression and traumatic stress in this association.

METHODS

A cross-sectional study of HCW using self-report questionnaires, during the first peak of the pandemic in Israel (April 2020), conducted in a large tertiary medical center in Israel. Study population included 189 physicians and nurses working in designated COVID-19 wards and a comparison group of 643 HCW. Mean age of the total sample was 41.7 ± 11.1, 67% were female, 42.1% physicians, with overall mean number of years of professional experience 14.2 ± 20. The exposure was working in COVID-19 wards and related specific stressors and negative experiences. Primary outcome measurement was the Insomnia Severity Index (ISI). Secondary outcomes included the Primary Care-Post Traumatic Stress Disorder Screen (PC-PTSD-5); the Patient Health Questionnaire-9 (PHQ-9) for depression; the anxiety module of the Patient-Reported Outcomes Measurement Information System (PROMIS); Pandemic-Related Stress Factors (PRSF) and witnessing patient suffering and death.

RESULTS

Compared with non-COVID-19 HCW, COVID-19 HCW were more likely to be male (41.3% vs. 30.7%) and younger (36.91 ± 8.81 vs. 43.14 ± 11.35 years). COVID-19 HCW reported higher prevalence of sleep difficulties: 63% vs. 50.7% in the non-COVID group (OR 1.62, 95% CI 1.15-2.29, p = 0.006), mostly difficulty maintaining sleep: 26.5% vs. 18.5% (OR 1.65, 95% CI 1.11-2.44, p = 0.012). Negative COVID-19 work-related experiences, specifically witnessing patient physical suffering and death, partially explained the association. Although past psychological problems and current depression and PTSD were associated with difficulty maintaining sleep, the main association remained robust also after controlling for those conditions in the full model.

CONCLUSION AND RELEVANCE

COVID-19 frontline HCW were more likely to report sleep difficulties, mainly difficulty maintaining sleep, as compared with non-COVID-19 HCW working at the same hospital. Negative patient-care related experiences likely mediated the increased probability for those difficulties. Future research is needed to elucidate the long-term trajectories of sleep difficulties among HCW during large scale outbreaks, and to identify risk factors for their persistence.

Dynamic changes in mental health status related to the COVID-19 pandemic among health care workers and inpatients in China

BACKGROUND

Exposure to coronavirus disease 2019 (COVID-19) can cause severe mental health problems, the dynamics of which remain unclear. This study evaluated the mental status of frontline health care workers (FHWs) and suspected infected patients (SIPs) during different periods of the COVID-19 outbreak.

MATERIALS AND METHODS

Demographic and psychological data were collected through a cross-sectional survey of 409 participants in a hospital from 20 January to 7 August 2020. COVID-19 outbreaks were divided into three periods owing to the time, place, and scale, including the national outbreak period (a nationwide pandemic period from 20 January to 8 April 2020), sporadic period (a stable period from 9 April to 10 June), and local epidemic period (a local pandemic in Beijing from 11 June to 7 August 2020). Acute psychological disorders (APDs), including symptoms of anxiety and depression, were assessed using the Zung Self-Rating Anxiety/Depression Scale (SAS/SDS).

RESULTS

A total of 206 FHWs and 203 SIPs completed the electronic questionnaire. Overall, the prevalence rates of anxiety and depression among SIPs were 3.9 and 19.4%, respectively, while significantly higher prevalence rates (17.7 and 25.1%) were found among FHWs, P-value < 0.05. Psychological status among SIPs did not differ significantly across the three periods. The FHWs were more vulnerable, as their SAS and SDS scores and almost all the dimension scores were significantly higher during the local epidemic period than during the national outbreak and sporadic periods (all P-values < 0.001). The prevalence of anxiety (34.41%) and depression (41.94%) was significantly higher during the local epidemic period (P < 0.001). Logistic and linear mixed models showed that age, sex, and doctor-patient ratio especially, independently influenced most dimension scores of SAS and SDS among FHWs (P < 0.05).

CONCLUSION

Compared to the COVID-19 epidemic at the national level, the local epidemic had a greater influence on FHWs' mental health. More attention should be given to the workload of FHWs.

COVID-19 Pandemic Driven Knowledge, Attitude, Clinical Practice, Distress Reactions, and Post-Traumatic Growth of Dental Care Providers in Riyadh City, Saudi Arabia: A Cross-Sectional Study

Objective:

The present study aimed to assess knowledge, attitude, clinical practices, distress reactions, and post-traumatic growth of dentists during the COVID-19 pandemic in Riyadh City.

Methodology:

An online questionnaire was developed to assess various dental professionals from both governmental and private sectors during the early COVID-19 outbreak in Riyadh City, Saudi Arabia. The questionnaire was framed to assess the demographic variables, knowledge, attitude, and clinical practices towards handling the COVID-19 pandemic. Furthermore, the general anxiety disorder-7 (GAD-7), worry questionnaire items, short form of post-traumatic growth inventory (PTGI-SF), and life satisfaction questionnaire items were developed to assess the anxiety, worries, post-traumatic growth, and life satisfaction of dental care providers following the traumatic events. Data were analysed using SPSS 22.0 and R environment ver.3.2.2. Continuous measurement results were presented as mean ± SD, and categorical measurements results were presented in number (%).

Results:

Our study's significant findings revealed that a majority of the dentists were in the age group of 21-30 and practiced general dentistry. The study participants in age groups 51–60 and 41–50 years old showed more liability in perceiving COVID-19 as an extremely dangerous disease than 31–40 and 21–30 age groups. The majority of respondents (63.4%) had an anxiety scale score of greater than 40, followed by 22.8% with scores 20-40 and 13.9% with scores less than 20, respectively. The mean scores for the GAD-7 and the worry items were 8.24 ± 3.21 and 13.92 ± 4.77, respectively. The data showed that most survey participants had adopted moderate post-traumatic changes during the pandemic, as evident by their mean score of 34.17 ± 3.40. The life satisfaction of the participants was neutral, as demonstrated by their mean score of 20.16 ± 4.03.

Conclusion:

This study’s findings delineated that the COVID-19 pandemic situation has influenced dentists' mental health, with a moderate level of anxiety, and worries among other psychological symptoms. Furthermore, there was adequate knowledge regarding the COVID-19 among dentists; however, the pandemic affected the financial conditions of the respondents. There was a moderate level of post-traumatic growth and neutral life satisfaction of the dental providers.

The role of resilience and coping among Italian healthcare workers during the COVID-19 pandemic

Objective:

To evaluate the psychological state of healthcare workers (HCWs) in the field of rehabilitation during the COVID-19 pandemic.

Methods:

Cross-sectional observational study. Sample of 334 HCWs including: nurses, medical doctors, therapists, scientists, and clerical workers working at the IRCCS San Raffaele Roma rehabilitation hospital during the second wave of the COVID-19 pandemic. Anonymous web-based questionnaire included 14-item Resilience Scale, Brief-COPE, Hospital Anxiety Depression Scale, Fear of COVID-19 Scale. Occupational and sociodemographic characteristics.

Results:

High levels of resilience, low levels of anxiety, depression, and fear were observed in the study population; the most frequently used coping strategies in the Brief-COPE were acceptance, planning, and active coping. Specifically, 87% of the participants reported a moderate to high level of resilience, with the highest level observed in nurses while physicians show the lowest level. HCWs showed symptoms of anxiety (29%), depressive symptoms (10%), and fear caused by the COVID-19 pandemic (44%). Statistically significant differences were observed between different occupations for fear (p <0.05) and resilience (p <0.01). Levels of anxiety and fear appeared to be higher in female and younger workers. The latter group - who also reported higher levels of depression - showed lower levels of resilience.

Conclusions:

In our study hospital and non-hospital workers show different emotional, cognitive, and behavioural resources when facing stressful situations, like in the case of the SARS-CoV-2 pandemics. Our results support the role of resilience and the proper use of problem-focused and emotion-focused coping strategies as protective factors from psychological distress.

The Moderating Role of Personal Resources Between Demands and Ill-Being of Romanian Healthcare Professionals in the COVID-19 Pandemic

Background and Objectives: The illness caused by the new coronavirus (COVID-19) triggered considerable mental consequences for the medical staff. Our aim was to research whether frontline healthcare workers' positive psychological state-PsyCap-impacts the relationship between anxiety/depression and burnout/mental health complaints. Material and Methods: One hundred twenty-six medical professionals working on the frontline at the Intensive Care Unit and Emergency Department in Romania took validated surveys between March and April 2020. All information was collected online after accessing a link that was received in an email message. The inclusion criteria concerned the categories of healthcare professionals who came into direct contact with patients during the COVID-19 global epidemic through the performed medical act, as well as time spent in the medical field of ICU an EM, namely at least 1 year in the department. We excluded from the research other categories of employees and auxiliary staff, as well as healthcare workers with <1-year experience in the medical field. The moderating role of personal resources (PsyCap) between demands (such as anxiety and depression) and ill-being (burnout and mental health complaints) of healthcare professionals were tested via hierarchical multiple regressions. Results: We tested the moderating role of PsyCap on the relation between anxiety and ill-being. The results indicated that high anxiety predicts lower emotional exhaustion and a low level of mental health complaints about Romanian healthcare professionals when PsyCap is high. The moderating role of PsyCap on the relation between depression and ill-being was tested in the second hypothesis. The results indicated that high depression predicts lower inefficacy and a low level of mental health complaints about Romanian healthcare professionals when PsyCap is increased. Conclusions: PsyCap is a crucial variable that may decrease the impact of anxiety and depression on psychological outcomes such as emotional exhaustion, inefficacy, and psychological problems among Romanian medical professionals working on the frontline during the COVID-19 global epidemic. Thus, psychological interventions that help medical staff gain personal resources are appropriate in the context of the COVID-19 pandemic.

COVID-Related Stress and Work Intentions in a Sample of US Health Care Workers

OBJECTIVE

To evaluate relationships between coronavirus disease 2019 (COVID-19)-related stress and work intentions in a sample of US health care workers.

PATIENTS AND METHODS

Between July 1 and December 31, 2020, health care workers were surveyed for fear of viral exposure or transmission, COVID-19-related anxiety or depression, work overload, burnout, and intentions to reduce hours or leave their jobs.

RESULTS

Among 20,665 respondents at 124 institutions (median organizational response rate, 34%), intention to reduce hours was highest among nurses (33.7%; n=776), physicians (31.4%; n=2914), and advanced practice providers (APPs; 28.9%; n=608) while lowest among clerical staff (13.6%; n=242) and administrators (6.8%; n=50; all P<.001). Burnout (odds ratio [OR], 2.15; 95% CI, 1.93 to 2.38), fear of exposure, COVID-19-related anxiety/depression, and workload were independently related to intent to reduce work hours within 12 months (all P<.01). Intention to leave one's practice within 2 years was highest among nurses (40.0%; n=921), APPs (33.0%; n=694), other clinical staff (29.4%; n=718), and physicians (23.8%; n=2204) while lowest among administrators (12.6%; n=93; all P<.001). Burnout (OR, 2.57; 95% CI, 2.29 to 2.88), fear of exposure, COVID-19-related anxiety/depression, and workload were predictors of intent to leave. Feeling valued by one's organization was protective of reducing hours (OR, 0.65; 95% CI, 0.59 to 0.72) and intending to leave (OR, 0.40; 95% CI, 0.36 to 0.45; all P<.01).

CONCLUSION

Approximately 1 in 3 physicians, APPs, and nurses surveyed intend to reduce work hours. One in 5 physicians and 2 in 5 nurses intend to leave their practice altogether. Reducing burnout and improving a sense of feeling valued may allow health care organizations to better maintain their workforces postpandemic.

Psychiatric symptoms and moral injury among US healthcare workers in the COVID-19 era

BACKGROUND

Emerging cross-sectional data indicate that healthcare workers (HCWs) in the COVID-19 era face particular mental health risks. Moral injury - a betrayal of one's values and beliefs, is a potential concern for HCWs who witness the devastating impact of acute COVID-19 illness while too often feeling helpless to respond. This study longitudinally examined rates of depression, generalized anxiety disorder (GAD), posttraumatic stress disorder (PTSD), and moral injury among United States HCWs in the COVID-19 era. We anticipated finding high levels of clinical symptoms and moral injury that would remain stable over time. We also expected to find positive correlations between clinical symptoms and moral injury.

METHODS

This three-wave study assessed clinical symptoms and moral injury among 350 HCWs at baseline, 30, and 90 days between September and December 2020. Anxiety, depression, PTSD, and moral injury were measured using the Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9), Primary Care PTSD Screen (PC-PTSD), and Moral Injury Events Scale (MIES).

RESULTS

Of the 350 HCWs, 72% reported probable anxiety, depression, and/or PTSD disorders at baseline, 62% at day 30, and 64% at day 90. High level of moral injury was associated with a range of psychopathology including suicidal ideation, especially among healthcare workers self-reporting COVID-19 exposure.

CONCLUSIONS

Findings demonstrate broad, persisting, and diverse mental health consequences of the COVID-19 pandemic among United States HCWs. This study is the first to longitudinally examine the relationships between moral injury and psychopathology among HCWs, emphasizing the need to increase HCWs' access to mental healthcare.

A Public Health Framework for Preventing Mental Disorders in the Context of Pandemics

The COVID-19 pandemic has universally threatened the building blocks of mental health, well-being, and quality of life, namely, expectations of safety, connectedness, hope, and individual and societal efficacy. Consequently, unprecedently large numbers of individuals are significantly stressed and many are at risk for relapse of mental health problems, exacerbations of existing mental and behavioral health problems, and new onset clinical problems. Because of the scope of the problem, a population-based public health perspective is needed, which in the context of disasters has well-established theories and prevention approaches. Public health approaches to disasters and pandemics focus on preventing subclinical problems from becoming clinical disorders, in comparison to clinical care approaches that focus on treating established disorders. Fortunately, specialty care clinicians who typically think about assessing and treating established disorders have the training and clinical competencies to deliver prevention-focused interventions. This paper is designed to help specialty care clinicians who use cognitive-behavioral strategies to understand the biopsychosocial impacts and resource deficits associated with COVID-19-related stressors and the public health perspective to address them. We also provide ways clinicians can help people who are suffering from significant stress and resource deficits bounce back and regain functioning. We describe psychological first aid, stress management, repeated ecological assessment, writing about stressors, problem-solving, and behavioral activation approaches to assist individuals at risk for enduring stress-linked problems.

The effect of COVID-19 on tourists' intention to resume hotel consumption: The role of resilience

This study aims to better understand how one particular personal capacity-psychological resilience-may help consumers adapt to the 'new normal' provoked by the COVID-19 pandemic in the hotel context, which is characterized by high uncertainty. We conducted a quantitative empirical study among consumers of hotel services, which showed that their psychological resilience has a negative effect on their perceived health risk and emotional risk. This negative effect on risk helps increase tourist intention to return to consuming hotel services despite the on-going pandemic. The findings are of value to the literature and the professional sector alike, as they demonstrate both relationships jointly for the first time. The work can help hotel firms to design more effective strategies for approaching customers in the 'new normal'.

Moral distress in frontline healthcare workers in the initial epicenter of the COVID-19 pandemic in the United States: Relationship to PTSD symptoms, burnout, and psychosocial functioning

INTRODUCTION

Little is known about the relationship between moral distress and mental health problems. We examined moral distress in 2579 frontline healthcare workers (FHCWs) caring for coronavirus disease 2019 (COVID-19) patients during the height of the spring 2020 pandemic surge in New York City. The goals of the study were to identify common dimensions of COVID-19 moral distress; and to examine the relationship between moral distress, and positive screen for COVID-19-related posttraumatic stress disorder (PTSD) symptoms, burnout, and work and interpersonal functional difficulties.

METHOD

Data were collected in spring 2020, through an anonymous survey delivered to a purposively-selected sample of 6026 FHCWs at Mount Sinai Hospital; 2579 endorsed treating COVID-19 patients and provided complete survey responses. Physicians, house staff, nurses, physician assistants, social workers, chaplains, and clinical dietitians comprised the sample.

RESULTS

The majority of the sample (52.7%-87.8%) endorsed moral distress. Factor analyses revealed three dimensions of COVID-19 moral distress: negative impact on family, fear of infecting others, and work-related concerns. All three factors were significantly associated with severity and positive screen for COVID-19-related PTSD symptoms, burnout, and work and interpersonal difficulties. Relative importance analyses revealed that concerns about work competencies and personal relationships were most strongly related to all outcomes.

CONCLUSION

Moral distress is prevalent in FHCWs and includes family-, infection-, and work-related concerns. Prevention and treatment efforts to address moral distress during the acute phase of potentially morally injurious events may help mitigate risk for PTSD, burnout, and functional difficulties.

The experiences of frontline nurses in Wuhan: A qualitative analysis of nurse online diaries during the COVID-19 pandemic

Aims and objective

To explore the experiences of frontline nurses through analyzing nurse online diaries during the pandemic.

Background

Over 42,600 healthcare professionals took care of patients with COVID‐19 in Wuhan in the initial months between 23 January 2020 and 8 April 2020. Many used to write online diaries on Sina Microblog and still wrote about their experiences in the front line on this site. However, there has been little research on frontline nurses' experiences in the initial months of the pandemic through analyzing their narratives.

Design

A qualitative descriptive design.

Methods

A qualitative content analysis was used to analyze online diaries written by frontline nurses in Wuhan. A total of 205 entries in online diaries were collected from 12 frontline nurses, as accessible to those who subscribed to Sina Microblog social media site, between 23 January 2020 and 8 April 2020. NVivo12 was used to help analyze the data, and COREQ reporting guidelines were also used in this study.

Results

Two themes were identified: constructing a better self and constructing a strong support network. A better self was constructed in describing positive emotions, commitment to care, pride and achievements, and whole‐person growth. A strong support network was constructed through social support via different sources and gaining self‐support via narrating their personal experiences in diaries.

Conclusions

Frontline nurses demonstrated personal growth, psychological well‐being, and professionalism in the process of constructing a better self and a strong support network.

Relevance to clinical practice

The findings indicate that frontline nurses can use narratives as debriefing opportunities and a way of gaining self‐support. We suggest that online communities of professional support be used as an essential platform for sharing narratives and gaining a more comprehensive understanding of frontline nurses in the COVID‐19 pandemic and other global public health events.

Effects of Depression and Resilience of Public Workers on Work-related Stress and Anxiety in Response to the COVID-19 Pandemic

BACKGROUND

This study explored the clinical variables related to public workers' stress and anxiety regarding the viral epidemic, and the mediating effect of resilience on the relationship between their depression and anxiety in response to coronavirus disease 2019 (COVID-19) pandemic.

METHODS

A total of 938 public workers answered anonymous questionnaires in May 2020. The survey included rating scales such as the Stress and Anxiety to Viral Epidemics-9 (SAVE-9), Patients Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and Connor-Davidson Resilience Scale 2 items (CD-RISC 2), and subjects also answered whether they were employed in COVID-19 related fields.

RESULTS

Married, female, junior, public workers reported a higher level of stress and anxiety in response to the viral epidemic. Furthermore, high levels of stress and anxiety toward the epidemic are defined by high PHQ-9, high GAD-7, and low CD-RISC 2 scores. It could also be seen that resilience mediated the effect of depression in public workers and their stress and anxiety levels toward the epidemic.

CONCLUSION

It is important to reduce the psychological burden of public workers and manage their mental health to help them cope with the epidemic wisely and efficiently. Among many mental health factors, psychological resilience represents an essential target for psychological intervention among public workers.

Health-Care Professionals Amid the COVID-19 Pandemic: How Emotional Intelligence May Enhance Work Performance Traversing the Mediating Role of Work Engagement

Upon the eruption of COVID-19, frontline health-care workers confronted substantial workload and stress along with braving additional difficulties when performing at work. The main aim of this research was to assess the mediating role of work engagement in the direct impact of emotional intelligence on health-care professionals' work performance. A cross-sectional study was conducted in several Spanish hospitals during the second half of 2020. A total of 1549 health-care workers (62.1% women; mean age 36.51 years) filled the Wong and Law Emotional Intelligence Scale, the Utrecht Work Engagement Scale and the Individual Work Performance Questionnaire. Our findings demonstrated that work engagement plays a mediating effect between emotional intelligence and work performance, even when accounting for sociodemographic variables. Indeed, among the three constructs of engagement, vigor dimension (a1b1 = 0.09; CI: 0.06; 0.12; p < 0.01) emerges over dedication (a2b2 = 0.083; CI = 0.05, 0.1; p < 0.01) and absorption (a3b3 = 0.047; CI = 0.02, 0.07; p < 0.01) as the most decisive one. Herewith, it is apparent that professionals with a higher self-perception of emotional intelligence report stronger levels of engagement, thereby leading to greater performance overall. The present work evinces the necessity for proactively developing the emotional competencies of the health-care workforce, especially in high-emotional demand contexts.

Resilience, Coping Strategies and Posttraumatic Growth in the Workplace Following COVID-19: A Narrative Review on the Positive Aspects of Trauma

The COVID-19 pandemic represents a traumatic event that has profoundly changed working conditions with detrimental consequences for workers' health, in particular for the healthcare population directly involved in addressing the emergency. Nevertheless, previous research has demonstrated that traumatic experiences can also lead to positive reactions, stimulating resilience and feelings of growth. The aim of this narrative review is to investigate the positive aspects associated with the COVID-19 pandemic and the possible health prevention and promotion strategies by analyzing the available scientific evidence. In particular, we focus on the constructs of resilience, coping strategies and posttraumatic growth (PTG). A literature search was performed on the PubMed, EMBASE, Scopus, Web of Science, Google Scholar and Psycinfo databases. Forty-six articles were included in the literature synthesis. Psychological resilience is a fundamental variable for reducing and preventing the negative psychological effects of the pandemic and is associated with lower levels of depression, anxiety and burnout. At the individual and organizational level, resilience plays a crucial role in enhancing wellbeing in healthcare and non-healthcare workers. Connected to resilience, adaptive coping strategies are essential for managing the emergency and work-related stress. Several positive factors influencing resilience have been highlighted in the development of PTG. At the same time, high levels of resilience and positive coping strategies can enhance personal growth. Considering the possible long-term coexistence and consequences of COVID-19, organizational interventions should aim to improve workers' adaptive coping skills, resilience and PTG in order to promote wellbeing.

Resilience, Psychological Well-Being and Daily Functioning Following Hospitalization for Respiratory Distress Due to SARS-CoV-2 Infection

The ongoing COVID-19 pandemic has affected people's psychological well-being, and hospitalized patients could face an even greater risk of psychological distress. We aimed to study resilience in recovered COVID-19 patients after hospital discharge. We recruited 50 patients (38 males, aged 28-77) who were hospitalized for COVID-19 between March and April 2020. Participants underwent a psychological assessment 5 months after hospital discharge. We administered the Connor-Davidson Resilience Scale (CD-RISC-25), Beck's Depression inventory-II (BDI-II), and the State-Trait Anxiety Inventory Y-form (STAI). We also evaluated the impact of persisting physical, behavioral, and cognitive symptoms on resilience. Patients reported low resilience in the months following hospital discharge (CD-RISC-25 score [mean ± SD] = 55.82 ± 20.76), compared to data from studies on the general population. Lower resilience was associated with mood disturbances in the months following clinical recovery (p = 0.005), persisting fatigue (p = 0.015), sleep changes (p = 0.046), and subjective cognitive complaints (p < 0.05). Recovered COVID-19 patients exhibit low resilience following hospital discharge, which affects psychological well-being. The presence of persisting symptoms following hospital discharge affects psychological resilience. Interventions tailored to increase resilience should be considered to improve quality of life for recovered COVID-19 patients.

A Microbiome-Driven Approach to Combating Depression During the COVID-19 Pandemic

The significant stressors brought about and exacerbated by COVID-19 are associated with startling surges in mental health illnesses, specifically those related to depressive disorders. Given the huge impact of depression on society, and an incomplete understanding of impactful therapeutics, we have examined the current literature surrounding the microbiome and gut-brain axis to advance a potential complementary approach to address depression and depressive disorders that have increased during the COVID-19 pandemic. While we understand that the impact of the human gut microbiome on emotional health is a newly emerging field and more research needs to be conducted, the current evidence is extremely promising and suggests at least part of the answer to understanding depression in more depth may lie within the microbiome. As a result of these findings, we propose that a microbiome-based holistic approach, which involves carefully annotating the microbiome and potential modification through diet, probiotics, and lifestyle changes, may address depression. This paper's primary purpose is to shed light on the link between the gut microbiome and depression, including the gut-brain axis and propose a holistic approach to microbiome modification, with the ultimate goal of assisting individuals to manage their battle with depression through diet, probiotics, and lifestyle changes, in addition to offering a semblance of hope during these challenging times.

Inpatient Telemedicine and New Models of Care during COVID-19: Hospital Design Strategies to Enhance Patient and Staff Safety

The challenges of the COVID-19 pandemic have led to the development of new hospital design strategies and models of care. To enhance staff safety while preserving patient safety and quality of care, hospitals have created a new model of remote inpatient care using telemedicine technologies. The design of the COVID-19 units divided the space into contaminated and clean zones and integrated a control room with audio-visual technologies to remotely supervise, communicate, and support the care being provided in the contaminated zone. The research is based on semi-structured interviews and observations of care processes that implemented a new model of inpatient telemedicine at Sheba Medical Center in Israel in different COVID-19 units, including an intensive care unit (ICU) and internal medicine unit (IMU). The study examines the impact of the diverse design layouts of the different units associated with the implementation of digital technologies for remote care on patient and staff safety. The results demonstrate the challenges and opportunities of integrating inpatient telemedicine for critical and intermediate care to enhance patient and staff safety. We contribute insights into the design of hospital units to support new models of remote care and suggest implications for Evidence-based Design (EBD), which will guide much needed future research.

Association among income loss, financial strain and depressive symptoms during COVID-19: Evidence from two longitudinal studies

BACKGROUND

COVID-19 pandemic has major ramifications for global health and economy, with growing concerns about economic recession and implications for mental health. Here we investigated the associations between pandemic-related income loss with financial strain and mental health trajectories over a 1-month course, in two independent cohorts.

METHODS

Two independent studies were conducted in the U.S and in Israel at the beginning of the outbreak (March-April 2020, T1; study I: N = 2904, study II: N = 1267) and at a 1-month follow-up (T2; study I: N = 1318, study II: N = 241). Mixed-effects models were applied to assess associations among COVID-19-related income loss, financial strain, and pandemic-related worries about health, with anxiety and depression, controlling for multiple covariates including pre-COVID-19 income.

RESULTS

In both studies, income loss and financial strain were associated with greater depressive symptoms at T1, above and beyond T1 anxiety, worries about health, and pre-COVID-19 income. Worsening of income loss was associated with exacerbation of depression at T2 in both studies. Worsening of subjective financial strain was associated with exacerbation of depression at T2 in one study (US).

CONCLUSIONS

Income loss and financial strain were uniquely associated with depressive symptoms and their exacerbation over time, above and beyond pandemic-related anxiety. In times when a myriad of stressors are affecting mental health worldwide, our findings reveal specific links between the economic impact of COVID-19 and psychiatric outcomes.

Distress, Appraisal, and Coping Among the Frontline Healthcare Provider Redeployed to the Epicenter in China During COVID-19 Pandemic

Objective: The central issue of this research is to evaluate the extent of cognitive appraisal and coping processes within the pandemic encounter and determines their influence on frontline healthcare providers who had been dispatched to the coronavirus disease 2019 (COVID-19) epicenter (HPDE) distress symptoms. Materials and methods: An electronic survey of the HPDE and frontline healthcare providers who worked in their original medical facility (HPOF) was conducted from March 1 to 15, 2020. Two variables, appraisal (measured with an 18-item questionnaire) and coping (measured The Brief Cope questionnaire), were used in the analysis to explain distress symptoms (Impact of Event Scale-Revised). Results: A total of 723 eligible respondents completed the survey with a response rate of 57.3% (351 HPDE and 372 HPOF). The mean IES-R scores of HPDE respondents were 26.47 ± 11.7. Of HPDE respondents, 246 (70.09%) reported distress symptoms (score 9-88). The scores of intrusion, avoidance, and hyperarousal for HPDE were 10.28 ± 4.7, 8.97 ± 4.3, and 7.20 ± 3.2, respectively. The respondents had higher scores in overall distress and three subscales than HPOF. Appraisal and coping variables explained 77% of the distress variance. Five appraisal variables (health of self, health of family/others, virus spread, vulnerability or loss of control, and general health) were positively associated with distress symptoms. Four coping variables (active coping, positive reframing, self-distraction, and behavioral disengagement) were negatively associated with distress level, whereas self-blame was positively associated with distress symptoms. Regarding the appraisal, the scores of HPDE were significantly higher than HPOF (all p-values < 0.05), whereas being isolated was not significantly different between HDPE nurses and HPOF nurses. HPDE was significantly more likely to use humor, emotional support, instrumental support, self-distractions, venting, substance use, denial, behavioral disengagement, and self-blame (P < 0.05), whereas HPOF was significantly more likely to use active coping and acceptance (P < 0.05). HPDE doctors were significantly more likely than nurses to use active coping and acceptance (P < 0.05), whereas HPDE nurses were significantly more likely to use emotional support and use self-blame (P < 0.05). Conclusion: Frontline healthcare providers who had been dispatched to the COVID-19 epicenter respondents had a higher distress level. Therefore, we should provide proactive psychological support based on specific appraisal and coping variables.

Intentional mentoring: maximizing the impact of underrepresented future scientists in the 21st century

Mentoring is a developmental experience intended to increase the willingness to learn and establish credibility while building positive relationships through networking. In this commentary, we focus on intentional mentoring for underrepresented mentees, including individuals that belong to minority racial, ethnic and gender identity groups in Science, Technology, Engineering, Mathematics and Medicine (STEMM) fields. Intentional mentoring is the superpower action necessary for developing harmony and comprehending the purpose and value of the mentor/mentee relationship. Regardless of a mentor's career stage, we believe the strategies discussed may be used to create a supportive and constructive mentorship environment; thereby improving the retention rates of underrepresented mentees within the scientific community.

Optimism, mindfulness, and resilience as potential protective factors for the mental health consequences of fear of the coronavirus

The COVID-19 pandemic has a substantial impact on mental health. Prior reports have shown that depression, anxiety, and stress have increased throughout the pandemic. Nonetheless, not everyone is affected by these negative consequences and some people may be relatively unaffected. In this online study in a predominantly Dutch and Belgian sample (N = 546), we investigated whether positive personality traits such as optimism, mindfulness, and resilience may protect against the negative mental health consequences (i.e., fear of the coronavirus, depression, stress, and anxiety) of the COVID-19 pandemic. We found that fear of COVID-19 was related to higher depression, stress, and anxiety. However, for participants scoring high on mindfulness, optimism, and resilience, this relationship was weakened. In addition to these findings, we present the results of network analyses to explore the network structure between these constructs. These results help to identify possible ways through which psychological well-being can be promoted during the COVID-19 pandemic.

Neuroticism, resilience, and social support: correlates of severe anxiety among hospital workers during the COVID-19 pandemic in Nigeria and Botswana

Background

The role of healthcare workers (HCWs) during the COVID-19 pandemic may make them more susceptible to anxiety than the general population. This study aimed to determine the prevalence of anxiety and evaluate the potential effects of resilience, neuroticism, social support, and other sociodemographic factors on anxiety among HCWs from two African countries.

Methods

A cross-sectional survey of 373 HCWs was conducted in Botswana and Nigeria, using an anxiety rating scale, neuroticism subscale of Big Five Inventory, Oslo social support scale, and Resilience Scale. Data collection was done between May 1 and September 30, 2020.

Results

The participants’ mean age (SD) was 38.42 (8.10) years, and 65.1% were females. Forty-nine (13.1%) of the HCWs reported clinical anxiety. In the final model of hierarchical multiple regression, neuroticism (B = 0.51, t = 10.59, p = p < 0.01), resilience (B = 0.34, t = − 7.11, p < 0.01), and social support (B = 0.079, t = − 2.11, p = 0.035) were associated with severe anxiety, after controlling for the significant sociodemographic factors.

Conclusions

Severe anxiety exists among HCWs in Africa, although the rate was lower than reported elsewhere. Neuroticism, resilience, and social support may be vital targets for psychological intervention in a pandemic as COVID-19; thus, their roles should be further explored.

Mental health and illness of medical students and newly graduated doctors during the pandemic of SARS-Cov-2/COVID-19

Introduction: SARS-Cov-2 virus pandemic causes serious emotional consequences. It has occurred widespread medical courses suspension, and graduations were anticipated. Field hospitals, set up to treat patients with mild to moderate COVID-19, were the main workplaces of newly graduated doctors. Objective: To assess the impact of SARS-Cov-2/COVID-19 pandemic on mental health of medical interns and newly graduated doctors. Method: This is a cross-sectional study performed using a digital platform. Links to forms were sent in two moments: moment 1 (M1), at the beginning of the pandemic, in the first half of April/2020 and moment 2 (M2), after six months of pandemic, in the second half of September/2020. All students from the medical internship and all doctors graduated since 2018 from the three medical schools in Sergipe-NE-Brazil were invited. Results: 335 forms were answered in April and 148 in September. In M1 88.9% considered themselves exposed to excess of information about COVID-19, which was associated with anxiety symptoms (p = 0.04). Long family physical distance was also associated with these symptoms, as increased appetite (p = 0.01), feeling shortness of breath (p = 0.003) and sweating (p = 0.007). Fear of acquire COVID-19 was reported as intense by almost half of participants, and of transmitting by 85.7% in M1. In M2 41.2% reported the death of friends or relatives. Psychiatric illness was described by 38.5% and psychotropic drugs use by 30.1% in M1, especially those who lived alone (p = 0.03) and the single ones (p = 0.01). Alcohol intake was reported by 54.3%, and among doctors graduated in 2020 it increased from 50% in M1 to 85% in M2 (p = 0.04). Conclusion: The pandemic had a negative impact on the mental health of medical students and newly graduated doctors. Exposure to excessive COVID-19 information and family physical distance were associated to anxiety symptoms. Among doctors graduated in 2020, alcohol intake increased during pandemic evolution.

Teaching during the Pandemic: A Comparison in Psychological Wellbeing among Smart Working Professions

Background: As a result of the COVID-19 pandemic, since March 2020, the Italian population was forced into lockdown to prevent the spread of the virus. The restrictive measures imposed forced many organizations and workers to work through online platforms and no longer in-person. Smart working, enjoyed by some workers for its flexibility, affected several professional categories. The purpose of this study was to investigate whether there are differences in the psychological variables related to four groups of professional categories (practitioners, managers, executive employees, teachers), particularly the teachers group. Methods: A total sample of 628 individuals was recruited through a random probability sample across Italy. Due to the lockdown, an online questionnaire was developed; several validated scales were chosen, and some ad hoc constructed items related to the smart working experience were included. Results: The results showed statistically significant differences between the four groups of examined smart workers. Conclusions: All workers have had to readjust to this new way of working, but our results show that teachers were the most affected, both in the perception of their psychological well-being and in the management of the smart working mode.

Psychological resilience, coping behaviours and social support among health care workers during the COVID-19 pandemic: A systematic review of quantitative studies

Aim

To appraise and synthesize studies examining resilience, coping behaviours and social support among health care workers during the coronavirus pandemic.

Background

A wide range of evidence has shown that health care workers, currently on the frontlines in the fight against COVID‐19, are not spared from the psychological and mental health‐related consequences of the pandemic. Studies synthesizing the role of coping behaviours, resilience and social support in safeguarding the mental health of health care workers during the pandemic are largely unknown.

Evaluation

This is a systematic review with a narrative synthesis. A total of 31 articles were included in the review.

Key Issues

Health care workers utilized both problem‐centred and emotion‐centred coping to manage the stress associated with the coronavirus pandemic. Coping behaviours, resilience and social support were associated with positive mental and psychological health outcomes.

Conclusion

Substantial evidence supports the effectiveness of coping behaviours, resilience and social support to preserve psychological and mental health among health care workers during the COVID‐19 pandemic.

Implications for Nursing Management

In order to safeguard the mental health of health care workers during the pandemic, hospital and nursing administrators should implement proactive measures to sustain resilience in HCWs, build coping skills and implement creative ways to foster social support in health care workers through theory‐based interventions, supportive leadership and fostering a resilient work environment.

Women in healthcare experiencing occupational stress and burnout during COVID-19: a rapid review

Context

COVID-19 has had an unprecedent impact on physicians, nurses and other health professionals around the world, and a serious healthcare burnout crisis is emerging as a result of this pandemic.

Objectives

We aim to identify the causes of occupational stress and burnout in women in medicine, nursing and other health professions during the COVID-19 pandemic and interventions that can support female health professionals deal with this crisis through a rapid review.

Methods

We searched MEDLINE, Embase, CINAHL, PsycINFO and ERIC from December 2019 to 30 September 2020. The review protocol was registered in PROSPERO and is available online. We selected all empirical studies that discussed stress and burnout in women healthcare workers during the COVID-19 pandemic.

Results

The literature search identified 6148 citations. A review of abstracts led to the retrieval of 721 full-text articles for assessment, of which 47 articles were included for review. Our findings show that concerns of safety (65%), staff and resource adequacy (43%), workload and compensation (37%) and job roles and security (41%) appeared as common triggers of stress in the literature.

Conclusions and relevance

The current literature primarily focuses on self-focused initiatives such as wellness activities, coping strategies, reliance of family, friends and work colleagues to organisational-led initiatives such as access to psychological support and training. Very limited evidence exists about the organisational interventions such as work modification, financial security and systems improvement.

The association between witnessing patient death and mental health outcomes in frontline COVID-19 healthcare workers

BACKGROUND

Healthcare workers (HCW) treating coronavirus disease 2019 (COVID-19) patients face high levels of psychological stress. We aimed to compare mental health outcomes, risk and protective factors for posttraumatic stress symptoms (PTSS), probable depression, and anxiety between HCW working in COVID-19 and non-COVID-19 wards.

METHODS

A self-report survey, administered in a large tertiary hospital in Israel during the peak of the COVID-19 outbreak was completed by 828 HCW (42.2% physicians, 57.8% nurses. Patient-Reported Outcomes Measurement Information System; the Patient Health Questionnaire-9; the Primary Care-Post Traumatic Stress Disorder Screen for DSM-5 (PC-PTSD-5) were used for assessing anxiety, depression, and PTSS, respectively. Pandemic-related stress factors, negative experiences, and potential protective factors were also assessed.

RESULTS

Median PC-PTSD scores differed significantly between study teams (χ² [5] = 17.24; p = .004). Prevalence of probable depression and anxiety were similar in both groups. Risk factors for mental health outcomes included mental exhaustion, anxiety about being infected and infecting family. Overall, higher proportion of the COVID-19 team witnessed patient deaths as compared to the non-COVID-19 team (50.2% vs. 24.7%). Witnessing patient death at the COVID-19 wards was associated with a four-fold increased likelihood of PTSS (odds ratio [OR] = 3.97; 95% confidence interval [CI], 1.58-9.99; p = .0007), compared with the non-COVID-19 wards (OR 0.91; 95% CI, 0.51-1.61; p = .43).

CONCLUSIONS

Witnessing patient death appears to be a risk factor for PTSS unique to HCW directly engaged in treating patients with COVID-19. Our findings suggest that helping HCW cope with COVID-19 related deaths might reduce their risk of posttraumatic stress.

Resilience and Work-Related Stress May Affect Depressive Symptoms in Nursing Professionals during the COVID-19 Pandemic Era

OBJECTIVE

We aimed to investigate the effect of nursing professionals' resilience on their mental health, work-related stress, and anxiety in response to the COVID-19 pandemic.

METHODS

We conducted an online survey in the Asan Medical Center and Ulsan University Hospital, South Korea. We extracted data of 824 nursing professionals who consented to participate, including demographic variables and the Stress and Anxiety to Viral Epidemics-9 (SAVE-9), PHQ-9, GAD-7, and Brief Resilience Scale scores.

RESULTS

Resilience was negatively correlated with Patient Health Questionnaire-9 (PHQ-9) (rho=-0.23), Generalized Anxiety Scale-7 items (GAD-7) (rho=-0.25), Stress and Anxiety to Viral Epidem-ics-6 items (SAVE-6) (rho=-0.15), and Stress And anxiety to Viral Epidemics-3 items (SAVE-3) (rho=-0.13, all, p<0.001). Logistic regression analysis adjusting age, marital status, and years of employment revealed that high level of general anxiety [adjusted odds ratio (aOR)=1.40, 95% confidence interval (CI)=1.31-1.50], work-related stress during viral epidemics (aOR=1.16, 95% CI=1.03-1.29), and a low level of resilience (aOR=0.91, 95% CI=0.85-0.97) were expecting variables for the depression of healthcare workers.

CONCLUSION

Nursing professionals' level of resilience may be associated with low level of work-related stress and anxiety induced by a viral epidemic. We need to explore further the possibility of resilience as coping strategy of healthcare workers in this pandemic era.

Trajectories of post-traumatic stress symptoms, anxiety, and depression in hospitalized COVID-19 patients: A one-month follow-up

OBJECTIVES

Little is known about the mental health outcomes of hospitalized COVID-19 patients. The aims of the study were: (1) to examine the trajectories of anxiety, depression, and pandemic-related stress factors (PRSF) of COVID-19 hospitalized patients one-month following hospitalization; (2) to assess the presence of post-traumatic stress symptoms (PTSS) a month after hospitalization; (3) to identify baseline risk and protective factors that would predict PTSS one month after hospitalization.

METHODS

We contacted hospitalized COVID-19 patients (n = 64) by phone, at three time-points: during the first days after admission to the hospital (T1); after ~two weeks from the beginning of hospitalization (T2), and one month after hospitalization (T3). At all time-points we assessed the levels of anxiety and depression symptoms, as well as PRSF. At T3, PTSS were assessed.

RESULTS

The levels of depressive and anxiety symptoms decreased one-month following hospitalization. Moreover, higher levels of anxiety (standardized β = 1.15, 95% CI = 0.81-1.49, p < 0.001) and depression (β = 0.97, 95% CI = 0.63-1.31 p < 0.001) symptoms during the first week of hospitalization, feeling socially disconnected (β = 0.59, 95% CI = 0.37-0.81 p < 0.001) and experiencing a longer hospitalization period (β = 0.25, 95% CI = 0.03-0.47 p = 0.026) predicted higher PTSS scores a month post-hospitalization.

CONCLUSIONS

We identified early hospitalization risk factors for the development of PTSS one month after hospitalization that should be targeted to reduce the risk for PTSS.

The mediator role of the fear of COVID-19 in the relationship between psychological resilience and life satisfaction

COVID-19, which has recently affected the world, has caused serious adversities in many areas as well as on the mental health of individuals. People have had a serious fearful mood due to situations such as catching COVID-19, having health problems after catching the disease, and worrying about infecting someone else. This negative mood is discussed in the literature through the concept of the fear of COVID-19. Accordingly, the mediator role of the fear of COVID-19 in the relationship between psychological resilience and life satisfaction was examined in this study. This study was conducted with 430 Turkish university students, 279 women and 151 men, who are between the ages of 18 and 30. The data of the study were collected with the psychological resilience, the fear of COVID-19 and life satisfaction scales. As a result of the analysis, it was concluded that psychological resilience is a negative predictor of the fear of COVID-19 and a positive predictor of life satisfaction, and that the fear of COVID-19 is a negative predictor of life satisfaction. It was also concluded that the fear of COVID-19 mediates the relationship between psychological resilience and life satisfaction. The results are discussed in relation to the relevant literature, and suggestions are made for practitioners and researchers.

Anxiety levels during a second local COVID-19 pandemic breakout among quarantined people: A cross sectional survey in China

Only a few studies investigated the impact of quarantine on anxiety of general population during a second wave of COVID-19 breakout. We aimed to compare anxiety levels of quarantined and non-quarantined people and investigate factors affecting anxiety during the second COVID-19 pandemic. A total of 1837 participants were included in this cross-sectional study. Anxiety was measured by the State-Trait Anxiety Inventory (STAI). Participants were divided into the quarantined group (QG) and non-quarantined group (Non-QG). The mean STAI-S score in the QG was significantly higher than Non-QG (41.8 ± 11.2 vs 40.01 ± 9.9), so was the proportion of severe state anxiety (11.6% vs 5.5%). Males in the QG were significantly more anxious than females evaluated by both STAI-S and STAI-T. High income was independent protective factors while moderate or bad health status and high trait anxiety level were independent risk factors for severe state anxiety. In conclusion, the COVID-19 confinement could significantly increase anxiety of quarantined people. Males were more vulnerable to the quarantine of COVID-19 with significantly increased anxiety level than females. The results suggest that attention should be paid to anxiety during a second round of quarantine due to COVID-19 and are of help in planning psychological interventions.

A study on the anxiety level and stress during Covid19 lockdown among the general population of West Bengal, India- A must know for primary care physicians

Background:

Covid19 pandemic has resulted in drastic changes in human lives across the globe in the form of lockdown and an uncertain future. Information regarding the COVID-19-related anxiety and well-being among the public in India is very limited, especially from the state of West Bengal. We conducted this e-survey among the general population of West Bengal to assess the anxiety levels and the well-being status during lockdown. This information would be helpful to guide family physicians to screen patients for anxiety from the primary care level.

Aims:

The main aim of this questionnaire based study was to assess the levels of anxiety and well-being status among the public including the frontline workers in West Bengal, India.

Materials and Methods:

A prospective study was conducted with a validated e-questionnaire after Institutional Ethics committee approval, from 18^th April, 2020 to 3^rd May, 2020. The questionnaire had 12 questions which included the Generalized Anxiety disorder (GAD)-7 scale and the WHO-5 scale (5 question-items) to assess the well-being of the participants. The survey link was distributed through the social networking sites of WhatsApp, LinkedIn, Facebook and Twitter and e-mails within West Bengal. Microsoft Excel (version 2016) was used to analyse the data.

Results:

A total of 355 responses were received 15.49% responders were observed to have anxiety and 37.74% participants had low well-being scores. Majority of healthcare workers (89.47%) were seen to have anxiety and a significant (52.03%) had a low well-being status.

Conclusions:

We report the presence of anxiety and low well-being among the general population of West Bengal. It is important to understand the current psychological status of the public for the family physicians as many would visit them with vague symptoms. There is a dire need to screen all patients including front line workers visiting primary care physicians for mental health to ensure better clinical outcome.