Coping With COVID-19: Emergency Stress, Secondary Trauma and Self-Efficacy in Healthcare and Emergency Workers in Italy

Mental health and help seeking among trauma-exposed emergency service staff: a qualitative evidence synthesis

OBJECTIVES

To identify factors and contexts that may contribute to mental health and recovery from psychological difficulties for emergency service workers (ESWs) exposed to occupational trauma, and barriers and facilitators to help-seeking behaviour among trauma-exposed ESWs.

BACKGROUND

ESWs are at greater risk of stressor-related psychopathology than the general population. Exposure to occupational stressors and trauma contribute to the observed rates of post-trauma psychopathology in this occupational group with implications for workforce sustainability. Types of organisational interventions offered to trauma-exposed ESWs are inconsistent across the UK, with uncertainty around how to engage staff.

DESIGN

Four databases (OVID MEDLINE, EMBASE, PsycINFO and SCOPUS) were systematically searched from 1 January 1980 to March 2020, with citation tracking and reference chaining. A modified Critical Appraisal Skills Programme tool and quality appraisal prompts were used to identify fatally flawed studies. Qualitative studies of trauma-exposure in front-line ESWs were included, and data were extracted using a customised extraction table. Included studies were analysed using thematic synthesis.

RESULTS

A qualitative evidence synthesis was conducted with 24 qualitative studies meeting inclusion criteria, as defined by the PerSPEcTiF framework. Fourteen descriptive themes emerged from this review, categorised into two overarching constructs: (1) factors contributing to mental health (such as the need for downtime, peer support and reassurance) and (2) factors influencing help-seeking behaviour (such as stigma, the content/form/mandatory nature of interventions, and mental health literacy issues including emotional awareness and education).

CONCLUSION

ESWs reported disconnect between the organisations' cultural positioning on trauma-related mental health, the reality of undertaking the role and the perceived applicability and usefulness of trauma interventions. Following traumatic exposure, ESWs identify benefitting from recovery time and informal support from trusted colleagues. A culture which encourages help seeking and open dialogue around mental health may reduce stigma and improve recovery from mental ill health associated with trauma exposure.

The Impact of the COVID-19 Pandemic on Mental Health, Occupational Functioning, and Professional Retention Among Health Care Workers and First Responders

BACKGROUND

The COVID-19 pandemic has greatly affected front-line health care workers (HCW) and first responders (FR). The specific components of COVID-19 related occupational stressors (CROS) associated with psychiatric symptoms and reduced occupational functioning or retention remain poorly understood.

OBJECTIVES

Examine the relationships between total and factored CROS, psychiatric symptoms, and occupational outcomes.

DESIGN

Observational, self-report, single time-point online assessment.

PARTICIPANTS

A total of 510 US HCW (N = 301) and FR (N = 200) with occupational duties affected by the COVID-19 pandemic.

MAIN OUTCOMES AND MEASURES

CROS were assessed using a custom 17-item questionnaire. Post-traumatic stress disorder (PTSD), depression, insomnia, and generalized anxiety symptoms were assessed using the PTSD Checklist-5 (PCL5), Patient Health Questionnaire-9 (PHQ9), Insomnia Severity Index (ISI), and General Anxiety Disorder-7 (GAD7). Respondents' likelihood of leaving current field and occupational functioning were assessed with 2-item PROMIS subscales. Relationships were modeled using multivariable regression. Open-ended responses were coded using rapid template analysis.

RESULTS

CROS total scores correlated significantly with all four psychiatric symptom domains (R's = .42-.53), likelihood of leaving one's current occupation (R = .18), and trouble doing usual work (R = .28), all p's < .001. Half of HCW indicated a decreased likelihood of staying in their current occupation as a result of the pandemic. CROS were fit to a 3-factor model consisting of risk, demoralization, and volume factors. All CROS factors were associated with psychiatric symptom burden, but demoralization was most prominently associated with psychiatric symptoms and negative occupational outcomes. Among psychiatric symptoms, PTSD symptoms were most strongly associated with negative occupational outcomes. Open-ended statements emphasized lack of protection and support, increased occupational demands, and emotional impact of work duties.

CONCLUSIONS AND RELEVANCE

These results demonstrate potentially treatable psychiatric symptoms in HCW and FR experiencing CROS, impacting both wellbeing and the health care system. Mitigating CROS, particularly by addressing factors driving demoralization, may improve HCW and FR mental health, occupational functioning, and retention.

Biting the bullet: When self-efficacy mediates the stressful effects of COVID-19 beliefs

The impact that COVID-19 had on individuals globally has been immense. Our study aims to determine if the various COVID-19 related beliefs (information seeking; invulnerability; disruption; health importance and response effectiveness) are predictors of perceived stress and if self-efficacy acts as a mediator in reducing perceived COVID-19 related stress. From a large sample of 23,629, data were assessed using validated multi-item measures for seven COVID-19 related beliefs, self-efficacy and perceived stress. After conducting a series of tests and checks via Confirmatory Factor Analyses, linear modelling and mediation analyses with bootstrapping were applied to test direct and mediation hypotheses. It is found that stress perception is most strongly affected by self-efficacy and perceived disruption. Except for information seeking, which positively affected perceived stress, self-efficacy partially mediates all other COVID-19 related beliefs (perceptions of disruption, health importance and response effectiveness) in conjunction with their direct effects. Only perceived invulnerability elicited opposite effects on stress, increasing stress directly but decreasing stress indirectly by increasing self-efficacy. This finding gives reason to believe that individuals may disclose that they are less vulnerable to COVID-19, fostering their self-efficacy, but still accept that stressing factors such as economic and social consequences apply. Overall, reinforcing self-efficacy was carved out as the most important resilience factor against perceiving high levels of stress. On this basis, implications for research and practice are provided.

Professional Self-Concept and Self-Confidence for Nurses Dealing with COVID-19 Patients

Purpose: To identify the impact of dealing with COVID-19 patients in clinical areas on nurses’ professional self-concept and self-confidence. Background: Professional self-concept is considered a critical factor in the recruitment/retention process in nursing, nursing shortage, career satisfaction, and academic achievements. Professional self-confidence is also a crucial determinant in staff satisfaction, reducing turnover, and increasing work engagement. Design: Descriptive, comparative study. Methods: The study was conducted between February to May 2021 by utilizing a convenience sampling technique. A total of 170 nurses from two facilities were recruited from two COVID-19- and non-COVID-19-designated facilities. The level of professional self-concept and self-confidence was assessed by utilizing the Nurses’ Self-Concept Instrument and Self-Confidence Scale. Results: The professional self-concept level among the group exposed to COVID-19 patients was lower than the comparison group, while the professional self-confidence level among the exposed group to COVID-19 patients was similar to the comparison group. On the other hand, the satisfied staff and those who received professional training in dealing with COVID-19 patients reported a higher level of professional self-concept. Conclusions: Dealing with COVID-19 patients has an impact on professional self-concept; the exposure group was lower than those who did not deal with COVID-19 patients, while the professional self-confidence level among the exposed group was similar to the comparison group. Getting professional training in dealing with COVID-19 patients and being satisfied at work were significant factors in improving professional self-concept. Policymakers should create strategies that target the improvement of professional training in dealing with COVID-19 patients.

Healthcare professionals' experience of using in situ simulation training in preparation for the COVID-19 pandemic: a qualitative focus group study from a Danish hospital

OBJECTIVES

The COVID-19 pandemic forced hospital organisation and healthcare professionals to prepare for large quantities of patients in isolation rooms. In situ simulation may seem promising in order to manage the organisational changes that the pandemic require. This study aims to investigate in situ simulations influence on healthcare professional's self-perceived preparedness to face the pandemic.

DESIGN

A qualitative focus group study.

SETTING

We conducted full scale in situ simulations over a 3-week period in April 2020, including 277 healthcare professionals, at a Danish University Hospital. Subsequently, six semistructured focus group interviews, including 22 participants from the simulations, were conducted in May 2020.

PARTICIPANTS

22 healthcare professionals participated in the focus group interviews.

METHODS

The simulations consisted of a briefing, two scenarios focusing on acute respiratory insufficiency and correct use of personal protective equipment (PPE), and a debriefing. We conducted six focus group interviews using comparable semistructured interview guides focusing on the organisational restructuring of the departments and outcomes of the needs-driven simulation-based programme. We used thematic analysis to identify main themes.

RESULTS

The informants perceived that the simulations resulted in positive experiences for the healthcare professionals and perceived the organisational changes as effective. They highlighted that simulation enhanced teamwork, demystified the COVID-19 disease, and improved skills, in correct use of PPE and acute treatment of COVID-19 patients. Data revealed that a predefined simulation task force including both experienced simulators and medical experts for facilitation of in situ simulation would be beneficial.

CONCLUSION

In situ simulation may be useful to enhance learning on organisation and individual level during a pandemic. This educational activity could serve an important role in facilitating hospital preparation and education of large numbers of healthcare professionals during a healthcare crisis. Introduction of a simulation task force is suggested to handle coordination and rapid enrolment across the hospital.

TURNOVER INTENTION AND CORONAPHOBIA AMONG FRONTLINE NURSES DURING THE SECOND SURGE OF COVID-19: THE MEDIATING ROLE OF SOCIAL SUPPORT AND COPING SKILLS

BACKGROUND

Turnover among frontline healthcare workers, particularly nurses, reached an alarming rate during the COVID-19 pandemic. This turnover has been attributed, in part, to excessive fear of the virus (a condition called coronaphobia). Studies have not yet been conducted examining whether social support and coping skills could act as buffers between coronaphobia and the intention to leave.

AIM

To examine the relationship between coronaphobia and frontline nurses' organizational and professional turnover intention and to assess whether social support and coping skills can buffer this relationship.

METHODS

A correlational research design was used to collect responses through an online questionnaire from a convenience sample of 687 frontline nurses from the Central Philippines. Data was analysed using descriptive (mean, standard deviation, percentages) and inferential statistics (t - test, Pearson r correlation coefficient, ANOVA, and multiple linear regression).

RESULTS

More than half of the frontline nurses experienced coronaphobia, while 25.8% reported a desire to leave their job and 20.7% reported a desire to leave their profession. Coronaphobia had direct significant effects on nurses' organizational (β=.424, p<.001) and professional turnover intention (β=.316, p<.001). Social support and coping skills partially mediated the relationship between organizational (β=.365, p<.001; β=.362, p<.001) and professional turnover intention (β=.279, p<.001; β=.289, p<.001).

CONCLUSION

Frontline nurses who experienced coronaphobia were more likely to quit their job and the nursing profession. Increasing nurses' social support and enhancing their coping skills reduced the negative effects of coronaphobia, resulting in improved nurse retention.

IMPLICATIONS FOR NURSING MANAGEMENT

Institutional approaches to reduce coronaphobia and turnover intention during the pandemic can be facilitated by improving social support through innovative approaches (e.g., use of technology, social media) and equipping nurses with positive coping skills through coping skills training and other empirically based coping skill-building interventions.

Mortality among healthcare workers in Indonesia during 18 months of COVID-19

The impact of SARS-CoV-2 infections upon Indonesian health care workers (HCWs) is unknown due to the lack of systematic collection and analysis of mortality data specific to HCWs in this setting. This report details the results of a systematic compilation, abstraction and analysis of HCW fatalities in Indonesia during the first 18 months of COVID-19. HCW who passed away between March 2020 and July 2021 were identified using Pusara Digital, a community-based digital cemetery database dedicated to HCW. We calculated the mortality rates and death risk ratio of HCWs versus the general population. The analysis indicates that at least 1,545 HCWs died during the study period. Death rates among males and females HCWs were nearly equivalent (51% vs. 49%). The majority were physicians and specialists (535, 35%), nurses (428, 28%), and midwives (359, 23%). Most deaths occurred between the ages of 40 to 59 years old, with the median age being 50 years (IQR: 39-59). At least 322 deaths (21%) occurred with pre-existing conditions, including 45 pregnant women. During the first 18 months of COVID-19 in Indonesia, we estimated a minimum HCW mortality rate of 1.707 deaths per 1,000 HCWs. The provincial rates of HCW mortality ranged from 0.136 (West Sulawesi) to 5.32 HCW deaths per 1,000 HCWs (East Java). The HCW mortality rate was significantly higher than that of the general population (RR = 4.92, 95% CI 4.67-5.17). The COVID-19 pandemic in Indonesia resulted in the loss of many hundreds of HCWs, the majority of whom were senior healthcare workers. The HCW mortality rate is five times that of the general population. A national systematic surveillance of occupational mortality is urgently needed in this setting.

Exploring the Psychological Stress, Anxiety Factors, and Coping Mechanisms of Critical Care Unit Nurses During the COVID-19 Outbreak in Saudi Arabia

Background: The spread of coronavirus disease 2019 (COVID-19) throughout the world leads to a series of modifications of several National Health Service organizations, with a potential series of psychological consequences among nurses.

Methods: This study was undertaken to assess the psychological stress, anxiety factors, and coping mechanisms of critical care unit nurses during the COVID-19 outbreak. A cross-sectional research design was employed, and the convenience sample consisted of 469 nurses working at several hospitals in Saudi Arabia during the period from July to September 2020. This study used the Generalized Anxiety Disorder, Coping Mechanism, and Nursing Stress scale.

Results: Interestingly, more than one-third and one-quarter of the studied nurses had severe and moderate anxiety levels, respectively. In addition, the most anxiety-causing factors included providing care for their infected colleagues and worrying about infecting their families. More than one-quarter and slightly less than half of the studied nurses had high and moderate stress levels, respectively. Furthermore, more than half of the participants had low coping mechanisms and one-quarter had moderate coping mechanisms. In addition, there was a strong positive correlation between anxiety and stress levels, and there was a strong negative correlation between coping mechanisms and stress and anxiety levels.

Conclusions: Collectively, this study explored the psychological stress, anxiety factors, and coping mechanisms among critical care unit nurses during the COVID-19 outbreak in Saudi Arabia. Continuous educational programs for nurses on using coping mechanisms should be developed in combination with teaching preventive measures for defining a psychological intervention plan within a mandatory occupational health surveillance program. This study recommends that constructive planning and necessary provision of supportive measures by the legal authorities and policymakers protect nurses and minimize their psychological stress to fulfill high-quality nursing care.

Psychological Distress and Coping Strategies among Nurses during the COVID-19 Pandemic: A Cross-Sectional Online Survey

Background:

The emergence of COVID-19 has a significant impact on nurse’s overall health. The severity and magnitude of the COVID-19 pandemic means it is extremely likely that health-care professionals will experience psychological distress as a result of their direct contact with patients who have contracted the infection.

Objectives:

This study aimed to evaluate levels of psychological distress among nurses during the COVID-19 pandemic, determine the associated factors, and identify nurses’ coping strategies.

Methods:

This study is a cross-sectional design. Overall, 130 nurses answered online questionnaires. The questionnaires measured sociodemographic characteristics, Fear of COVID-19 Scale, the Depression, Anxiety, and Stress Scale, and the Brief Coping Inventory.

Results:

Nurses have a moderate level of fear (mean score: 24.34 ± 13.43) and depression (43.8% of the sample), and severe anxiety (73.8%) and stress (45.4%). Anxiety and fear were positively correlated (r = .675, p < .001). Independent t-tests revealed that female nurses had higher psychological distress and fear than male nurses (p = 0.015 and p = 0.038, respectively). Nurses who cared for patients who had tested positive for coronavirus disease 2019 and those who had a friend or family member who had tested positive had higher fear and psychological distress than their respective counterparts (p < .001 and p = .010, respectively). Working more hours was moderately correlated with fear and anxiety (p = 0.016). Nurses were found to generally adopt maladaptive coping styles.

Conclusion:

Through careful study of the factors determined through this research to be associated with psychological distress among nurses, the health-care community can better prepare to mitigate nurses’ emotional and psychological toll in future pandemic situations. Working with patients who have tested positive for COVID-2019 causes psychological distress for nurses.

Stress and Maladaptive Coping of Italians Health Care Professionals during the First Wave of the Pandemic

Stress during the pandemic has had an impact on the mental health of healthcare professionals (HCPs). However, little is known about coping and “maladaptive” coping behaviours of this population. This study investigates “maladaptive” coping behaviours and their correlation with stress, anxiety and insomnia of Italian HCPs during the pandemic. It reports on a cross-sectional, descriptive and correlational study based on a survey of 1955 Italian HCPs. Overall participants reported increases in cigarette smoking, time spent online and video playing. Overall reported alcohol consumption decreased but increased in those reporting drinking more than once a week. Those reporting starting smoking during the pandemic were found to have higher SAS and PSS scores. Those reporting being online for 3 or more hours were found to have higher ISS scores. Doctors who reported playing video games were found to have higher PSS, ISS and SAS scores whilst nurses who reported playing video games were found to have higher ISS scores. Doctors who reported playing for longer than one hour had higher PSS scores. Online behaviours may be a coping behaviour of HCPs affected by the pandemic. However, this is an underexplored area for the wellbeing of HCPs. These deficits need to be addressed going forward.

Psychological Impact of the COVID-19 Pandemic on Out-of-Hospital Health Professionals: A Living Systematic Review

Health professionals (HPs), especially those working in the front line, have been one of the groups most affected by the COVID-19 pandemic. The objective of this study is to identify the best available scientific evidence on the impact of the COVID-19 pandemic on the mental health of out-of-hospital HPs in terms of stress, anxiety, depression, and self-efficacy. A living systematic review of the literature was designed, consulting the electronic online versions of the CINHAL, Cochrane Library, Cuiden, IBECS, JBI, LILACS, Medline PyscoDoc, PsycoINFO, Scopus, and Web of Science databases in November 2021. Original research was selected, published in either English, Spanish, French, Italian, or Portuguese. In total, 2082 publications were identified, of which 16 were included in this review. The mental health of out-of-hospital HPs was affected. Being a woman or having direct contact with patients showing suspicious signs of COVID-19 or confirmed cases were the factors related to a greater risk of developing high levels of stress and anxiety; in the case of depressive symptoms, it was having a clinical history of illnesses that could weaken their defenses against infection. Stopping unpleasant emotions and thoughts was the coping strategy most frequently used by these HPs.

Efectividad de áreas de conservación privada comunal en bosques montanos nublados del norte de Perú

Las Áreas de Conservación Privada (ACP) son uno de los mecanismos de conservación, gestionadas por ciudadanos privados que más protagonismo han adquirido en los escenarios de conservación local en los últimos años. En este estudio evaluamos la efectividad de cuatro ACP gestionadas por comunidades locales (CC). Se aplicó el Índice de Efectividad Compuesto (IEC) para determinar la efectividad del diseño, la integridad ecológica y la gestión. Los resultados muestran sistemas de gestión con una efectividad media, tres de las cuatro ACP evaluados (Copallín, Huaylla Belén-Colcamar y Tilacancha) reportan un diseño efectivo. Los rangos altitudinales protegidos están entre 2500 y 3500 m.s.n.m., con un índice de representatividad de la superficie promedio de 4,55% con respecto al área conservada en la categoría ACP para el departamento de Amazonas. La evaluación de la integridad ecológica indica que las ACP presentan menor superficie transformada (TS) (0-10%) y mayor TS en sus áreas circundantes, especialmente en el ACP Tilacancha (13,37% de TS en un buffer de 1,5 km). La suma ponderada de los índices individuales resulta en índices de efectividad compuestos de mayor a menor para el ACP Copallín (2,22), Hierba Buena Allpayacku (1,82), Huaylla Belen Colcamar (1,81) y Tilacancha (1,56).

Quality of Life, Insomnia and Coping Strategies during COVID-19 Pandemic in Hospital Workers. A Cross-Sectional Study

COVID-19 became a pandemic in a few months, leading to adverse health outcomes, reducing the quality of life, affecting the sleep/wake cycle, and altering coping strategies, especially among hospital personnel. Life quality, insomnia, and coping strategies were thus assessed among hospital personnel during the first wave of the COVID-19 pandemic in Italy. This cross-sectional study was conducted from May to November 2020 through an online survey. There were 558 participants (28.5% males and 71.5% females) enrolled in two different metropolitan areas (in North and South of Italy, respectively). Three standardized questionnaires were administered: European Quality of life–5 Dimensions (EQ-5D), Athens Insomnia Scale (AIS), and Brief COPE. Differences in sociodemographic characteristics and work-related factors were also investigated in order to identify possible predictors through a generalized linear model and logistic regression analysis. Results showed good perceived life quality and high insomnia prevalence. After sample stratification, the statistical analysis highlighted that personal (gender, age, educational level) and work-related factors (employment in COVID wards, remote working) played different roles in predicting quality of life, insomnia, and coping attitude. Active, Planning, and Acceptance were the most frequently adopted coping strategies. Despite women confirming their attitude in reacting to the difficulties, adopting emotion-focused coping strategies, they showed a higher probability to develop insomnia, so a gender perspective should be considered in the health protection of this working category. An integrated approach should be implemented at individual, interpersonal and organizational levels aiming to monitor psychological distress, favor regular sharing and communication between peers, and also allow conciliation of work with family life. At the organizational level, preventive and protective measures adequate to work-related risk to COVID-19 should be adopted.

Reported effects of the COVID-19 pandemic on the psychological status of emergency healthcare workers: A scoping review

BACKGROUND

While literature on psychological consequences among frontline healthcare workers (HCWs) flourishes, understanding the psychological burden on this group is particularly crucial, as their exposure to COVID-19 makes them especially at high risk. We explored what is known about psychological effects of the COVID-19 pandemic on emergency HCWs.

METHODS

We used a scoping review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews.

RESULTS

The search identified 5432 articles, from which a total of 21 were included in the final review. Anxiety, burnout, depression, inadequate sleep, post-traumatic stress disorder (PTSD) symptoms, distress/stress and secondary trauma, were all reportedly experienced by emergency HCWs. Anxiety, burnout, depression and stress levels were higher among physicians and nurses compared to others. Post-traumatic stress disorder symptoms were higher among reserve medics, while Red Cross volunteers developed similar reactions of psychological stress and secondary trauma to other healthcare workers. Male HCWs reported more post-traumatic stress disorder symptoms than females, while stress was higher among females than male HCWs.

CONCLUSIONS

Emergency HCWs providing care during the COVID-19 pandemic are at risk from specific psychological impacts, including anxiety, burnout, depression, inadequate sleep, PTSD symptoms, psychological distress/stress and secondary trauma, and stress TWEETABLE ABSTRACT: Emergency healthcare workers are at direct risk of psychological impacts from the COVID-19 pandemic.

The amplifying effect of perceived group politicization: Effects of group perceptions and identification on anxiety and coping self-efficacy among members of UK COVID-19 mutual aid groups

Mutual aid groups developed and mobilized in communities across the UK and globally at the outset of the pandemic in order to support vulnerable community members with practical assistance and emotional support, with some understanding their work in political terms. This study adopted a “social cure” lens to investigate the effects of group identification and group perceptions on anxiety and coping self‐efficacy among members of UK Covid‐19 mutual aid groups. Survey data were collected from self‐identified members of these groups (N = 844) during the initial period of “lockdown” restrictions in April – May 2020. Correlational analyses showed that identification with the mutual aid group was linked to more positive group perceptions and better self‐reported psychological outcomes. Perceived group politicization showed the reverse pattern. Mixed support for the “social cure” model was evident; the effect of group identification on coping self‐efficacy (but not anxiety) was serially mediated by perceived support and collective efficacy. Perceived group politicization was a significant moderator, seeming to amplify the indirect effect of group identification on coping self‐efficacy via perceived support. Results are discussed in light of previous empirical work on the social cure and Covid‐19 mutual aid groups. Please refer to the Supplementary Material section to find this article's Community and Social Impact Statement.

Healthcare worker stress, anxiety and burnout during the COVID-19 pandemic in Singapore: A 6-month multi-centre prospective study

Aim

The long-term stress, anxiety and job burnout experienced by healthcare workers (HCWs) are important to consider as the novel coronavirus disease (COVID-19) pandemic stresses healthcare systems globally. The primary objective was to examine the changes in the proportion of HCWs reporting stress, anxiety, and job burnout over six months during the peak of the pandemic in Singapore. The secondary objective was to examine the extent that objective job characteristics, HCW-perceived job factors, and HCW personal resources were associated with stress, anxiety, and job burnout.

Method

A sample of HCWs (doctors, nurses, allied health professionals, administrative and operations staff; N = 2744) was recruited via invitation to participate in an online survey from four tertiary hospitals. Data were gathered between March-August 2020, which included a 2-month lockdown period. HCWs completed monthly web-based self-reported assessments of stress (Perceived Stress Scale-4), anxiety (Generalized Anxiety Disorder-7), and job burnout (Physician Work Life Scale).

Results

The majority of the sample consisted of female HCWs (81%) and nurses (60%). Using random-intercept logistic regression models, elevated perceived stress, anxiety and job burnout were reported by 33%, 13%, and 24% of the overall sample at baseline respectively. The proportion of HCWs reporting stress and job burnout increased by approximately 1·0% and 1·2% respectively per month. Anxiety did not significantly increase. Working long hours was associated with higher odds, while teamwork and feeling appreciated at work were associated with lower odds, of stress, anxiety, and job burnout.

Conclusions

Perceived stress and job burnout showed a mild increase over six months, even after exiting the lockdown. Teamwork and feeling appreciated at work were protective and are targets for developing organizational interventions to mitigate expected poor outcomes among frontline HCWs.

Mental health and resilience during the coronavirus pandemic: A machine learning approach

Objective

This study explored risk and resilience factors of mental health functioning during the coronavirus disease (COVID‐19) pandemic.

Methods

A sample of 467 adults (M age = 33.14, 63.6% female) reported on mental health (depression, anxiety, posttraumatic stress disorder [PTSD], and somatic symptoms), demands and impacts of COVID‐19, resources (e.g., social support, health care access), demographics, and psychosocial resilience factors.

Results

Depression, anxiety, and PTSD rates were 44%, 36%, and 23%, respectively. Supervised machine learning models identified psychosocial factors as the primary significant predictors across outcomes. Greater trauma coping self‐efficacy and forward‐focused coping, but not trauma‐focused coping, were associated with better mental health. When accounting for psychosocial resilience factors, few external resources and demographic variables emerged as significant predictors.

Conclusion

With ongoing stressors and traumas, employing coping strategies that emphasize distraction over trauma processing may be warranted. Clinical and community outreach efforts should target trauma coping self‐efficacy to bolster resilience during a pandemic.

Learning Difficulties and Loneliness in College and Beyond: The Mediating Role of Self-Efficacy, Proactive Coping, and Hope

Following the conservation of resources, social-cognitive and hope theories, the goals of this study were to identify the role of self-efficacy, proactive coping, and hope as mediators in the relations between learning difficulties and loneliness distress. A questionnaire was sent to current and past students. The sample consisted of 498 participants. The results demonstrated that individuals with learning difficulties reported higher levels of loneliness compared with individuals without learning difficulties. Moreover, self-efficacy, proactive coping, and hope mediated the relations between levels of learning difficulties and loneliness. Specifically, the final model emphasized the important role of hopeful beliefs, since hope mediated the relations between learning difficulties, self-efficacy, and proactive coping with loneliness. In terms of practical implications, professionals' awareness as well as psychoeducational programs could be tailor-made to enhance hopeful beliefs and reduce loneliness.

Association Between Fear of COVID-19 and Emotional Distress in Nurses With Mediating Role of Socio-Demographic Features

Objectives: To determine the predictive association between fear of COVID-19 and emotional distress (depression, anxiety, and stress) in frontline and non-frontline nurses. To explore the mediating role of socio-demographic features. Methods: Correlational cross-sectional research design was implied. A total of 500 on-duty male and female, frontline and non-frontline, nurses were included from five major hospitals in Gujrat (Aziz Bhatti Shaheed Hospital, City Hospital, Doctors Hospital, Akram Hospital, and Gujrat Hospital). Fear of COVID-19 scale and the Urdu version of depression, anxiety, and stress scale - 21 (DASS-21) were used to measure variables of interest. Descriptive statistics, structural equation modeling (SEM), linear regression, and t-test were carried out using Statistical Package for Social Sciences (SPSS) 21. Result: Structural equation modeling (SEM) revealed a significant predictive link between fear of COVID-19 and depression, anxiety, and stress (goodness of model fit; NFI = 0.93, GFI = 0.914, AGFI = 0.93, CFI = 0.936, and IFI = 0.936). Furthermore, a significant mediating effect of certain demographic features was discovered by SEM (CMIN/DF = 1.11, NFI = 0.94, TLI = 0.98, GFI = 0.08, AGFI = 0.93, RMSEA = 0.029, CFI = 0.99, and IFI = 0.99). Results of linear regression analysis also revealed a momentous predictive association between fear of COVID-19 and emotional distress (R = 0.860). In comparative analysis, the results of t-test explored the statistical significant difference in fear of COVID-19 and emotional distress between frontline (mean = 25.775, 36.147 and SD = 1.75, 2.23) and non-frontline nurses (mean = 21.702, 27.353 and SD = 4.607, 10.212), with t (130) =7.111, 6.92. Conclusion: Managing the mediating effect of demographic characteristics and reducing the fear of COVID-19 can help nurses to overcome emotional distress, such as depression, anxiety, and stress. Further, this will increase the productivity among nurses.

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.

Associations between Personality Traits, Intolerance of Uncertainty, Coping Strategies, and Stress in Italian Frontline and Non-Frontline HCWs during the COVID-19 Pandemic-A Multi-Group Path-Analysis

The COVID-19 pandemic represented a very difficult physical and psychological challenge for the general population and even more for healthcare workers (HCWs). The main aim of the present study is to test whether there were significant differences between frontline and non-frontline Italian HCWs concerning (a) personality traits, intolerance of uncertainty, coping strategies and perceived stress, and (b) the models of their associations. A total of 682 Italian HCWs completed a self-report questionnaire: 280 employed in COVID-19 wards and 402 in other wards. The analysis of variance omnibus test revealed significant differences between the two groups only for perceived stress, which was higher among the frontline. The multi-group path analysis revealed significant differences in the structure of the associations between the two groups of HCWs, specifically concerning the relations between: personality traits and intolerance of uncertainty; intolerance of uncertainty and coping strategies. Regarding the relation between coping strategies and stress no difference was identified between the two groups. In both of them, emotionally focused coping was negatively related with perceived stress, whereas dysfunctional coping was positively related with stress. These results could be useful in planning actions aiming to reduce stress and improve the effectiveness of HCWs' interventions. Training programs aimed to provide HCWs with a skillset to tackle uncertain and stressful circumstances could represent an appropriate support to develop a preventive approach during outbreaks.

The Role of Coping Behavior in Healthcare Workers' Distress and Somatization During the COVID-19 Pandemic

Background: Constantly searching for a balance between work demands and their own physical and psychological health has challenged medical and nursing staff during the immediate wake of this COVID-19 viral epidemic leading to acute stress reactions and psychosomatic symptoms. Coping behavior might be a buffer for work-related stress in relation to mental well-being. The present study aims to evaluate the role of positive and negative stress-reducing activities on healthcare workers' mental and physical well-being. Methods: This was a cross-sectional study using an online survey that was sent out using our network of healthcare workers at the University of Antwerp and through social media. Socio-demographic data, coping behavior with the Palliative Pallet Scale (P3), and distress and somatization using the Four-dimensional symptom checklist were collected. Surveys were completed by 1,376 participants. Results: The results clearly showed that positive stress-reducing activities are related to fewer symptoms of distress and somatization. Providing direct care to COVID-19 patients was associated with a higher decrease of applying positive stress-reducing activities during the peak of the pandemic compared to the ideal situation. Finally, fewer symptoms of distress and somatization were associated with the following activities: reading, mind sports games, keeping a hobby collection, studying; engaging in sexual activities with your partner; cleaning the house, tidying up, working in the garden, doing household chores; exercising alone; walking, or taking a trip together with someone; exercise together with someone; watching TV, listening/playing (to) music/, playing computer games; playing a card game or other board game; and preparing something extra tasteful outside regular meals. Conclusion: Our study demonstrated an association between concrete coping behaviors and distress and somatization in healthcare workers during the first peak of the COVID-19 pandemic. The results provide relevant and additional insights to develop and investigate interventions among others in personal leadership and resilience.

Sense of Coherence and COVID-19: A Longitudinal Study

The strong restrictive measures adopted in 2020 against the spread of the COVID-19 pandemic in Italy have deeply affected the general population's mental health. In the current longitudinal study, we specifically focus on sense of coherence (SOC), both in terms of comprehensibility/manageability and meaningfulness, among a large sample of Italian adults; SOC is a potential resource likely to foster the ability to cope with stressors. A total of 2,191 Italian participants (65.8% female) aged 18-82 completed an anonymous online self-report questionnaire at Time 1 (during the lockdown, March 2020) and at Time 2 (at the resumption of most activities, July 2020). The Repeated Measures Latent Profile Analysis (RMLPA) allowed us to identify seven different SOC profiles based on the change in both SOC dimensions, ranging from a strong "crisis" in terms of this resource in the face of the pandemic to a solid possibility to count on it. Interestingly, female and younger respondents were more likely to belong to those profiles characterized by lower levels of SOC, and these profiles have specific relations with fear and wellbeing. The implications of these results and the further expansion of the study are discussed.Supplemental data for this article is available online at https://doi.org/10.1080/00223980.2021.1952151 .

Psychological consequences of hospital isolation during the COVID-19 pandemic - research on the sample of polish firefighting academy students

Currently, a very important thread of research on COVID-19 is to determine the dimension of the psychopathological emotional reactions induced by the COVID-19 pandemic. A non-experimental online research project was designed to determine the predictors of the severity of psychopathological symptoms, such as depression and PTSD symptoms, and the nature of the feedback mechanism between them in groups of men, remaining in hospital isolation due to infection and at-home isolation during the COVID-19 epidemic. The presence of symptoms of depression, post-traumatic stress disorder (PTSD) and a sense of threat due to the pandemic were assessed using the following screening tests: IES-R by Weiss and Marmar, PHQ-9 by Spitzer et al., and a self-constructed sliding scale for assessing COVID-19 anxiety. The study was carried out on a group of 57 firefighting cadets, hospitalized in a COVID-19 isolation room (M_age = 23.01), staying in isolation due to SARS-CoV-2 virus infection and a control group of 57 healthy men (M_age = 41.38) staying at home during quarantine and national lockdown. COVID-19 pandemic causes many psychopathological reactions. The predictive models revealed that the predictors of symptoms of PTSD in isolated patients included depression and the experienced sense of COVID-19 threat resulting from the disease, while in the control group the symptoms of depression were the only predictor of PTSD. PTSD experiences are usually associated with depression. It may also be a form of the re-experiencing process or the effect of high affectivity, indirectly confirmed by the participation of hyperarousal in the feedback loop. Our findings highlight the importance of mental health aspects in patients treated during the COVID-19 pandemic. The COVID-19 pandemic requires social distancing, quarantine and isolation, which may cause psychopathological symptoms not only in affected people, but also in the general population. Moreover, the need for greater psychological support can be emphasized for both: the sick and the general population.

A Cross-Sectional Examination of the Mental Wellbeing, Coping and Quality of Working Life in Health and Social Care Workers in the UK at Two Time Points of the COVID-19 Pandemic

As the COVID-19 pandemic continues to evolve around the world, it is important to examine its effect on societies and individuals, including health and social care (HSC) professionals. The aim of this study was to compare cross-sectional data collected from HSC staff in the UK at two time points during the COVID-19 pandemic: Phase 1 (May-July 2020) and Phase 2 (November 2020-January 2021). The HSC staff surveyed consisted of nurses, midwives, allied health professionals, social care workers and social workers from across the UK (England, Wales, Scotland, Northern Ireland). Multiple regressions were used to examine the effects of different coping strategies and demographic and work-related variables on participants' wellbeing and quality of working life to see how and if the predictors changed over time. An additional multiple regression was used to directly examine the effects of time (Phase 1 vs. Phase 2) on the outcome variables. Findings suggested that both wellbeing and quality of working life deteriorated from Phase 1 to Phase 2. The results have the potential to inform interventions for HSC staff during future waves of the COVID-19 pandemic, other infectious outbreaks or even other circumstances putting long-term pressures on HSC systems.

Work Climate Scale in Emergency Services: Abridged Version

This study is based on a 40-item work climate scale in hospital emergency services (WCSHES). Teams working in these emergency services experience a heavy workload and have a limited amount of time with each patient. COVID-19 has further complicated these existing issues. Therefore, we believed it would be helpful to draft an abridged version of the 40-item WCSHES, considering both validity and reliability criteria, but giving greater weight to validity. One hundred and twenty-six workers between the ages of 20 to 64 (M = 32.45; standard deviation (SD = 9.73)) years old participated voluntarily in the study. The validity, reliability, and fit model were evaluated in an iterative process. The confirmatory factor analysis yielded appropriate global fit indices in the abridged 24-item version (Χ²(248) = 367.84; p < 0.01, RMSEA = 0.06 with an interval of 90% from 0.05 to 0.07, SRMR = 0.08, GFI = 0.9, AGFI = 0.96, CFI = 0.98, NFI = 0.95, and NNFI = 0.98), along with test criteria validity (ρ_XY = 0.68, p < 0.001) and excellent reliability (α = 0.94 and ω = 0.94), maintaining the same conceptualization and usefulness of the original scale. The abridged 24-item version was used to measure four work climate factors (work satisfaction, productivity/achievement of aims, interpersonal relations, and performance at work). Evidence of the usefulness of the new abridged scale is provided along with a description of our study limitations and future areas for development.

The Healers Are Broken: A Call for Trauma-Informed Professional Development in Nursing

The COVID-19 pandemic has highlighted the fact that nurses are at risk for poor mental health, but there is evidence that this risk existed long before the pandemic started. Nurses in professional development have a unique opportunity to support nurses through trauma-informed professional development. Evidence-based interventions, such as peer support, attention to cultural differences, and empowerment, can enhance protective factors and also promote recovery from trauma-related poor mental health outcomes.

How Having a Clear Why Can Help Us Cope With Almost Anything: Meaningful Well-Being and the COVID-19 Pandemic in México

Background: Coronavirus disease 2019 (COVID-19) has resulted in an increase in known risk factors for mental health problems. Mexico adopted lockdown and physical distancing as a containment strategy with potential consequences on day to day life, such as social isolation, loss of income and loneliness that can have important consequences in terms of mental health. Objective: We aimed to examine the effect of the initial phases of the COVID-19 pandemic on psychological distress, well-being and perceived physical health among Mexican-base respondents and to examine whether coping strategies would play a potential intermediating role in relation to these variables. Under the Existential Positive Psychology perspective, an emphasis was made on meaning-centered coping. Methods: A cross-sectional study was conducted between April 30 and June 16th 2020 among 604 Mexicans-base respondents of which 471 were women and 132 men. Data was collected by using online questionnaires. Psychological distress was measured using the Depression, Anxiety, and Stress Scale (DASS-21). The Brief COPE Inventory was used to assess problem-focused and emotion-focused coping strategies. We also used the Meaning-Centered Coping Scale (MCCS). PERMA-Profiler was used to assess well-being, perceived physical health, and loneliness. Profiler and Descriptive analyses and bivariate linear regression were performed to examine the association of variables. Results: 45.9% of the participants reported moderate to extremely severe psychological distress. Our results demonstrate that problem-focused and emotion-focused coping were positively related to psychological distress, whereas meaning-centered coping was negatively associated with distress. Furthermore, psychological distress played a potential negative role in the perceived physical health, while meaning-centered coping and well-being buffered the negative influence of psychological distress on perceived physical health (completely standardized indirect effect = -0.01, SE: 0.012, 95% CI [-0.065; -0.017]. Conclusion: Meaning-centered coping was found to suppress the negative influence of psychological distress on sensation of decreased physical health corroborating the critical role of meaning in life in promoting well-being. Future studies can further examine the value of the critical role of meaning in life in promoting well-being as a protective factor against severe distress during traumatic events. Findings of this study can be used to orient policies and interventions aimed to alleviate suffering in the midst of the COVID-19 pandemic.

Protective Factors against Emergency Stress and Burnout in Healthcare and Emergency Workers during Second Wave of COVID-19

Working as healthcare workers (HCWs) and emergency workers (EWs) during the first wave of COVID-19 has been associated with high levels of stress and burnout, while hardiness, coping strategies and resilience have emerged as protective factors. No studies have so far investigated these psychological factors during the second wave. We aimed to verify the trend of stress levels, burnout, coping strategies and resilience during the pandemic in Italian healthcare and emergency workers by comparing a first sample recruited from the first COVID-19 wave (N = 240) with a second sample relating to the second wave (N = 260). Through an online platform we administered questionnaires to measure stress, burnout, resilience, hardiness and coping strategies. The results showed that in the two waves the total stress levels of HCWs and EWs did not differ, while the physical stress and hardiness scores in the second wave were greater. No differences were found in the coping strategies used. An analysis of burnout levels in the second wave sample found that stress showed a high predictive power in the emotional exhaustion and depersonalization scales. Hardiness and resilience emerged as protective factors in reducing stress. The implications for the need to provide support and to improve hardiness for HCWs and EWs are discussed.

A mixed methods study of an organization's approach to the COVID-19 health care crisis

Background

Healthcare emergency can increase work-related stress and reduce nurses’ job satisfaction and quality of life. Managerial decisions and proactive interventions implemented to react to the emergency ensure the best patient outcomes.

Purpose

The purpose of this study was to verify whether a proactive organizational approach can limit nurses’ work-related stress and help preserve their job satisfaction and quality of life during a health emergency.

Methods

A longitudinal mixed methods study was conducted. Data were collected before and after the transformation into a SARS-CoV-2 Hospital and the implementation of organizational interventions. Focus groups were conducted to investigate quantitative data.

Findings

After the implementation of interventions and as the pandemic progressed, work-related stress decreased and job satisfaction and quality of life increased.

Discussion

Through proactive organization, even during an emergency, nurses are prepared for working, and work-related stress due to changes is reduced. Nurses are motivated and satisfied with their organization and management, and quality of life increases.

The Mental Health Impact of 2019-nCOVID on Healthcare Workers From North-Eastern Piedmont, Italy. Focus on Burnout

The 2019-nCOVID pandemic as a public health emergency has faced healthcare systems with unprecedented challenges. Our study aimed to focus on the mental health impact of the 2019-nCOVID pandemic on healthcare workers (HCWs) from North-Eastern Piedmont, Italy. For this purpose, we performed an online survey which was e-mailed to HCWs at the end of the first peak of the pandemic. We involved both frontline and not-frontline HCWs, employed in the hospital or in healthcare services outside the hospital. The primary outcome of our research was the assessment of burnout, while secondary outcomes included the investigation of anxiety, depression, and post-traumatic stress symptoms. We observed higher levels of burnout (especially in the Depersonalization and Personal Accomplishment dimensions), in females, in HCWs aged <30 years, in those exposed to changes in their daily and family habits, in those who had to change their duties at work and in residents in training. In our HCWs sample we found lower levels of anxiety and depression than those reported in the literature. The problematic levels of burnout and adverse psychological outcomes observed during the pandemic cannot be underestimated. Given the recurrence in autumn 2020 of a new pandemic peak, which has once again put a strain on the health system and HCWs, it is supported the importance of a careful assessment of HCWs' mental health, and of the possible risk and protective factors both in the work environment and in the extra-work one.

Family Presence for Critically Ill Patients During a Pandemic

Family engagement is a key component of high-quality critical care, with known benefits for patients, care teams, and family members themselves. The COVID-19 pandemic led to rapid enactment of prohibitions or restrictions on visitation that now persist, particularly for patients with COVID-19. Reevaluation of these policies in response to advances in knowledge and resources since the early pandemic is critical because COVID-19 will continue to be a public health threat for months to years, and future pandemics are likely. This article reviews rationales and evidence for restricting or permitting family members' physical presence and provides broad guidance for health care systems to develop and implement policies that maximize benefit and minimize risk of family visitation during COVID-19 and future similar public health crises.

Am I choosing the right career? The implications of COVID-19 on the occupational attitudes of hospitality management students

The hospitality industry is under threat from COVID-19 and the possibility of future crises remains very real. To improve understanding of how such a crisis impacts the attractiveness of pursuing a career in the hospitality industry, this study examines the effects of negative emotions invoked by COVID-19 on hospitality management students' occupational attitudes. Using a sample of 425 students, we find that in addition to diminishing their occupational identification and in turn, job choice intentions, that the effects of these negative emotions are channeled through three salient motivational pathways, namely self-efficacy, intrinsic and extrinsic motivation, and passion. Thus, the study not only advances theory by providing a more nuanced conceptualization of the effects of negative emotions on occupational attitudes but it identifies important leverage points that can be harnessed to help mitigate the harmful emotional effects of a crisis, such as COVID-19, important and timely contributions that the authors hope will benefit aspiring hospitality industry talent and help restore the attractiveness of careers in the hospitality industry. Future research directions and implications to theory and practice are discussed.

Nursing work intention, stress, and professionalism in response to the COVID-19 outbreak in Iran: A cross-sectional study

BACKGROUND

Professionalism, stress and demographic factors are the three key influences in nurses' intention to provide care.

OBJECTIVES

This study examined the levels of work intention, stress and professionalism of nurses and determine the relationship between nursing work intention and factors in response to COVID-19.

METHODS

This cross-sectional study was conducted on 362 nurses from COVID-19-devoted hospitals in Iran. A self-administered electronic-based questionnaire was developed and used to determine levels of stress, professionalism, and nursing intention. Multiple regression analysis was carried out to analyze the correlation between nursing intention with respect to stress and professionalism.

RESULTS

The overall stress, professionalism, and nursing intention scores were 48.56, 21.46, and 17.83 respectively. There were significant differences in nursing intention scores between gender, marital status, and having training groups (p < 0.05). The regression analysis revealed that nursing intention had a significant relationship with older age (p < 0.001,S.E = 1.11,B = 17.02), higher income level (p < 0.001,S.E = 1.81,B = 6.98), having previous training (p = 0.008,S.E = 1.22,B = 3.27), higher stress level (p < 0.001,S.E = 2.37,B = -21.39), and high professionalism level (p < 0.001,S.E = 1.16,B = 11.99).

CONCLUSION

Having an adequate staff requirement plan, planning appropriate training for nurses, and proactive psychological support are crucial to prevent burnout and continue to provide nursing services.

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.

Psychological Differences Among Healthcare Workers of a Rehabilitation Institute During the COVID-19 Pandemic: A Two-Step Study

Introduction: Healthcare workers facing the threatening COVID-19 can experience severe difficulties. Despite the need to evaluate both the psychological distress and positive protective resources, brief and reliable assessment tools are lacking. Aim: Study 1 aimed at developing a new assessment tool to measure psychological distress and esteem in healthcare workers during the COVID-19 pandemic. Study 2 aimed to explore and compare the psychological reactions of healthcare workers of the COVID-19 and the non-COVID-19 wards. Methods: In Study 1, psychologists created 25 items based on their clinical experience. A preliminary qualitative evaluation selected the best 15 items for the new tool (CPI-HP) assessing the COVID-19 psychological impact with 2 scales: psychological distress and esteem. The CPI-HP was administered to 110 healthcare professionals to study its psychometric properties and the internal structure with exploratory graph analysis and confirmatory factor analysis. Study 2 compared two groups of healthcare professionals of the COVID-19 and non-COVID-19 departments. Results: In Study 1, the CPI-HP showed satisfying psychometric properties, and the two-factor structure was confirmed with good fit indices. In Study 2, the two groups of healthcare workers showed comparable levels of psychological distress and resilient coping, but the COVID-19 group displayed significantly higher esteem and appreciation of the experience. Discussion: All operators showed high psychological distress during the emergency, but the COVID-19 group reported higher resources, probably due to stronger group cohesion and greater esteem, perceived meaning, and own work value. Conclusion: Assessing the psychological distress and resources of healthcare professionals with specific tools is important. Psychological interventions should promote their psychological health.

Perceived organizational support and PTSD symptoms of frontline healthcare workers in the outbreak of COVID-19 in Wuhan: The mediating effects of self-efficacy and coping strategies

The present study aimed to examine the effect of perceived organizational support on the PTSD symptoms of frontline healthcare workers, and to examine the mediating effects of coping self-efficacy and coping strategies in this relationship. A short-term longitudinal study design was used to conduct two waves of online surveys in March and April 2020. Participants comprised 107 medical staff in both waves of investigation. Self-efficacy, coping strategies, and perceived organizational support were reported at Wave 1, and PTSD symptoms were reported at Wave 2. Results indicated that (1) The prevalence of probable PTSD was 9.3% and 4.7% on the Chinese version of the Impact of Events Scale-Revised of 33 and 35, respectively. Local healthcare workers had greater risks of PTSD than the members of medical rescue teams. Doctors reported higher PTSD symptoms than nurses. (2) Perceived organizational support had a significant indirect effect on PTSD symptoms through the mediation of problem-focused coping strategies and the sequential mediating effect of coping self-efficacy and problem-focused coping strategies. The findings highlight the importance of providing adequate organizational support to reduce PTSD symptoms in frontline medical staff during the COVID-19 pandemic.

Psychosocial Framework of Resilience: Navigating Needs and Adversities During the Pandemic, A Qualitative Exploration in the Indian Frontline Physicians

INTRODUCTION

Frontline healthcare workers (HCW) have faced significant plight during the ongoing Coronavirus disease 2019 (COVID-19) pandemic. Studies have shown their vulnerabilities to depression, anxiety disorders, post-traumatic stress, and insomnia. In a developing country like India, with a rising caseload, resource limitations, and stigma, the adversities faced by the physicians are more significant. We attempted to hear their "voices" to understand their adversities and conceptualize their resilience framework.

METHODS

A qualitative approach was used with a constructivist paradigm. After an initial pilot, a socio-demographically heterogeneous population of 172 physicians working in COVID-designated centers were purposively sampled from all over India. Following in-depth virtual interviews using a pre-formed semi-structured guide, the data was transcribed and translated verbatim. The interview was focused on their challenges, needs, and processes of coping and support. Charmaz's grounded theory was used for analysis supplemented by NVivo 10 software.

RESULTS

Fear of infection, uncertainty, stigma, guilt, and social isolation emerged as the main challenges. Simultaneously, their "unmet needs" were flexible work policies, administrative measures for better medical protection, the sensitivity of media toward the image of HCW, effective risk communication for their health, and finally, social inclusion. Their resilience "framework" emerged as a process while navigating these adversities and consisted of three facets: forming a "resilient identity," managing the resilience, and working through the socio-occupational distress. The role of mental well-being, social network, peer support, problem negotiation, and self-care emerged as the key coping strategies.

CONCLUSION

The study findings support the global call for better psychosocial health and quality of life of the frontline HCWs. Their "unheard voices" explored in the study can anchor subsequent resilience-enhancing interventions and policies. Guidelines focusing on the psychological wellbeing of frontline HCWs need to be grounded in their unmet needs and lived experiences.

Lessons From the First Wave of COVID-19: Work-Related Consequences, Clinical Knowledge, Emotional Distress, and Safety-Conscious Behavior in Healthcare Workers in Switzerland

The coronavirus disease (COVID-19) imposes an unusual risk to the physical and mental health of healthcare workers and thereby to the functioning of healthcare systems during the crisis. This study investigates the clinical knowledge of healthcare workers about COVID-19, their ways of acquiring information, their emotional distress and risk perception, their adherence to preventive guidelines, their changed work situation due to the pandemic, and their perception of how the healthcare system has coped with the pandemic. It is based on a quantitative cross-sectional survey of 185 Swiss healthcare workers directly attending to patients during the pandemic, with 22% (n = 40) of them being assigned to COVID-19-infected patients. The participants answered between 16th June and 15th July 2020, shortly after the first wave of COVID-19 had been overcome and the national government had relaxed its preventive regulations to a great extent. The questionnaire incorporated parts of the "Standard questionnaire on risk perception of an infectious disease outbreak" (version 2015), which were adapted to the case of COVID-19. Clinical knowledge was lowest regarding the effectiveness of standard hygiene (p < 0.05). Knowledge of infectiousness, incubation time, and life-threatening disease progression was higher, however still significantly lower than regarding asymptomatic cases and transmission without physical contact (p < 0.001). 70% (95%-confidence interval: 64-77%) of the healthcare workers reported considerable emotional distress on at least one of the measured dimensions. They worried significantly more strongly about patients, elderly people, and family members, than about their own health (p < 0.001). Adherence to (not legally binding) preventive guidelines by the government displayed patterns such that not all guidelines were followed equally. Most of the participants were faced with a lack of protective materials, personnel, structures, processes, and contingency plans. An increase in stress level was the most prevalent among the diverse effects the pandemic had on their work situation. Better medical equipment (including drugs), better protection for their own mental and physical health, more (assigned) personnel, more comprehensive information about the symptoms of the disease, and a system of earlier warning were the primary lessons to be learned in view of upcoming waves of the pandemic.

Factors Associated With Psychological Distress in Health-Care Workers During an Infectious Disease Outbreak: A Rapid Systematic Review of the Evidence

Objective: Health-care workers (HCW) are at risk for psychological distress during an infectious disease outbreak, such as the coronavirus pandemic, due to the demands of dealing with a public health emergency. This rapid systematic review examined the factors associated with psychological distress among HCW during an outbreak. Method: We systematically reviewed literature on the factors associated with psychological distress (demographic characteristics, occupational, social, psychological, and infection-related factors) in HCW during an outbreak (COVID-19, SARS, MERS, H1N1, H7N9, and Ebola). Four electronic databases were searched (2000 to 15 November 2020) for relevant peer-reviewed research according to a pre-registered protocol. A narrative synthesis was conducted to identify fixed, modifiable, and infection-related factors linked to distress and psychiatric morbidity. Results: From the 4,621 records identified, 138 with data from 143,246 HCW in 139 studies were included. All but two studies were cross-sectional. The majority of the studies were conducted during COVID-19 (k = 107, N = 34,334) and SARS (k = 21, N = 18,096). Consistent evidence indicated that being female, a nurse, experiencing stigma, maladaptive coping, having contact or risk of contact with infected patients, and experiencing quarantine, were risk factors for psychological distress among HCW. Personal and organizational social support, perceiving control, positive work attitudes, sufficient information about the outbreak and proper protection, training, and resources, were associated with less psychological distress. Conclusions: This review highlights the key factors to the identify HCW who are most at risk for psychological distress during an outbreak and modifying factors to reduce distress and improve resilience. Recommendations are that HCW at risk for increased distress receive early interventions and ongoing monitoring because there is evidence that HCW distress can persist for up to 3 years after an outbreak. Further research needs to track the associations of risk and resilience factors with distress over time and the extent to which certain factors are inter-related and contribute to sustained or transient distress.

Post-Traumatic Stress Symptoms in Healthcare Workers Dealing with the COVID-19 Pandemic: A Systematic Review

Prevention of post-traumatic stress symptoms (PTSS) in healthcare workers (HCWs) facing the current COVID-19 pandemic is a challenge worldwide as HCWs are likely to experience acute and chronic, often unpredictable, occupational stressors leading to PTSS. This review aims to analyze the literature to discover which topics have been focused on and what the latest developments are in managing the occupational risk of PTSS in HCWs during the current pandemic. For the purpose of this review, we searched for publications in MEDLINE/Pubmed using selected keywords. The articles were reviewed and categorized into one or more of the following categories based on their subject matter: risk assessment, risk management, occurrence rates. A total of 16 publications matched our inclusion criteria. The topics discussed were: “Risk Assessment”, “Occurrence Rates”, and “Risk Management”. Young age, low work experience, female gender, heavy workload, working in unsafe settings, and lack of training and social support were found to be predictors of PTSS. This review’s findings showed the need for urgent interventions aimed at protecting HCWs from the psychological impact of traumatic events related to the pandemic and leading to PTSS; healthcare policies need to consider preventive and management strategies toward PTSS, and the related psychic sequelae, in HCWs.

Self-Oriented Empathy and Compassion Fatigue: The Serial Mediation of Dispositional Mindfulness and Counselor's Self-Efficacy

This study aimed to explore the association between self-oriented empathy and compassion fatigue, and examine the potential mediating roles of dispositional mindfulness and the counselor's self-efficacy. A total of 712 hotline psychological counselors were recruited from the Mental Health Service Platform at Central China Normal University, Ministry of Education during the outbreak of Corona Virus Disease 2019, then were asked to complete the questionnaires measuring self-oriented empathy, compassion fatigue, dispositional mindfulness, and counselor's self-efficacy. Structural equation modeling was utilized to analyze the possible associations and explore potential mediations. In addition to reporting confidence intervals (CI), we employed a new method named model-based constrained optimization procedure to test hypotheses of indirect effects. Results showed that self-oriented empathy was positively associated with compassion fatigue. Dispositional mindfulness and counselor's self-efficacy independently and serially mediated the associations between self-oriented empathy and compassion fatigue. The findings of this study confirmed and complemented the etiological and the multi-factor model of compassion fatigue. Moreover, the results indicate that it is useful and necessary to add some training for increasing counselor's self-efficacy in mindfulness-based interventions in order to decrease compassion fatigue.

Together Against COVID-19 Concerns: The Role of the Dyadic Coping Process for Partners' Psychological Well-Being During the Pandemic

The situation caused by the 2019 coronavirus disease (COVID-19) has been representing a great source of concern and a challenge to the psychological well-being of many individuals around the world. For couples in particular, this extraordinary rise in concern, combined with the stress posed by the virus containment measures, such as prolonged cohabitation and lack of support networks, may have increased the likelihood of couple problems. At the same time, however, COVID-19 concerns may have been a stimulus to activate couples’ stress management processes. A couple’s resource, which may have an important role in dealing with COVID-19 concerns and stress, is dyadic coping, i.e., the process through which partners face stress together. Drawing on a sample of 1,823 Italian individuals involved in a couple relationship, the current study tested a serial mediation model in which concerns about COVID-19 predicted psychological well-being, through both explicit stress communication and perceived partner dyadic coping responses. In addition, the study explored whether this dyadic coping process functioned the same way in satisfied and dissatisfied couples. Results showed that concerns about the situation related to COVID-19 significantly threatened individuals’ psychological well-being. However, these concerns positively predicted explicit stress communication, which in turn positively predicted perceived partner’s dyadic coping responses, which finally positively predicted psychological well-being. In addition, in the group of dissatisfied individuals, the association between explicit stress communication and perceived partners’ dyadic coping responses was not significant. The present study adds to the research on couples’ coping by testing for the first time the whole theoretical model of dyadic coping and does so during a global emergency situation. The study also suggests key components of preventive interventions for individuals in couples.

A Postcard From Italy: Challenges and Psychosocial Resources of Partners Living With and Without a Chronic Disease During COVID-19 Epidemic

The new Coronavirus (COVID-19) has been declared a global pandemic by the World Health Organization (WHO). The sudden outbreak of this new virus and the measure of lockdown adopted to contain the epidemic have profoundly changed the lifestyles of the Italian population, with an impact on people's quality of life and on their social relationships. In particular, due to forced and prolonged cohabitation, couples may be subject to specific stressors during the epidemic. In addition, living with a chronic health condition may add specific challenges to the ones posed by the epidemic itself. The present cross-sectional study aimed to provide a picture of the challenges as well as the resources for both individual and relational well-being of Italian individuals in a couple relationship (N = 1921), with a specific attention to the comparison between individuals living with and without a chronic disease. Results showed that people with a chronic disease had lower psychological well-being and more fears and worries about the COVID-19. People with a chronic disease perceived fewer resources than healthy people. Moreover, the challenges are shown to be associated with less psychological well-being and high pessimism about the future. Instead individual, relational, and social resources play a protective role during the pandemic for both healthy and chronically ill people.

Personal Accomplishment and Hardiness in Reducing Emergency Stress and Burnout among COVID-19 Emergency Workers

During the severe phase of the pandemic, COVID-19 emergency workers were engaged in long and numerous shifts of duty, resulting in exposure to various stress factors. A high stress level is associated with risk of burnout. Resilience and personal accomplishment can effectively help mitigate and reduce emergency stress levels and emotional exhaustion. The main aim of this study was to analyze the relationship of emergency stress and hardiness with burnout among emergency workers. The participants included 494 emergency volunteers from the Red Cross Committee in Veneto, Italy, engaged in various health, emergency, and social activities aimed at COVID-19 patients and people at risk of contracting the virus. Questionnaires used to measure emergency stress, hardiness and burnout were administered on an online platform. We analyzed the influence of age, sex, weekly hours of service, stress risk factors, and use of personal protective equipment. To verify the predictive effects of risk and protective factors on burnout, correlational and multivariate analyses, and regressions were conducted. Hardiness showed an effect in reducing emergency stress levels, emotional exhaustion, and depersonalization and simultaneously increased personal accomplishment.

COVID-19: Risk Factors and Protective Role of Resilience and Coping Strategies for Emergency Stress and Secondary Trauma in Medical Staff and Emergency Workers—An Online-Based Inquiry

The COVID-19 crisis has placed a heavy burden on medical staff and emergency workers, who may be at risk of developing psychological distress and secondary trauma. Coping and resilience to stress during a pandemic are protective factors that can mitigate the potential adverse psychological effects. Here, we investigated the direct and mediated effects of coping strategies and hardiness on secondary trauma among Italian medical staff (physicians and nurses, n = 140) and emergency workers (firefighters, civil protection, and ambulance personnel, n = 100) involved in the first phase of the pandemic. For this purpose, we collected data from participants through online questionnaires to measure emergency stress, coping strategies, hardiness, and secondary trauma. Other variables analyzed were age, sex, direct contact with COVID-19 patients, and use of personal protective equipment (PPE). We performed a correlational analysis, regressions, and a mediation analysis. The results show that nurses and physicians experienced higher levels of emergency stress than emergency workers. Direct contact with COVID-19 patients, female sex, unexpected events, and lack of PPE were risk factors for emergency stress, while resilience and coping strategies played a protective role. Mediation analysis shows that coping strategies and hardiness are protective factors and reduce the effect of stress on secondary trauma.

Hardiness and Coping Strategies as Mediators of Stress and Secondary Trauma in Emergency Workers during the COVID-19 Pandemic

The work environment of emergency workers is an important factor related to stress. Coping with the COVID-19 emergency is a factor that is highly related to stress, and severe stress is a risk factor for developing secondary trauma. Coping and resilience can help rescue workers to better respond in emergency situations and could protect them from secondary trauma. We aimed to explore the relationship of emergency stress, hardiness, coping strategies, and secondary trauma among emergency workers and the mediating roles of coping strategies and hardiness on the effect of stress in producing secondary trauma. The study involved 513 emergency workers from the Red Cross Committee in Veneto, one of the Italian regions most affected by the COVID-19. Participants completed questionnaires online to measure emergency stress (physical, emotional, cognitive, organizational‒relational, COVID-19, and inefficacy decisional), hardiness, coping strategies, and secondary trauma. Other variables analyzed were age, gender, weekly hours of service, and use of personal protective equipment (PPE). We performed t-tests, a correlational analysis, regressions, and a mediation analysis. Hardiness and coping strategies, in particular, which stop unpleasant emotions and thoughts and problem-focused, emerged as mediators in reducing the predicted effect of stress on secondary trauma. The mediating effects of hardiness and coping strategies were found to reduce the effect of stress on arousal by 15% and the effect on avoidance by 25%.