Survey of Insomnia and Related Social Psychological Factors Among Medical Staff Involved in the 2019 Novel Coronavirus Disease Outbreak

Roles of doctor-patient relationship perception and job satisfaction in the impact of workplace violence on medical professionals' turnover intentions in the early phase of COVID-19: a cross-sectional study in China

OBJECTIVE

This study aimed to explore the role of the doctor-patient relationship (DPR) perception from the perspective of medical professionals in the association between workplace violence (WPV), job satisfaction and turnover intention in the early stages of the COVID-19 pandemic based on the affective events theory (AET).

DESIGN

A cross-sectional study.

SETTING

Nine medical institutions in Beijing were enrolled in this study.

PARTICIPANTS

In total, 792 medical professionals participated in the study, excluding administrators and logisticians.

RESULTS

The structural equation model was well adapted (comparative fit index (CFI) = 0.933; root mean square error of approximation (RMSEA) = 0.060). DPR mediated the association between WPV and job satisfaction, with an indirect effect of 0.247 (p<0.001). DPR perception mediated the effect of WPV on turnover intention, with an indirect effect of 0.090 (p<0.001). It also played a chain-mediating role in job satisfaction between WPV and turnover intention, with a mediation value of 0.117 (p<0.001), accounting for 53.42% of the total effect.

CONCLUSIONS

This study developed a stable model using AET. DPR perception plays an important role in the relationship between WPV and job satisfaction and turnover intention, suggesting the key impact of emotional factors. This has strong practical implications for maintaining the stability of medical teams. Therefore, medical institutions should improve the level of DPR perception from the perspective of medical professionals to effectively prevent mental health problems following WPV.

Influencing factors of sleep disorders and sleep quality in healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis

AIM

The aim of this study was to identify the influencing factors of sleep disorders and sleep quality in healthcare workers during the COVID-19 pandemic.

DESIGN

Systematic review and meta-analysis of observational research.

METHODS

The databases of the Cochrane Library, Web of Science, PubMed, Embase, SinoMed database, CNKI, Wanfang Data, and VIP were systematically searched. The quality of studies was assessed using the Agency for Healthcare Research and Quality evaluation criteria and the Newcastle-Ottawa scale.

RESULTS

A total of 29 studies were included, of which 20 were cross-sectional studies, eight were cohort studies, and 1 was a case-control study; 17 influencing factors were finally identified. Greater risk of sleep disturbance was associated with female gender, single relationship status, chronic disease, insomnia history, less exercise, lack of social support, frontline work, days served in frontline work, department of service, night shift, years of work experience, anxiety, depression, stress, received psychological assistance, worried about being infected, and degree of fear with COVID-19.

CONCLUSIONS

During the COVID-19 pandemic, healthcare workers did have worse sleep quality than the general population. The influencing factors of sleep disorders and sleep quality in healthcare workers are multifaceted. Identification and timely intervention of resolvable influencing factors are particularly important for preventing sleep disorders and improving sleep.

PATIENT OR PUBLIC CONTRIBUTION

This is a meta-analysis of previously published studies so there was no patient or public contribution.

Spatial, temporal, and motivational changes due to the COVID-19 pandemic in a nature-based leisure activity - A global survey of birders

Birdwatchers contribute an immense amount of data to citizen science databases. Thus, birding is important from the leisure perspective and from nature conservation. During the COVID-19 pandemic, we studied birdwatchers on a global scale in over 50 countries by applying the model of behavior change, which focuses on changes in opportunity (spatial, temporal), motivation, and capability (avoidance behavior). The sample consisted of 5051 participants (3437 men, 1575 women, mean age 49 years). Birders changed their spatial behavior to more local birding and to avoidance behavior by choosing different places and different clock times. Concerning motivation, being outdoors showed the highest increase and being with friends the strongest decrease. Higher specialized birders experienced a stronger shift toward regional birding. Birders that focused on new, local, or unrewarding places experienced an increase in motivation. Our study empirically supports the behavior change model and highlights the need to address the heterogeneity of the recreationists.

Effect of one-shot cognitive behavioral therapy on insomnia and heart rate variability of health care workers at the time of COVID-19 pandemic: a randomized controlled trial

OBJECTIVES

The emergence of sleep disturbances in response to major stressful events has been previously documented. Heart rate variability (HRV) is an objective marker that provides insight into autonomic nervous system dynamics. The aim of the present study was to examine the preliminary effectiveness of a one-shot session of cognitive behavioral therapy for insomnia (CBT-I) for frontline healthcare providers with acute insomnia.

METHODS

This study was conducted from 2020 to 2021 on healthcare workers with insomnia. The healthcare workers were randomly allocated to receive either one-shot cognitive behavioral therapy or routine care. Insomnia severity index (ISI) and heart rate variability were assessed before and 1 month after the interventions.

RESULTS

Among 57 patients (n = 31 in the intervention group and n = 26 in the control group), mean (± SD) age of both groups were 34.6 (± 9.5) and 36.6 (± 6.9), respectively. Most participants in both groups were female (81% and 65% in the intervention and control groups, respectively; p-value = 0.10). Insomnia severity index score decreased in the intervention group from 13.3 to 6.7 (p < 0.001). The change before and after the intervention was significant between the two groups for HF-normalized unit (high-frequency power band [0.15-0.40 Hz] in the normalized unit) and LF/HF (the ratio of low frequency to high frequency). HF-normalized unit increased in the intervention group (35.8 ± 21.5 vs. 45.6 ± 19.8 before and after the intervention, respectively), and decreased in the control group (43.9 ± 16.5 vs. 39.8 ± 18.5, before and after the intervention, respectively).

CONCLUSION

The findings suggest that a single-shot session of cognitive behavioral therapy for insomnia is effective in managing acute insomnia symptoms in healthcare workers.

Prevalence of burnout and mental health problems among medical staff during the COVID-19 pandemic: a systematic review and meta-analysis

OBJECTIVE

The COVID-19 pandemic has had a significant impact on the burnout and mental health of medical staff. This meta-analysis aims to provide additional (and updated) evidence related to burnout and mental health problems among medical staff using a broader data pool.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

PubMed, Embase, Cochrane Library, CNKI, Wanfang data and three preprint databases (SSRN, bioRxiv and medRxiv) were searched from 1 January 2020 to 17 May 2021.

ELIGIBILITY CRITERIA

We included observational studies investigating the prevalence of burnout and mental health problems among medical staff during the COVID-19 pandemic, including cross-sectional study, cohort study and case-control study.

DATA EXTRACTION AND SYNTHESIS

Two independent reviewers used a self-designed form to extract the primary data. The Joanna Briggs Institute quality appraisal tool was used to assess the quality of selected studies. Heterogeneity among studies was assessed by I² statistic. A random-effects model was used to pool the prevalence. Subgroup analysis was performed to explore between-group differences.

RESULTS

250 studies were included, with a sample of 292 230 participants from 46 countries. The pooled prevalence of burnout, anxiety, depression, insomnia, stress, post-traumatic stress disorder symptoms and somatic symptoms was 43.6% (95% CI 36.3% to 51.2%), 37.1% (95% CI 34.7% to 39.7%), 37.6% (95% CI 35.0% to 40.4%), 43.7% (95% CI 39.1% to 48.5%), 41.3% (95% CI 35.1% to 47.9%), 30.6% (95% CI 23.6% to 38.5%) and 25.0% (95% CI 16.7% to 35.6%), respectively. Subgroup analysis showed a higher prevalence of anxiety, depression and insomnia in frontline workers than in non-frontline workers, and a higher prevalence of anxiety in females than males. Mild cases accounted for the most significant proportion of the outcomes except for stress.

CONCLUSIONS

This study highlights that identifying the risks of burnout and mental health problems and adopting preventive interventions are priorities for policymakers and medical staff to avoid long-term occupational, health and social impacts.

PROSPERO REGISTRATION NUMBER

CRD42021254425.

Burnout status, occupational satisfaction, and intention to leave the profession of nurses during the COVID-19 pandemic period; The Case of Turkey

We examined the burnout status, professional satisfaction and intention to leave the profession of nurses who are actively working in Turkey during the COVID-19 pandemic period. We conducted the descriptive study with 371 nurses and collected using Copenhagen Burnout Scale (CBS), Occupational satisfaction scale (OSS) and Intention to leave the profession scale (ILPS). In this study, nurses showed a high level of exhaustion and intention to leave work, and a low level of occupational satisfaction. In the fight against COVID-19, the continuity of health services, at the same time, in order to provide adequate quality and safe health care, reducing working hours, bringing the shifts to an appropriate and reasonable time, improving the working environment and approaches that will increase their motivation and professional satisfaction are important to prevent nurses from experiencing burnout and to keep them in their professions and workplaces.

The COVID-19 pandemic impact on the Polish medical personnel work: a survey and in-depth interviews study

Objective

The objective of the study was to examine the impact of the COVID-19 pandemic on the work of medical personnel in terms of: task scope, preparation to perform medical tasks related to the pandemic, team collaboration, involvement in tasks performed, concerns about performing tasks related to the pandemic, stress levels.

Methods

The mixed-method approach was applied to this cross-sectional study. The online questionnaire which included 40 questions was completed via Google among medical personnel in Poland. Eight semi-structured, in-depth interviews were conducted to deepen the data obtained with the questionnaires.

Participants

The questionnaire was completed by 215 healthcare professionals, with the largest group being nurses (56.3%) followed by physicians (22.3%), midwives (11.6%) and other healthcare professionals (e.g., physiotherapists, paramedics, nutritionists - 9.8%). Among the respondents were people who worked in the hospital in the so-called "covid wards" (31.2%) and other hospital wards (60%) as well as people who were employed outside the hospital (8.8%).

Results

The pandemic affected the nature and range of tasks performed by health professionals. Initially, respondents felt unprepared to work under pandemic conditions, but over time their ratings increased in all areas studied. More than half of respondents reported no change in interpersonal relationship within the team, but nearly 35% noted a worsening and only one in 10 claimed improvement. Study participants rated their own commitment to tasks slightly higher than that of their colleagues (mean 4.9 and 4.4 respectively) but the overall rating was high. The mean self-rating of work stress increased from 3.7 before the pandemic to 5.1 during the pandemic. Most of the respondents were afraid of transmission of the infection to their relatives. Other fears included the possibility of making a medical error, not being able to help the patient, not having enough personal protective equipment (PPE) and contracting SARS-CoV-2.

Conclusion

The conducted study revealed that the organization of medical care in the initial period of the pandemic, especially the hospital care of patients infected with SARS-CoV-2, was quite chaotic. The most affected were the people who were transferred to work in the covid wards. Not all medical professionals were prepared to work with the COVID-19 patients, as they lacked experience working in such facilities, especially in intensive care units (ICU). Working under time pressure and under new conditions led mainly to an increase in perceived stress and conflicts between staff.

Physical and stressful psychological impacts of prolonged personal protective equipment use during the COVID-19 pandemic: A cross-sectional survey study

BACKGROUND

Healthcare workers (HCWs) caring for COVID-19 infected patients are exposed to stressful and traumatic events with potential for severe and sustained adverse mental and physical health consequences. Our aim was to assess the magnitude of physical and mental health outcomes of HCWs due to the prolonged use of personal protective equipment (PPE) treating COVID-19 patients.

METHODS

This cross-sectional study assessed the symptoms of stress, anxiety, insomnia, and psychological resilience using the Stress and Anxiety to Viral Epidemics (SAVE) scale, Insomnia Severity Index (ISI), and Resilience Scale (RS), respectively, in Italy between 1st February and 31st March 2022. The physical outcomes reported included vertigo, dyspnea, nausea, micturition desire, retroauricular pain, thirst, discomfort at work, physical fatigue, and thermal stress. The relationships between prolonged PPE use and psychological outcomes and physical discomforts were analyzed using Generalized Linear Models (GLMs). We calculated the factor mean scores and a binary outcome to measure study outcomes.

FINDINGS

We found that 23% of the respondents reported stress related symptoms, 33% anxiety, 43% moderate to severe insomnia, and 67% reported moderate to very low resilience. The GLMs suggested that older people (>55 years old) are less likely to suffer from stress compared to younger people (<35 y.o); conversely, HCW aged more than 35 years are more inclined to suffer from insomnia than younger people (<35 y.o). Female HCW reported a lower probability of resilience than males. University employed HCWs were less likely to report anxiety than those who worked in a community hospital. The odds of suffering from insomnia for social workers was significantly higher than for other HCWs. Female HCW>3 years old, enrolled in training programs for nursing, social work, technical training and other healthcare professionals increased the probability of reported physical discomforts. HCW that worked on non COVID-19 wards and used PPE for low-medium exposure level, were at lower risks for lasting physical side effects as compared to the HCW who worked in high-risk PPE intense, COVID-19 environments.

INTERPRETATION

The study suggests that frontline HCWs who had extensive PPE exposure while directly engaged in the diagnosis, treatment, and care for patients with COVID-19 are at significant risks for lasting physical and psychological harm and distress.

Baseline symptoms of depression and anxiety negatively impact the effectiveness of CBTi in treating acute insomnia among young adults

Background

Cognitive-behavioural therapy for insomnia (CBTi) is the first-line treatment for those with this sleep disorder. However, depressive and anxiety symptoms often co-occur with acute insomnia, which may affect the effectiveness of CBTi treatment.

Aims

This study aimed to determine the impact of depressive and anxiety symptoms on the efficacy of CBTi in treating acute insomnia.

Methods

A single-arm clinical trial was conducted among individuals who have acute insomnia. Participants underwent self-guided CBTi for 1-week. Their insomnia, depressive symptoms and anxiety symptoms were evaluated using the Insomnia Severity Index and the Hospital Anxiety and Depression Scale at baseline, post-treatment and 3-month follow-up. Repeated measures analysis of variance was used to assess the effectiveness of CBTi in treating insomnia, depressive symptoms and anxiety symptoms. A multivariate Cox regression model was used to determine the impact of depressive and anxiety symptoms on insomnia.

Results

The study found significant reductions in insomnia, depressive symptoms and anxiety symptoms at both post-treatment and 3-month follow-up (F=17.45, p<0.001; F=36.37, p=0.001; and F=81.51, p<0.001, respectively). The duration of CBTi treatment had a positive impact on insomnia recovery (hazard ratio (HR)=0.94, p=0.018). However, baseline depressive symptoms (HR=1.83, p=0.004) and baseline anxiety symptoms (HR=1.99, p=0.001) had significant negative effects on insomnia recovery.

Conclusions

The study showed that a 1-week self-guided CBTi treatment is effective in treating acute insomnia and comorbid depressive and anxiety symptoms. However, baseline depressive and anxiety symptoms negatively impact treatment effectiveness. Therefore, clinicians should assess for depressive and anxiety symptoms before treating acute insomnia with monotherapy CBTi.

Anxiety, insomnia and family support in nurses, two years after the onset of the pandemic crisis

Introduction

The Covid-19 pandemic continues to cause serious physical and mental problems for health professionals, particularly nurses.

Aim

To estimate the prevalence of anxiety and insomnia and to evaluate their possible association with family support received by nurses two years after the onset of the pandemic.

Materials and methods

In total, the study participants were 404 nurses (335 females and 69 males) with a mean age of 42.88 (SD = 10.9) years and a mean of 17.96 (SD = 12) years working as nurses. Nurses from five tertiary hospitals in Athens constituted the study population who completed the questionnaires State-Trait Anxiety Inventory (STAI), Athens Insomnia Scale (AIS) and Family Support Scale (FSS), in the months of November and December 2021. Regarding demographic and occupational characteristics, gender, age and years of experience as nurses were recorded.

Results

60.1% of the nurses showed abnormal scores in state anxiety, with 46.8% in trait anxiety, and 61.4% showed insomnia. Women showed higher scores on the two subscales of anxiety and the insomnia scale compared to men (p < 0.01 and p < 0.05 respectively), while they showed a lower score on the FSS without statistical significance (p > 0.05). Positive correlations (p < 0.01) were found between the State Anxiety Inventory, Trait Anxiety Inventory and AIS, while all of them showed a high negative correlation with FSS (p < 0.01). Age showed a negative correlation with Trait Anxiety Inventory (p < 0.05). As shown by the mediation analysis, the relationship between state anxiety and insomnia was mediated by trait anxiety, whereas state anxiety appeared to be dependent on family support.

Conclusions

Nurses continue to experience high levels of anxiety and insomnia and feel less supported by their families than in the first year of the pandemic. Insomnia appears to be dependent on state anxiety, with a significant indirect effect of trait anxiety, while family support seems to affect state anxiety.

Mediating role of psychological flexibility in the effect of obsessive-compulsive symptoms on sleep quality among nurses during the COVID-19 pandemic

Front-line nurses suffered unprecedented mental distress and severe insomnia during the COVID-19 pandemic. Present study aimed to explore the relationship between obsessive-compulsive symptoms and sleep quality and examine the potential mediating role of psychological flexibility between obsessive-compulsive symptoms and sleep quality. A total of 496 nurses from a Chinese large-scale Class 3 A Comprehensive Hospital were included in an online cross-sectional survey and completed the revised obsessive-compulsive inventory (OCI-R), Multidimensional Psychological Flexibility Inventory (MPFI) and Pittsburgh Sleep Quality Index (PSQI). As predicted, obsessive-compulsive symptoms were negatively associated with psychological flexibility and sleep quality, and psychological flexibility was positively associated with sleep quality. In addition, the relationship between obsessive-compulsive symptoms and sleep quality was partially mediated by psychological flexibility, which can provide some reference for the treatment of the obsessive-compulsive disorder (OCD) and insomnia, and lead to improvements in clinical and psychotherapy planning.

Determining the relationship between sleep disturbances in children and parental stress during COVID-19 pandemic

This study aimed to determine the relationship between child sleep disturbances and parental stress during the COVID-19 pandemic. This cross-sectional web-based study was conducted between February and April 2021 among 409 parents residing in Turkey who had children between the ages of 6 and 16 years. Data were collected online using the Sleep Disturbance Scale for Children (SDSC) and the Parental Stress Scale (PSS). In the study, there was a significant relationship found between the mean scores of the SDSC and PSS (r = 0.499, p < 0.001). In the multiple regression analysis, family type, socioeconomic status, occupation, the presence of sleep problems in the child before the pandemic, and the total score of the PSS significantly affected the total score of the SDSC. The presence of sleep problems in the child before the pandemic was significantly associated with the total score of the PSS (p < 0.05). Approximately 3.9% of the children had sleep disturbances (at scores over 70 points) during the COVID-19 pandemic. In conclusion, as the stress levels of parents increase, the rate of sleep disturbances in their children increases, and many demographic characteristics are associated with the occurrence of sleep disturbances in their children. It is important that parents do not reflect on their stress related to the pandemic and that their children maintain a normal sleep pattern whenever possible. School nurses should educate children and their parents about the importance of enough sleep and factors that contribute to inadequate sleep among children during the COVID-19 pandemic.

COVID-19's Psychological Impact on Chronic Disease Patients Seeking Medical Care

BACKGROUND

The outbreak has harmed patients with multiple comorbidities and chronic conditions. The pandemic's psychological impact is thought to change their routine of seeking medical care. Research Question or Hypothesis: During COVID-19, patients with chronic conditions may experience anxiety, depression, and stress, and their pattern of seeking medical care may change.

MATERIALS AND METHODS

In May 2021, a cross-sectional, web-based study of patients with chronic diseases was conducted. Eligible patients (1036) were assessed for psychological disorders, primarily depression, stress, and anxiety, using the DASS-21 scale, and their pattern of receiving medical care during COVID-19.

RESULTS

During the pandemic, 52.5% of the patients with chronic diseases were depressed, 57.9% were anxious, and 35.6% were stressed. Patients with chronic diseases who had moderate to severe depression (34.9% versus 45.1%, p = 0.001), moderate to severe anxiety (43.6% versus 53.8%, p = 0.001), or moderate to severe stress (14.9% versus 34.8%, p = 0.001) were significantly more likely to have no follow-up for their chronic conditions.

CONCLUSIONS

Patients with chronic conditions experienced significant anxiety, depression, and stress during COVID-19, which changed their pattern of seeking medical care, and the majority of them did not receive follow-up for their chronic conditions.

Factors affecting health-related quality of life among firefighters during the COVID-19 pandemic: A single-center study

During the coronavirus disease 2019 (COVID-19) outbreak, firefighters have been working in an environment that is both physically and mentally taxing. This study aimed to investigate factors affecting health-related quality of life (HRQOL) among firefighters in Japan during the COVID-19 pandemic. A total of 227 firefighters from a single firefighting organization were surveyed in June 2021, during the fourth infection spread period of COVID-19 in Japan. Regression analysis was performed to examine factors affecting HRQOL of firefighters measured with the SF-8. In the present study, factors affecting HRQOL among firefighters during the COVID-19 pandemic were lack of sleep, physical abnormalities due to infection control measures, exercise habits, living with family members, and history of suspected COVID-19 infection. The present findings may help develop support services for first responders, including firefighters during the COVID-19 pandemic.

Sleep Quality, Insomnia, and Perceived Stress among Colombian Healthcare Workers during the COVID-19 Pandemic

Objective  The COVID-19 pandemic has imposed a great burden on healthcare workers worldwide. The aim of the present study was to assess sleep quality, insomnia, and perceived stress in healthcare workers of a high complexity hospital located in Bogota, Colombia. Methods  Cross-sectional study in which 1,155 healthcare workers at the Hospital Universitario San Ignacio in Bogotá, Colombia were included, between September and October 2020. Using an online-based survey, self-reported variables were assessed including demographics, Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), and 10 item Perceived Stress Scale (PSS-10). Associations between these variables were evaluated. Results  Fifty percent of the respondents were between 31 and 45 years old, and 76 percent were women. Most of the surveyed were the nursing staff. Poor sleep quality, insomnia, and high perceived stress was found in 74.9, 12.4, and 13.2%, respectively. Poor sleep quality was predominantly found in females, in the 31 to 45 years old group and in married personnel. Also, poor sleep quality was found in relation to a moderate to high perceived risk of COVID-19 infection by the family of the workers surveyed. Discussion  Poor sleep quality, moderate rates of insomnia, and perceived stress were found among healthcare workers committed to COVID-19 infected patients in Colombia. The identification of workers at greater risk and the implementation of targeted interventions are called upon as the results.

Life Habits of Healthcare Professionals during the Third Wave of COVID-19: A Cross-Sectional Study in a Spanish Hospital

(1) Background: To describe sleep quality, eating behaviour and alcohol, tobacco and illicit drug use among healthcare staff in a Spanish public hospital. (2) Methods: Cross-sectional descriptive study examining sleep quality (Pittsburg Sleep Quality Index), eating behaviour (Three Factor Eating Questionnaire (R18)), tobacco and drug use (ESTUDES questionnaire) and alcohol use (Cut down, Annoyed, Guilty, Eye-opener). (3) Results: 178 people, of whom 87.1% (155) were women, with an average age of 41.59 ± 10.9 years. A total of 59.6% of the healthcare workers had sleep problems, to a greater or lesser degree. The average daily consumption was 10.56 ± 6.74 cigarettes. The most commonly used drugs included cannabis, occasionally used by 88.37%, cocaine (4.75%), ecstasy (4.65%) and amphetamines (2.33%). A total of 22.73% of participants had increased their drug use, and 22.73% had increased their consumption during the pandemic, with beer and wine accounting for 87.2% of drinks consumed during this period. (4) Conclusions: In addition to the psychological and emotional impact already demonstrated, the COVID-19 crisis has repercussions on sleep quality, eating behaviour and alcohol, tobacco and drug consumption. Psychological disturbances have repercussions on physical and functional aspects of healthcare workers. It is feasible that these alterations are due to stress, and it is necessary to act through treatment and prevention as well as promote healthy habits.

Psychosocial Challenges of the Coronavirus Disease-2019 Pandemic Among Frontline Health Care Providers and Their Coping Mechanisms at Mbarara Regional Referral Hospital, Southwestern Uganda

Background

As a novel global health pandemic, Coronavirus Disease-2019 (COVID-2019) has posed various challenges to frontline healthcare providers (FHCPs). This study explored the social and psychological challenges of COVID-19 to the FHCPs at Mbarara Regional Referral Hospital, southwestern Uganda.

Methods

This was a cross-sectional study with a qualitative approach. Participants were purposively selected, consented, and interviewed. Interviews were audio-recorded and transcribed. Data were entered into NVivo 10 software and analyzed using a thematic analysis approach.

Results

Fourteen FHCPs with diverse roles, including 8 men, were interviewed. Participants' median age was 38 years (range: 26-51 years) and eleven of them were married. The subjects' experiences were explored in relation to perceived social and psychological challenges of working during the COVID-19 pandemic, and coping mechanisms in the COVID-19 pandemic situation. The social challenges identified were burnout, domestic violence, and a financially constrained environment. A further, psychological challenge was anxiety, as well as fear and distress. FHCPs responded with a variety of coping mechanisms, including situational acceptance, religious coping, coping through emotional support of others, and bulk purchase of supply-constrained basic necessities.

Conclusion

FHCPs experienced numerous social and psychological challenges, which negatively affected their quality of life amidst a wavering pandemic. As the pandemic rages on, creative and low-cost psychosocial interventions for FHCPs are needed, possibly including more formal peer support, and an improved flow of information about ongoing infectious disease control interventions, so FHCPs feel more knowledgeable about what is ahead.

The COVID-19 pandemic and mental health outcomes - A cross-sectional study among health care workers in Coastal South India

Background: Frontline health care workers (HCWs) are at increased risk of developing unfavourable mental health outcomes and burnout, especially during the COVID-19 pandemic. Recognizing the early warning signs of mental distress is very important to ensure the provision of quality patient care. Methods: In this facility-based cross-sectional study, HCWs of the teaching hospitals affiliated to Kasturba Medical College, Mangalore were assessed regarding their mental health status using a semi-structured questionnaire. All doctors and nurses who were willing to participate from these teaching hospitals were included in the study. Data was collected over a period of four months (1 st March -30 th June 2021) till the required sample size was reached and analysed using IBM SPSS and expressed using mean (standard deviation), median (interquartile range), and proportions. Univariate analysis was done to identify the factors associated with mental health outcomes among the HCWs and the corresponding unadjusted odds ratio and 95% confidence interval were reported. Results: A total of 245 HCWs [52.2% (n=128) doctors and 47.8% (n=117) nurses] were included in our study. The proportion of participants with depressive symptoms, anxiety, and insomnia assessed using PHQ-9, GAD-7, and ISI-7 scales were 49% (n=119), 38% (n=93), and 42% (n=102) respectively. Depression, anxiety, and insomnia were more likely to be experienced by HCWs aged > 27 years, females, and involved in COVID-19 patient care. (p>0.05) Conclusions:  Our findings that 38% of the examined HCWs had clinically relevant anxiety symptoms and 49% had clinically relevant depression symptoms draws attention to the importance of systematically tracking the mental health of HCWs during this ongoing pandemic. HCWs should monitor their stress reactions and seek appropriate help both on a personal and professional level. Appropriate workplace interventions including psychological support should be provided to HCWs, to ensure provision of uncompromised quality patient care.

The COVID-19 pandemic and mental health outcomes - A cross-sectional study among health care workers in Coastal South India

Background: Frontline health care workers (HCWs) are at increased risk of developing unfavourable mental health outcomes and burnout, especially during the COVID-19 pandemic. Recognizing the early warning signs of mental distress is very important to ensure the provision of quality patient care. Methods: In this facility-based cross-sectional study, HCWs of the teaching hospitals affiliated to Kasturba Medical College, Mangalore were assessed regarding their mental health status using a semi-structured questionnaire. All doctors and nurses who were willing to participate from these teaching hospitals were included in the study. Data was collected over a period of four months (1 st March -30 th June 2021) till the required sample size was reached and analysed using IBM SPSS and expressed using mean (standard deviation), median (interquartile range), and proportions. Univariate analysis was done to identify the factors associated with mental health outcomes among the HCWs and the corresponding unadjusted odds ratio and 95% confidence interval were reported. Results: A total of 245 HCWs [52.2% (n=128) doctors and 47.8% (n=117) nurses] were included in our study. The proportion of participants with depressive symptoms, anxiety, and insomnia assessed using PHQ-9, GAD-7, and ISI-7 scales were 49% (n=119), 38% (n=93), and 42% (n=102) respectively. Depression, anxiety, and insomnia were more likely to be experienced by HCWs aged > 27 years, females, and involved in COVID-19 patient care. (p>0.05) Conclusions:  Our findings that 38% of the examined HCWs had clinically relevant anxiety symptoms and 49% had clinically relevant depression symptoms draws attention to the importance of systematically tracking the mental health of HCWs during this ongoing pandemic. HCWs should monitor their stress reactions and seek appropriate help both on a personal and professional level. Appropriate workplace interventions including psychological support should be provided to HCWs, to ensure provision of uncompromised quality patient care.

Suicidal ideation in the general population in China after the COVID-19 pandemic was initially controlled

BACKGROUND

The COVID-19 pandemic increases the risk of psychological problems including suicidal ideation (SI) in the general population. In this study, we investigated the risk factors of SI after the COVID-19 pandemic was initially controlled in China.

METHODS

We conducted an online questionnaire via JD Health APP in China in June 2020. Demographic data, feelings and experiences related to the COVID-19 pandemic and psychological problems were collected. The participants (n = 14,690) were divided into the non-SI and SI groups. A binary logistic regression analysis was used to examine the correlates of SI.

RESULTS

Nine percent of the participants (1328/14690) reported SI. The regression analysis showed that SI was positively associated with ethnic minority (OR = 1.42 [1.08-1.85]), age (e.g. 18-30 years: OR = 2.31 [1.67-3.20]), having history of mental disorders (OR = 2.75 [2.27-3.35]), daily life disturbance due to health problems (OR = 1.67 [1.38-2.01]), being around someone with the COVID-19 (OR = 1.58 [1.30-1.91]), being uncertain about effective disease control (OR = 1.23 [1.03-1.46]), and having depressive symptoms (OR = 4.40 [3.59-5.39]), insomnia symptoms (OR = 2.49 [2.13-2.90]) or psychological distress (OR = 1.87 [1.59-2.18]).

LIMITATIONS

The main limitation is that the cross-sectional design of this study could not allow us to further explore the causality of SI.

CONCLUSIONS

The prevalence of SI was relatively high in general population after the COVID-19 pandemic was initially controlled in China. SI should be monitored continually after the COVID-19 pandemic.

“Cuidar do outro é cuidar de mim”

Introdução: Em janeiro de 2020, foi isolado na China o vírus SARS-CoV-2, causador da doença do coronavírus 19 (COVID-19), que posteriorment disseminou-se globalmente numa pandemia. A Atenção Primária à Saúde (APS) desempenha papel crucial na resposta global à ameaça, considerando-se o papel da APS como uma das portas de entrada do Sistema Único de Saúde (SUS) e como coordenadora do cuidado nesse sistema, com atuação ativa na resposta a surtos e epidemias. Nesse contexto, os profissionais atuantes na APS estão potencialmente expostos a sofrimento mental no cenário pandêmico. Objetivo: Analisar os níveis de sofrimento mental entre profissionais de saúde da APS de Petrolina (PE) no contexto da pandemia de COVID-19, verificando possível associação entre sofrimento mental e a atuação desses profissionais na linha de frente de combate à COVID-19. Métodos: Trata-se de estudo epidemiológico, transversal, com abordagem quantitativa e caráter exploratório. Foi aplicado um survey online com dados sociodemográficos e ocupacionais, bem como foi feita a avaliação do sofrimento mental nesse grupo de profissionais, por meio da aplicação da Escala de Distress Psicológico de Kessler (K10), sendo as respostas posteriormente analisadas estatisticamente. Resultados: Dos participantes, 48,6% apresentaram risco elevado para a presença de transtorno mental no contexto da pandemia de COVID-19, e uma média de 66,8%±21,7% dos sentimentos negativos experimentados têm relação com a pandemia. Além disso, nos 30 dias anteriores ao momento em que cada participante respondeu ao survey, 73,4% (correspondendo a 72,5% dos enfermeiros e 73,9% dos médicos) dos entrevistados relataram frequência maior que o habitual na ocorrência dos sentimentos investigados na Escala K10. A porcentagem média desses sentimentos atribuída às inseguranças/ incertezas/ medos relacionados à pandemia de COVID-19 é de 66,8% (com desvio padrão de ±21,7%). Dos respondentes, 99,1% (99,1%) consideram possível transmitir a infecção para familiares ou pessoas próximas. Trinta e sete (33,94% da população de estudo) declararam que fizeram uso de medicamento ansiolítico ou antidepressivo nos 30 dias anteriores ao momento em que o survey foi respondido, prescrito por médico assistente com quem realiza acompanhamento (19 participantes) ou por automedicação (18 participantes). É fator de sofrimento mental para os respondentes a possibilidade de ser veículo de transmissão de COVID-19 para familiares ou pessoas próximas. Observou-se associação estatisticamente significativa entre risco elevado de transtornos mentais e percepção dos respondentes (total e médicos) acerca dos equipamentos de proteção individual (EPI) disponíveis nas Unidades de Saúde. Não foi observada associação estatisticamente significativa entre sofrimento mental e demais indicadores. Conclusões: Num contexto de permanente medo e risco potencial de infecção por COVID-19 nesse grupo de profissionais, o sofrimento mental paira como ameaça permanente. Recomenda-se a adoção de estratégias para a abordagem do sofrimento mental nessa categoria profissional, além de estudos adicionais para determinar o perfil de adoecimento desse grupo.

Caring in a crisis: Understanding the stressors and uplifts for National Health Service frontline staff through the lens of clinical psychologists

The unprecedented public health crisis of the Covid-19 pandemic resulted in a significant challenge to the delivery of healthcare that has rarely been experienced before. The stress already faced by healthcare staff working in the National Health Service (NHS) has been further exacerbated during Covid-19, putting them at risk of adverse mental health outcomes. Through the lens of clinical psychologists who had provided support to frontline healthcare staff during the Covid-19 pandemic, this study aimed to better understand the stressors and uplifts healthcare staff experienced during Covid-19, the impact of these on the wellbeing of staff and patient care, and to examine the support needed to deal with the impact of a crisis. A qualitative study design using a combination of diaries followed by semi-structured interviews was utilised. Data was analysed using thematic analysis. The following five themes represented the stressors and uplifts experienced by NHS frontline healthcare staff during Covid-19, the impact on staff wellbeing and patient care: facing change; risks of working in the NHS environment; transcending the negatives; challenging professional values and haunted by patient deaths. The findings also highlight the importance of providing psychological support and suggest the need to continue to provide this support service to help NHS staff manage through subsequent waves of the pandemic. These findings can contribute towards both the management of the current Covid-19 pandemic and other similar crises in the future.

Intensive Neurofeedback Protocol: An Alpha Training to Improve Sleep Quality and Stress Modulation in Health Care Professionals During the Covid-19 Pandemic. A Pilot Study

Objective

health care workers (HCWs) represent a vulnerable group in the COVID-19 pandemic, given the exposure to greater risk and higher levels of work-related stress. Neurofeedback (NF) has shown to be effective in the treatment of stress-related symptoms. We aimed to assess the effectiveness of an alpha-increase NF protocol for the treatment of acute stress symptoms in HCWs exposed to the COVID-19 pandemic.

Method

eighteen medical doctors on duty during the COVID-19 health emergency underwent an intensive NF alpha-increase protocol. The mean alpha wave values were recorded at the beginning (T0) and at the last day of stimulation (T1). Rapid Stress Assessment: Italian version; Copenhagen Burnout Inventory (CBI); Pittsburgh Sleep Quality Index (PSQI), and Brief-COPE were administered as psychometric assessment.

Results

a significant increase in alpha wave values and a significant reduction of the PSQI scores from T0 to T1 were found.

Conclusions

NF alpha-increase protocol showed promising results in terms of stress modulation, sleep quality improvement, and safety in a pilot sample of HCWs.

AnsT-19: Development and Validation of a Scale to Access the Anxiety of Family Physicians during Teleconsultation

INTRODUCTION

Following the outbreak of the disease caused by the novel coronavirus it was necessary to increase the non-face-to-face care activity through alternative means such as teleconsultation in primary health care. The adjustment to a type of remote consultation could have generated anxiety among family physicians. The main aim of the present study was to develop and validate a scale to assess the anxiety of family physicians during teleconsultation.

MATERIAL AND METHODS

Observational, cross-sectional study involving a sample of family physicians working in Portugal. An online survey that evaluated anxiety in teleconsultation was developed.

RESULTS

A total of 359 valid responses were included in an exploratory factor analysis, after determining the number of factors to retain. A four-factor structure was detected with loadings ranging overall, from 0.44 to 0.98. Correlations between factors ranged from 0.42 to 0.58. Exploratory factor analysis results varied between good and very good fit, with chi-square/df result = 2.448, root mean square error of approximation (RMSEA) = 0.062 [90% CI = (0.053, 0.073)], root mean square of the residuals (RMSR) = 0.030 and Tucker Lewis index (TLI) = 0.931. Composite reliability was higher than 0.7 for all factors and average variance extracted was close or above 0.5 for the extracted factors, confirming convergent validity. McDonald's omega (ω) = 0.95 suggested the presence of a second-order factor, and thus a global measure for assessing anxiety during teleconsultation. Concurrent validity results were good, with correlations ranging from r = -0.277 to r = -0.393 with General Self-Efficacy scale (GSE) and r = 0.302 to r = 0.547 with Depression Anxiety Stress scales (DASS). Moderate correlations found between DASS and the dimensions of AnsT-19 suggest that AnsT-19 is capturing anxiety from the teleconsultation point of view. AnsT-19 factors and total score were significantly associated with gender, experience as a family doctor, psychotropic medication during the pandemic period and pre-pandemic experience of teleconsultation, indicating good construct validity. The limitations of the study are related to the convenience process, the use of an online survey and self-reported measurements.

CONCLUSION

AnsT-19 is a valid instrument to assess the anxiety of family physicians during teleconsultation.

Causal Model Analysis of the Effect of Formalism, Fear of Infection, COVID-19 Stress on Firefighters' Post-Traumatic Stress Syndrome and Insomnia

As the front line of epidemic prevention, firefighters are responsible for the transportation of infected cases. Firefighters are under a lot of stress from the new COVID-19, especially the fear that they may contract the virus at work and spread the virus to their families. In particular, the framework of this study incorporates Riggs' formalism variables. When firefighters think that the epidemic prevention regulations are inconsistent with the actual epidemic prevention, it will increase their work pressure on COVID-19. In this study, firefighters from all over Taiwan were used as the respondents, and a total of 453 respondents were obtained. This study uses confirmatory factor analysis and structural equation modeling to test the established hypotheses. The findings confirm that formalism, fear of self and family infection are positively influencing COVID-19 stress. COVID-19 stress positively affects PTSD and insomnia. COVID-19 stress negatively affects problem-focused strategies. Problem-focused strategies negatively affect post-traumatic stress disorder.

How does centralized isolation treatment strategy affect the medical staff's mental health during the COVID-19 pandemic?

Background

During the coronavirus 2019 (COVID-19) pandemic, the Chinese Government adopted a centralized isolation treatment (CIT) strategy for patients, which has greatly improved the efficiency of the pandemic response. However, compared to those in local hospitals, anti-COVID-19 medical staff in mobile cabin hospitals, where the CIT strategy was adopted, suffered more mental health problems. This study aimed to explore how the CIT strategy affected the medical staff's mental health by comparing anti-COVID-19 medical staff who worked in mobile cabin hospitals to those in fever clinics of local hospitals.

Methods

Following the standard scale development procedure, this study first developed a scale measuring the mental health of anti-COVID-19 medical staff. Using SPSS 23.0 and Amos 23.0 software, the exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and reliability analysis method were conducted to support the scale development. In the main investigation, a survey method using the developed scale was used, and 839 anti-COVID-19 medical staff from five hospitals in northern China were recruited as participants by snowball-sampling method. The first survey was conducted in February 2020, when the first round of COVID-19 was at a serious time. In April 2020, after the first round of COVID-19 in China was initially contained, and medical staff who worked in mobile cabin hospitals returned to local hospitals, a follow-up survey was conducted on these participants. Using SPSS 23.0 software, a series of 2 × 2 mixed-design ANOVA was conducted, in which working conditions (mobile cabin hospital vs. local hospital) served as a between-subject factor, time points (during vs. after the first round of COVID-19) served as a within-subject variable, and the indicators of the medical staff's mental health served as dependent variables respectively.

Results

The reliability and validity of the developed scale were desirable. The mental health problems of anti-COVID-19 medical staff were mainly manifested as anxiety, powerlessness, fear of infection, and somatization. Compared to those who worked in local hospitals, anti-COVID-19 medical staff who worked in mobile cabin hospitals where the CIT strategy was adopted suffered more powerlessness, fear of infection, and somatization. After returning to local hospitals, symptoms of fear of infection and powerlessness of medical staff who used to work in mobile cabin hospitals decreased significantly. However, their anxiety symptoms were not relieved, and their somatization symptoms even increased.

Conclusion

This study implied that the mental health of anti-COVID-19 medical staff in mobile cabin hospitals adopting CIT was worse than in local hospitals. Moreover, with the first outbreak in remission, the mental health recovery of medical staff in CIT hospitals was slower than in local hospitals. Relevant practitioners should pay more attention to the mental health condition of anti-COVID-19 medical staff who work in CIT hospitals. The psychological assistance service for them should continue even after they return to the local hospitals.

Investigating Physical Activity Habits and Sleep Disorders in the Nursing Staff of Greece During the COVID-19 Pandemic: A Multicenter Cross-Sectional Correlational Study

INTRODUCTION

The social isolation (lockdown) used worldwide as a measure to effectively prevent the infection of COVID-19 has been shown to be responsible for the high prevalence of depression, anxiety, insomnia, and post-traumatic stress symptoms. The aim of this study was to investigate the physical activity habits and sleep disorders in the nursing staff.

METHODOLOGY

This is a multicenter cross-sectional correlational study. The study population consisted of nurses and nursing assistants. Data were collected using the Greek version of the Pittsburgh Sleep Quality Index, the Fear of the COVID-19, and the Physical exercise questionnaire of the American College of Sports Medicine. Statistical analysis of data was done with IBM SPSS v. 22.0.

RESULTS

A total of 1710 nursing personnel aged 42.3 ± 9.1 years were included. At the beginning of the COVID-19 pandemic, 190 (11.1%) participants were physically active, and 2 years after the beginning of the COVID-19 pandemic, active were 130 (7.6%) participants. Both at the beginning and two years after the beginning of the pandemic, the sleep dimensions that scored higher were subjective sleep quality (1.98 ± 0.2 vs. 1.98 ± 0.3), sleep onset latency (1.89 ± 1.5 vs. 1.64 ± 1.6), and sleep duration (1.55 ± 0.9 vs. 1.65 ± 0.8). The total sleep score was 8.64 ± 3.1 at the beginning of the pandemic and 8.11 ± 3.7 two years after the beginning of the pandemic.

CONCLUSIONS

Nurses and nurses' assistants had less physical activity habits, slept less, and had more sleep disorders 2 years after the beginning of the pandemic in relation to the beginning of the pandemic.

Prevalence and associated factors of insomnia symptoms during the COVID-19 pandemic lockdown among Mettu town residents

BACKGROUND

Insomnia is a prevalent sleep disorder that affects people all over the world. Creating suitable interventions will require a better understanding of the magnitude and determinants of insomnia. This study aimed to assess the prevalence and associated factors of insomnia symptoms among residents of Mettu town during the pandemic lockdown.

METHODOLOGY

A community-based cross-sectional study was conducted among residents of Mettu town from October 1st to October 15th, 2020. Residents who lived in Mettu town at least for six months were included. To determine the prevalence and determinants of insomnia symptoms, both descriptive and inferential analyses were used. The chi-squared test of association and logistic regression was used to identify predictors of insomnia symptoms among residents of Mettu town. We used SPSS version 25 for all statistical analyses.

PRINCIPAL FINDINGS

The prevalence of depressive symptoms among residents of Mettu town was 52.6%. According to results of multivariable binary logistic regression, being female [AOR = 3.677, 95%CI: 2.124-6.365], being aged between 19 and 40 [AOR = 13.261, 95%CI: 6.953-25.291], being aged above 41 [AOR = 2.627, 95%CI: 1.120-6.159], smoking [AOR = 15.539, 95%CI: 7.961-30.329], satisfaction with information available [AOR = 0.310, 95%CI: 0.168-0.570], fear Corona Virus Disease 2019 (COVID-19), [AOR = 2.171, 95%CI: 1.262-3.733], feeling alienated from others [AOR = 3.288, 95%CI: 1.897-5.699], having somatic symptoms [AOR = 2.298, 95% CI: 1.360-3.884], having depressive symptoms [AOR = 1.841, 95% CI: 1.073-3.160], and experiencing psychological distress [AOR = 1.962, 95% CI: 1.173-3.281] were significantly associated with insomnia symptoms.

CONCLUSION

In this study, the prevalence of insomnia symptoms was found to be high among residents of Mettu town. Being female, being aged between 19 and 40, being aged above 41 years, smoking, fear of Corona Virus Disease 2019, feeling alienated from others, having somatic symptoms, having depressive symptoms, and experiencing psychological distress were all associated with an increased risk of developing insomnia symptoms while being satisfied with the information available decreased the risk of insomnia symptoms among residents of Mettu town. Interventions should be put in place to promote healthy sleep among residents of Mettu town.

Depression and insomnia among healthcare professionals during COVID-19 pandemic in Ethiopia: a systematic review and meta-analysis

Introduction

Healthcare professionals play a great role in the struggle against COVID-19. They are highly susceptible to COVID-19 due to their responsibilities. This susceptibility directly affects their mental health status. Comprehensive evidence on prevalence of depression and insomnia during this pandemic is vital. Thus, this study aims to provide the pooled prevalence of depression and insomnia, and their associated factors during the COVID-19 pandemic.

Materials and methods

This systematic review and meta-analysis follow the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Studies were searched from PubMed, Cochrane Library, CrossRef, African Journals Online and Google Scholar databases from the occurence of the pandemic to June 2022. Study selection, data extraction and methodological quality assessment were done by two authors independently. The I ² statistics was used for testing heterogeneity. A random effect model was used. Stata version 16.0 was used for statistical analysis.

Results

Eight studies were incorporated for this systematic review and meta-analysis. From seven studies the pooled prevalence of depression was 40% (95% CI [0.23-0.57]; I ² = 99.00%; P = 0.00). From three studies the pooled prevalence of insomnia was 35% (95% CI [0.13-0.58]; I ² = 98.20; P = 0.00). Associated factors of depression on healthcare workers (HCWs) were being female pooled AOR: 2.09; 95% CI [1.41-2.76], been married (pooled AOR = 2.95; 95% CI [1.83-4.07]). Due to limited studies available on the factors associated with insomnia, it is impossible to pool and associated factors were presented in narrative synthesis.

Conclusion

COVID-19 is highly associated with the prevalence of depression and insomnia among healthcare professionals in Ethiopia. The pooled prevalence of depression and insomnia were significantly higher among healthcare professionals. Appropriate psychological counseling package should be realized for healthcare workers (HCWs) in order to recover the general mental health problems. Trial registration. This review was registered PROSPERO with registration number CRD42022314865.

A Cross-Sectional Descriptive Study on the Attitudes Towards Patient Safety and Influencing Factors of Nurses in Infectious Diseases Wards

Background

Patient safety is an important aspect of healthcare delivery and is critical to healthcare quality. An assessment of the attitudes of nursing staff in infectious diseases wards towards patient safety may identify deficiencies and allow for the development of educational programmes to train nursing staff to participate in good patient safety practices.

Objective

To explore the current situation and influencing factors on nurses' attitudes towards patient safety in infectious diseases wards.

Methods

This cross-sectional study enrolled 446 nurses from infectious diseases wards in eight hospitals in the Hebei Province to participate in an electronic questionnaire survey from October to December 2020. The Chinese version of the safety attitude questionnaire was used to gather the opinions of these participants, and SPSS 22.0 statistical software was used to analyse the data.

Results

The average score of safety attitudes towards patients was 3.59 ± 0.30. The scores for each dimension, from high to low, were as follows: management perception: 3.77 ± 0.42 points, pressure perception: 3.77 ± 0.42 points, safety atmosphere: 3.57 ± 0.43 points, job satisfaction: 3.57 ± 0.43 points, teamwork: 3.55 ± 0.50 points and working conditions: 3.50 ± 0.45 points. The results of the multiple stepwise regression analysis showed that the influential factors on nurses' attitudes towards patient safety in infectious diseases wards were as follows: night shift working (β = 11.885, P = 0.000), years of nursing experience (β = 2.862, P = 0.001), education level (β = 4.462, P = 0.001) and marital status (β = 3.871, P = 1.002), which together explained 33.5% of the total variance.

Conclusion

Nurses' attitudes towards patient safety in infectious diseases wards were moderately high. Night shift work, years of nursing experience, education level and marital status affected nurses' attitudes towards patient safety. Managers should focus on these groups of nurses and improve their working conditions and job satisfaction to further enhance patient safety.

Traumatic stress in Egyptian doctors during COVID-19 pandemic

COVID-19 pandemic has heavily burdened healthcare systems throughout the world, causing substantial mental distress to medical professionals. We aim to investigate the associated traumatic stress in a sample of practicing physicians in Egypt during the COVID-19 pandemic. This cross-sectional study assessed depression, and Post-traumatic stress disorder (PTSD) among a sample of Egyptian physicians using an electronic survey. It included demographic and practice-related data, PTSD Checklist - Civilian Version (PCL-C) and the nine-item Patient Health Questionnaire (PHQ-9). Of the 124 respondents, 66.9% were at high risk for depression and 37.9% met criteria for diagnosis of PTSD. Female gender and perceived work-related stress were significantly associated with PTSD. PTSD and depression severity scores were positively correlated. These findings highlight the importance of timely mental support and intervention for medical workers.

Effects of Tele-Counseling on Reducing Anxiety Levels of COVID-19 Patients in Isolation Wards: An Observational Study

BACKGROUND

COVID-19 causes psychological distress and anxiety due to fear of infection and the possibility of worsening symptoms leading to mortality. Public health measures like contact tracing and lockdowns further increase the panic among infected patients and the public. We intended to assess the effect of telecounseling in reducing anxiety in patients admitted to isolation wards.

METHODS

In this multi-center observational study, we administered a Generalized Anxiety Disorder-7 (GAD-7) scale before and after telecounseling. The study group consisted of participants who gave consent for telecounseling, and those who did not give consent constituted the control group. The telecounseling was based on the Psychological First Aid model, due to its simplicity.

RESULTS

There was a statistically significant decrease in anxiety after telecounseling in the study group (P value ≤ 0.001, effect size = 0.484). There was a statistically significant decrease in anxiety in the study group compared to the control group (P value ≤ 0.001).

CONCLUSION

Telecounseling contributed to the reduction in anxiety in COVID-19 patients in isolation wards. Several other factors like severity of the infection, comorbid medical illness, pre-existing mental health issues, individual's level of coping with stress, and duration and place of admission may have affected the anxiety levels in the patients.

Prevalence and determinants of Italian physicians' burnout in the "post-COVID-19" era

PURPOSE

Several studies investigated prevalence and determinants of physicians' burnout during the peak of the COVID-19 pandemic, but only a few during the chronic phase of the pandemic. This study thus aimed to examine this topic referring to the "post-COVID-19 era", defined as a chronic and likely-to-be endemic status quo.

METHODS

A cross-sectional, online survey (November 2021-January 2022) was addressed to physicians in Lombardia (Northern Italy). Besides socio-demographic and COVID-19-related data, measures of personal, work- and patient-related burnout (Copenhagen Burnout Inventory; CBI), depression (Patient Health Questionnaire-8), anxiety (General Anxiety Disorder-7), and self-efficacy (General Self-Efficacy Scale) were collected. Linear/generalized linear models were run to test associations/predictions of interest.

RESULTS

Among the 958 respondents, burnout symptoms were clinically significant in 18.5% of them. Predictive models showed that female sex (OR = 0.73, 95% CI 0.42-1.27), younger age (OR = 0.94, 95% CI 0.59-1.48), shorter job tenure (OR = 1.01, 95% CI 0.62-1.65), trainee status (OR = 1.41, 95% CI 1.16-7.10), higher PHQ-8 (OR = 1.260, 95% CI 1.16-1.37), and GAD-7 scores (OR = 1.19, 95% CI 1.10-1.30) increased the risk to suffer from clinical burnout. COVID-19-related variables were mostly not related/associated to burnout levels.

CONCLUSION

In Italy, physicians' burnout is moderately prevalent also in the chronic phase of the pandemic, with its determinants being more intrinsic than environmental. The development of effective interventions is needed to help physicians cope with the new challenges of their job.

Depression, anxiety and stress levels of operating room workers during the COVID-19 pandemic period

Purpose: The objective of this study was to determine the depression, anxiety, and stress levels of operating room workers during the COVID-19 pandemic. Materials and Methods: The data were collected using the “Personal Information Form” and "Depression Anxiety Stress-21 (DASS-21)" scale. The personal information form consisted of eight questions including age, gender, profession, professional seniority, status of being diagnosed with COVID-19, being afraid of developing COVID-19, presence of chronic diseases and change in weight during the pandemic period. DASS-21 scale is a 4-point Likert type (never=0; always=3) scale and consists of seven questions with each predicting "depression, stress and anxiety dimensions". Results: A total of 253 volunteers with 161 (63.6%) being female and 92 (36.4%) male were included in this observational screening study. Anxiety score of female participants (5.65±4.44) was found to be statistically significantly higher compared to the male participants (3.94±4.68). Depression (5.97±4.41), anxiety (5.48±4.53) and stress (6.94±4.59) scores were significantly higher in the participants who were afraid of developing COVID-19. Depression, anxiety and stress scores were significantly higher in the participants with chronic diseases than in those without chronic diseases. Conclusion: The findings of our study indicate that the mean depression, anxiety and stress scores of the operating room personnel were mild.

Cross-lagged relationship between anxiety, depression, and sleep disturbance among college students during and after collective isolation

Object

Repeated quarantine policies over the past 3 years have led to poor psychological consequences for the public. Previous studies have proved that the quarantine policy leaves individuals vulnerable to anxiety, depression, and insomnia, especially among college students. This study aims to explore whether psychological problems during isolation continue with the release of isolation.

Methods

Overall, 2,787 college students both answered a web-based survey during and after the closure management was lifted. The Patient Health Questionnaire, Generalized Anxiety Disorder Scale, and Youth Self-rating Insomnia Scale were measured. The cross-lagged path model was used to explore the influence of psychological impact during isolation on the individual after the release.

Results

We found that anxiety and sleep disturbance levels alleviated significantly after quarantine, except for depression. As expected, a bidirectional relationship exists between anxiety, depression, and sleep disturbance. Moreover, depression and sleep disturbance can predict post quarantine depression, sleep disturbance, and anxiety, yet anxiety cannot predict sleep disturbance afterward.

Conclusion

Timely and effective intervention for anxiety, depression, and insomnia during isolation is essential for individuals to repair themselves quickly after the release.

The impact of COVID-19 on social support perception and stress of prehospital care providers

BACKGROUND

This study seeks to explore the impact of COVID-19 outbreak on the social support perception and acute stress disorder of prehospital care providers (PCPs) in the province of Denizli.

METHODS

This descriptive and cross-sectional study was conducted between December 25, 2020 and January 25, 2021. Out of 510 ambulatory care staff constituting the study population, there were 287 PCPs (%56.2), including 13 physicians, 89 paramedics, 134 emergency medical technicians, and 51 individuals from other occupational groups (nurse, driver, cleaning staff, medical secretary) based at emergency health services. The data collection tools employed in the study include an introductory information form, Multidimensional Scale of Perceived Social Support (MSPSS), and National Stressful Events Survey Acute Stress Disorder Short Scale (NSESSS), which was organized as an online questionnaire.

RESULTS

We analyzed the data from 287 PCPs that completed the form and scales. The mean score of the NSESSS was calculated as 1.53 ± 0.79. The PCPs who experienced health problems (1.85 ± 0.69), suffered from mental problems and received psychotherapy and medication (2.57 ± 0.57), encountered COVID-19 patients (1.58 ± 0.8), provided care for COVID-19 patients (1.59 ± 0.79), and took polymerase chain reaction (PCR) tests (1.68 ± 0.78) had higher acute stress symptom levels. The total mean score of MSPSS was calculated as 66.28 ± 17.22. Total MSPSS scores of the participants varied significantly in terms of age, marital status, taking a COVID-19 test, suffering from mental problems, status of encountering a COVID-19 patient, and workplace satisfaction (p < 0.05).

CONCLUSIONS

The findings are suggestive of high perceptions of multidimensional social support and low acute stress symptom levels of the PCPs during the COVID-19 pandemic period.

Sleep quality among workers in the health sector exposed to the COVID-19 pandemic

The ongoing pandemic of coronavirus disease (COVID-19) is a global health crisis that has posed enormous pressure on workers in the health sector (WHS), having a massive impact on their mental health. In this study, we aimed to evaluate the sleep quality of WHS during the pandemic and compare frontline WHS to those who are not directly engaged in the care of COVID-19 patients. This cross-sectional, self-reported online survey assessed the sleep quality of WHS in Austria using the Pittsburgh Sleep Quality Index (PSQI). The same questionnaire was sent out two times. Due to the unequal sample and anonymity of the study participants, we analyzed the data of each time point separate from each other. The first study was conducted in April/May 2020, during the first lockdown in Austria (Study1), and the second study was conducted in July/August 2020, when the social restrictions were loosened (Study2). T-test was used to compare the mean values of PSQI scores between frontline vs. non-frontline WHS, while two two-way ANCOVAs were used to analyze differences in the PSQI mean scores (controlled for age) for male vs. female between frontline vs. non-frontline WHS. During the first lockdown in Austria (Study1) we identified a shorter sleep duration of frontline WHS compared to the non-frontline group, however the difference in global PSQI score between these groups was statistically not significant. In the period after loosened restrictions (Study2) the sleep quality, sleep latency, sleep duration, sleep efficiency and global PSQI score was worse in frontline WHS compared to the non-frontline WHS. Furthermore, female WHS scored higher in the PSQI indicating a worse sleep than male WHS. In addition, nurses and nursing assistants had a higher prevalence of poor sleep quality than other occupational groups. Our results indicate that the COVID-19 pandemic negatively impacts the sleep of WHS, affecting particularly frontline WHS. Preventive interventions aiming to promote good sleep quality in WHS during a healthcare crisis like this pandemic are essential to enhance resilience and mitigate the vulnerability of this specific population.

Reflecting on earlier affected areas that shaped COVID-19 mental health efforts

The COVID-19 pandemic is a serious public health threat that many countries in the world are facing. While several measures are being taken to minimize the spread of infection, mental health efforts must address psychological challenges due to the pandemic. This commentary reflects on original research from earlier epicenters of COVID-19 and identifies effective practices and suggestions applicable to mental health interventions in the North American context. Tailored mental health services need to be provided for populations that are at high risk of infection. Suggested interventions targeting specific population groups, such as healthcare workers, COVID-19 patients, and vulnerable populations, are discussed.

Anti-COVID-19 measures threaten our healthy body weight: Changes in sleep and external synchronizers of circadian clocks during confinement

BACKGROUND & AIMS

Emergency measures in the face of the recent COVID-19 pandemic have been different among countries, although most have opted for confinement and restrictions on social contact. These measures have generated lifestyle changes with potential effects on individuals' health. The disturbances in daily routines due to confinement and remote work have impacted circadian rhythms and energy balance; however, the consequences of these disruptions have not been studied in depth. The objective was to evaluate the impact of 12-week confinement on body weight, considering changes in several external synchronizers of the biological clock.

METHODS

The participants, 521 university students (16-35 years), responded to 52 questions oriented to determine light exposure, sleep patterns, sedentary lifestyle, and eating times.

RESULTS

We found a reduction in sunlight exposure and sleep duration, an increment in sedentarism and screen exposure, and a delay in the timing of the main meals and sleep in the whole cohort. These behavioral changes were associated with a twofold increase in obesity. Subjects who increased their sedentary hours and shortened their sleep to a higher degree were those who gained more bodyweight. The most influential factors in body weight variation during confinement were sleep duration, physical activity (sedentarism), and light (timing of screen exposure). The mediation model explained 6% of the total body weight variation.

CONCLUSIONS

Results support a significant impact of confinement on several external synchronizers of the biological clock and on body weight. Health-related recommendations during the pandemic must include behavioral recommendations to mitigate the adverse effects on the biological clock.

A cross-sectional study on the impact of the COVID-19 pandemic on psychological outcomes: Multiple indicators and multiple causes modeling

Although the psychological impact of coronavirus disease 2019 (COVID-19) has been evaluated in the literature, further research is needed, particularly on post-traumatic stress disorder (PTSD) and psychological outcomes, is needed. This study aims to investigate the effect of the COVID-19 pandemic on psychological outcomes (depression, anxiety, and insomnia). A cross-sectional study using an online survey was conducted using the following instruments: Impact of Event Scale-Revised (IES-R), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder (GAD-7), and Insomnia Severity Index (ISI). Confirmatory factor analysis (CFA), structural equation model (SEM), multiple indicators and multiple causes (MIMIC) modeling, and differential item functioning (DIF) were performed to analyze the collected data. According to the results, participants with PTSD (n = 360) showed a higher level of depression, anxiety, and insomnia than those without PTSD (n = 639). Among the participants, 36.5% experienced moderate to severe symptoms of depression, and 32.6% had mild depressive symptoms. Moreover, 23.7% of participants experienced moderate to severe anxiety symptoms, and 33.1% had mild anxiety symptoms. In addition, 51.5% of participants experienced symptoms of insomnia. In conclusion, the PTSD caused by COVID-19 is significantly associated with depression, anxiety, and insomnia at the level of latent constructs and observed variables.

Psychological impact on healthcare workers, general population and affected individuals of SARS and COVID-19: A systematic review and meta-analysis

BACKGROUND

Any infectious disease outbreak may lead to a negative detrimental psychological impact on individuals and the community at large, however; there was no systematic review nor meta-analysis that examined the relationship between the psychological/mental health impact of SARS and COVID-19 outbreak in Asia.

METHODS AND DESIGN

A systematic search was conducted using PubMed, EMBASE, Medline, PsycINFO, and CINAHL databases from 1/1/2000 to 1/6/2020. In this systematic review and meta-analysis, we analyzed the psychological impact on confirmed/suspected cases, healthcare workers and the general public during the Severe Acute Respiratory Syndrome (SARS) outbreak and Coronavirus disease (COVID-19) epidemics. Primary outcomes included prevalence of depression, anxiety, stress, post-traumatic stress disorder, aggression, sleeping problems and psychological symptoms.

RESULT

Twenty-three eligible studies (N = 27,325) were included. Random effect model was used to analyze the data using STATA. Of these studies, 11 were related to the SARS outbreak and 12 related to COVID-19 outbreaks. The overall prevalence rate of anxiety during SARS and COVID-19 was 37.8% (95% CI: 21.1-54.5, P < 0.001, I2 = 96.9%) and 34.8% (95% CI: 29.1-40.4), respectively. For depression, the overall prevalence rate during SARS and COVID-19 was 30.9% (95% CI: 18.6-43.1, P < 0.001, I2 = 97.3%) and 32.4% (95% CI: 19.8-45.0, P < 0.001, I2 = 99.8%), respectively. The overall prevalence rate of stress was 9.4% (95% CI: -0.4 -19.2, P = 0.015, I2 = 83.3%) and 54.1% (95% CI: 35.7-72.6, P < 0.001, I2 = 98.8%) during SARS and COVID-19, respectively. The overall prevalence of PTSD was 15.1% (95% CI: 8.2-22.0, P < 0.001) during SARS epidemic, calculated by random-effects model (P < 0.05), with significant between-study heterogeneity (I2 = 93.5%).

CONCLUSION

The SARS and COVID-19 epidemics have brought about high levels of psychological distress to individuals. Psychological interventions and contingent digital mental health platform should be promptly established nationwide for continuous surveillance of the increasing prevalence of negative psychological symptoms. Health policymakers and mental health experts should jointly collaborate to provide timely, contingent mental health treatment and psychological support to those in need to reduce the global disease burden.

SYSTEMATIC REVIEW REGISTRATION

CRD42020182787, identifier PROSPER.

The COVID-19 stress may influence on the sex ratio at birth

The ratio of boys to girls (sex ratio) at birth (SRB) is about 1.01-1.05 in most populations and is influenced by various factors, such as maternal stress, maternal inflammation, and endocrine disruption. Male fetus is biologically weaker and more vulnerable to prenatal events than female fetuses. Hence, premature death (and consequently decline the SRB) is higher in boys than girls. The recent coronavirus disease 2019 (COVID-19) has been known to have a variety of stressful and psychological impacts. This stress may consequently enhance maternal inflammation, pregnancy complication, and fetal loss. Also, male fetuses have more adverse outcomes than female fetuses among asymptomatic pregnant women with SARS-Cov-2 infection. Inasmuch as the male fetus are more vulnerable to prenatal events and premature death, it is proposed that the SRB can decline in pregnant women following the COVID-19 stress. However, future studies are needed to define the impact of the COVID-19 on SRB rate.

Burnout among Emergency Nurses during COVID-19 Pandemic at Hail Governmental Hospitals in the Kingdom of Saudi Arabia

Background

Nurses' burnout is an extended response to stressors at work, which leads to a negative self-concept and reduces the professional outcome. This study aimed to evaluate the level of burnout among emergency nurses during the COVID-19 pandemic.

Methods

This cross-sectional study was conducted from October 2021 to December 2021. A total of 77 emergency nurses from King Khalid hospital 42 (54.5%), and King Salman Specialist hospital 35 (45.5%) in Hail city of Saudi Arabia, were selected using a convenient sampling method and included in the study. A self-administered questionnaire consisted of the socio-demographics data sheet, and the Copenhagen Burnout Inventory (CBI) tool to evaluate nurses' burnout.

Results

The overall rate of burnout among the studied nurses was moderate, with mean scores of 39±10. The highest rate was for personal burnout with mean scores of 41.4±16.5, while the lowest score was for client-related burnout with mean scores of 37.8±10.5. The total burnout mean scores for all dimensions of CBI are higher in divorced (46.7), older age (44.5), nursing technicians (43.4), low years of experience (42.5), lower educational level (41.9), non-Saudi (41.0), and males (40.5).

Conclusion

The prevalence of burnout among nurses in government hospitals in Hail city was moderate, which should be considered. No statistically significant association were found between socio-demographic variables and the mean scores of CBI. Therefore, it is necessary to investigate the factors associated with the occurrence of burnout, provide a training program to reduce it, and improve the mental and physical health of the emergency nurses.

Mental health outcomes and workplace quality of life among South African pharmacists during the COVID-19 pandemic: a cross-sectional study

Background

The effect of the COVID-19 pandemic on the mental health of healthcare workers is gaining attention globally. This study assessed the quality-of-working life (QoWL) and prevalence of, and risk factors for anxiety, depression and stress among South African pharmacists.

Methods

An online survey, after stratification by province, was sent to 3435 (target = 2454) randomly selected pharmacists between 14 April to 18 May 2021. Sociodemographic data were collected and mental health was assessed using the 7-item Generalized Anxiety Disorder scale, the 9-item Patient Health Questionnaire, Perceived Stress Scale and a modified Work-Related Quality-of-Life tool. Prevalence of anxiety, depression, stress and QoWL was estimated. A multivariate logistic regression analysis identified factors associated with mental health outcomes.

Results

A total of 953/2454 pharmacists (38.8%) responded. Of these, 56.5% were 40 years or younger, 78.5% were female, 45.4% were White race and 44.5% were practicing in a community pharmacy setting. Pharmacists demonstrated symptoms of anxiety (n = 605, 66.1%), depression (n = 561, 62.9%), stress (n = 642, 73.8%) and low QoWL (n = 409, 51.3%). Significant risk factors (aOR; 95%CI) for anxiety, depression and stress were female gender (1.96;1.36–2.83,1.84;1.27–2.67,1.58;1.05–2.38, history of mental health conditions (2.50; 1.52–4.13, 3.68; 2.19–6.19, 3.34;1.85–6.03) and significant COVID-19 mitigation changes to pharmacy practice (2.70; 1.36–5.38, 4.23; 2.06–8.70, 3.14;1.44–6.82), respectively. Practice changes were also associated with a low QoWL (5.19; 2.40–11.8). Compared to their Black/African colleagues, Indian pharmacists were at higher risk for anxiety (1.82; 1.03–3.23) and stress symptoms (2.28; 1.21–4.32), while risk for depression was significant amongst White pharmacists (1.86; 1.05–3.32). Pharmacists living apart from family were at significant risk for anxiety (1.66; 1.15–2.41), depression (1.52; 1.06–2.18) and low QoWL (1.60; 1.10–2.34).

Conclusions

COVID-19 pandemic has had a significant negative impact on the mental health of South African pharmacists. Interventions to support the psychological well-being and improve QoWL of pharmacists are needed.

COVID-19-Related Self-Stigma, Post-Traumatic Stress Disorder, Insomnia, and Smartphone Addiction Among Frontline Government Workers with COVID-19 Pandemic Control Duties

Purpose

The duties related to COVID-19 control and prevention may have caused psychological stress for the individuals in charge (eg, frontline government workers) and have reportedly led to mental health issues, such as insomnia and post-traumatic stress disorder (PTSD). However, the prevalence of these COVID-19-related disorders and their associated factors remain unclear. Therefore, the purpose of the present study was to investigate the prevalence rates of insomnia, PTSD, COVID-19-related self-stigma, and smartphone addiction, along with the identification of risk factors and protective factors for Taiwan frontline government workers with COVID-19 pandemic control duties.

Methods

The survey was carried out with 151 participants between September and October 2021. All participants completed the Fear of COVID-19 Scale (assessing fear of COVID-19), Self-Stigma Scale (assessing self-stigma during the COVID-19 pandemic), Smartphone Application-Based Addiction Scale (assessing the risk of smartphone addiction), Insomnia Severity Index (assessing insomnia), Impacts of Event Scale-6 (assessing PTSD), and a self-designed set of questions assessing trait resilience.

Results

The results showed that the prevalence rate was 31.1% for insomnia and 33.8% for PTSD. Furthermore, service duration (adjusted odds ratio [AOR] = 0.93; 95% confidence interval [CI] = 0.86, 0.999) and trait resilience (AOR = 0.19; 95% CI = 0.08, 0.46) were protective factors and fear of COVID-19 (AOR = 1.91; 95% CI = 1.02, 3.57) was a risk factor for insomnia. Fear of COVID-19 (AOR = 2.63; 95% CI = 1.35, 5.14), self-stigma (AOR = 3.62; 95% CI = 1.19, 11.02), and smartphone addiction (AOR = 1.09, 95% CI = 1.001, 1.19) were risk factors, and trait resilience was a protective factor (AOR = 0.58; 95% CI = 0.29, 1.17) for PTSD.

Conclusion

The findings demonstrated a high prevalence of insomnia and PTSD. Risk-reducing strategies and protective factor promotion strategies are recommended to help reduce the symptoms of insomnia and PTSD among Taiwan frontline government workers.

Primary care provider's job satisfaction and organizational commitment after COVID-19 restrictions ended: A mixed-method study using a mediation model

Objectives

More and more countries have decided to cancel most or even all COVD-19 restrictions. However, it is unclear how ending of restrictions will affect primary care providers' job satisfaction and organizational commitment. Our objectives are to explore the current status and possible change in primary care providers' job satisfaction and organizational commitment after massive restriction policies ended in China.

Methods

This was a mixed-method study that utilized structured questionnaires and semi-structured qualitative individual interviews. The 20-item Minnesota Satisfaction Questionnaire (MSQ) and 25-item organizational commitment survey were adopted to assess job satisfaction and organization commitment. Descriptive statistics and mediation models, as well as inductive thematic analysis, were used to analyze quantitative and qualitative data.

Results

A total of 18 interviews and 435 valid survey responses were included in our analysis. The average scores for job satisfaction and organizational commitment were 80.6 and 90.8. The thematic analysis revealed one major theme: ethical and moral responsibility to provide care as primary care providers, on which we established a mediation model. The mediation analysis revealed that normative commitment could positively affect the other four dimensions of organizational commitment and job satisfaction. The direct effect of affective commitment on job satisfaction was significant (LLCI = 0.11, ULCI = 0.31), and the mediators were identified to have a partial mediating effect instead of a total mediating effect.

Conclusion

After COVID-19 restrictions end, the job satisfaction and organizational commitment of primary care providers will return to levels before the pandemic and during this estimated process, a brief rise in resignation is predictable. The normative commitment positively affects the other four dimensions of organizational commitment and job satisfaction for primary care providers, which suggests a possible way to motivate primary care providers when restrictions end.

The effects of workload on the styles of anger expression and "trait anger" of healthcare professionals working in a COVID-19 pandemic hospital

PURPOSE

The aim of the study was to determine the effects of workload on the styles of anger expression and "trait anger" of health professionals working in a COVID-19 pandemic hospital.

DESIGN AND METHODS

This descriptive study was carried out at a COVID-19 pandemic hospital in Turkey. The sampling consisted of 493 healthcare professionals. The data were evaluated with the SPSS (23.0) software program.

FINDINGS

The study found that the participants who perceived the workload as higher, and could not tolerate the work they performed, were high in "trait anger" levels and their anger was suppressed.

PRACTICE IMPLICATIONS

Health institutions should consider the recognition of emotional risks and the planning of interventions as a priority for professionals involved in the care of COVID-19 infected patients.

The Mental Health of Health Care Workers in the UK During COVID-19: The Prevalence of Anxiety, Depression, and Stress

Introduction

The COVID-19 pandemic had a significant impact on the mental health of health care workers (HCWs).

Aim

This study investigated the mental health of HCWs working in Leicester, UK during COVID-19.

Settings

Two hospital trusts in Leicester, UK.

Methods

An online survey was sent to HCWs in two trusts in July 2020. The Generalized Anxiety Disorder-7 scale (GAD-7) and the Patient Health Questionnaire-9 scale (PHQ-9) were used to measure the prevalence rates of anxiety and depression. The Perceived Stress Scale-14 (PSS-14) was used to measure levels of perceived stress. Other questions were used to identify the prevalence of increased alcohol intake and possible risk factors.

Statistical Analysis Used

Chi-square test, independent sample t-test, ANOVA, and logistic regression.

Results

A total of 1009 HCWs completed the survey. Using a cutoff score of 5 (mild symptoms), for both GAD-7 and PHQ-9, 80.2% of participants had at least one condition and 71.5% had both. Using the cutoff score of 10 (moderate/severe symptoms), 27.2% had at least one condition and 27.25% had both conditions. In addition, 37.5% of those who did not report pre-existing mental health conditions now have at least one condition. About 33.6% of participants reported an increase in alcohol consumption. A number of risk factors were identified: having less social support, not feeling supported at work, and poor pre-existing mental health.

Conclusions

The pandemic had a significant impact on mental health of HCWs. Health organizations need to monitor and address these emerging effects.

Worry about COVID-19 as a predictor of future insomnia

The coronavirus disease 2019 (COVID-19) pandemic resulted in significant increases in insomnia, with up to 60% of people reporting increased insomnia. However, it is unclear whether exposure to risk factors for the virus or worries about COVID-19 are more strongly associated with insomnia. Using a three-part survey over the course of the first 6 months of the pandemic, we evaluated associations between COVID-19 exposures, COVID-19 worries, and insomnia. We hypothesised that COVID-19-related worries and exposure to risk of COVID-19 would predict increases in insomnia. Participants (N = 3,560) completed a survey at three time-points indicating their exposures to COVID-19 risk factors, COVID-19-related worries, and insomnia. COVID-19 worry variables were consistently associated with greater insomnia severity, whereas COVID-19 exposure variables were not. COVID-19 worries decreased significantly over time, and there were significant interactions between change in COVID-19 worries and change in insomnia severity over time. Individuals who experienced increases in COVID-19 worries also experienced increases in insomnia severity. Changes in worry during the COVID-19 pandemic were associated with changes in insomnia; worries about COVID-19 were a more consistent predictor of insomnia than COVID-19 exposures. Evidence-based treatments targeting virus-related worries may improve insomnia during this and future calamities.