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

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.

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.

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.

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.

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.

Prevalence Of Sleep Disorders Among Physicians And Nurses During COVID-19 Pandemic

The objective of our review was to analyze studies of prevalence sleep disorders among medical workers during COVID-19 pandemic. Material and Methods — Overall, during the analyzed period, studying domestic and foreign databases, we identified 94 publications on the development of sleep disorders among medical personnel working during COVID–19 pandemic in 2000-2021. However, only 88 of these publications complied with the objective of the review. We included 75 full-text publications in this review. Results — Physicians and nurses during COVID-19 pandemic do not have the opportunity to take therapy aimed at combating the symptoms of sleep disorders, due to the need to maintain sufficient attention and the risk of developing excessive drowsiness while on duty in a COVID -19 hospital. The latter can have a negative impact on their professional activities. Thus, this problem certainly requires professional psychotherapeutic correction. Unfortunately, not all medical institutions have such specialists. Conclusion — Based on the literature review, we found out that health care workers have a high risk of developing sleep disorders. This can include violations of the circadian rhythm, a decrease in the quality and duration of night sleep, daytime hypersomnia caused by shift work in a hospital. An additional factor affecting the frequency and severity of sleep disorders in healthcare workers (physicians and nurses) is chronic stress, the importance of which has increased during the COVID-19 pandemic. Currently, the above problem has not been completely solved and requires research in this area and the development of new programs to help medical personnel.

Pandeminin Gölgesinde Tıp Öğrencisi Olmak: Tıp Öğrencilerinin COVİD-19 Pandemisine Karşı Psikolojik Tepkileri ve Uzaktan Eğitim ile İlgili Görüşleri

Amaç: Bu çalışmada, preklinik dönem tıp öğrencilerinin COVİD-19 Pandemisine karşı psikolojik tepkilerinin ve öğrencilerin uzaktan eğitimle ilgili görüşlerinin araştırılması amaçlanmıştır. Metod: Gönüllü 722 öğrenci ile kesitsel bir çalışma yapıldı. Veriler 20-27 Aralık 2020 tarihleri arasında, çevrimiçi bir anket yolu ile toplandı. Veri toplama aracı olarak sosyodemografik bilgiler ve uzaktan eğitimle ilgili görüşlere yönelik bir soru formu ile Revize Olayların Etkisi Ölçeği ve Uykusuzluk Şiddeti ölçekleri kullanıldı. Bulgular: Katılımcıların yaş ortalaması 20.7±1.6 ve 393’ü (54.4%) kadındı. Öğrencilerin 699’u (96.8%) eğitimleri ile ilgili olarak kaygılanmakta, 181’i (25.1%) travma sonrası stress, 171’i (23.6%) uykusuzluk yaşamaktaydı. Travma sonrası stres olasılığı kadınlarda erkeklere göre (OR=1.489, 95% CI=1.02-2.16; p=0.038), COVİD-19’a yakalanan akrabası olanlarda olmayanlara göre (OR=1.489, 95% CI=1.02-2.16; p=0.038), yakınlarına COVİD-19 bulaşma korkusu fazla olanlarda az olan veya olmayanlara göre (OR=0.523, 95% CI=0.339-0.807; p=0.003), COVİD-19 ile ilgili haberleri sosyal medyadan takip edenlerde diğer kaynaklardan takip edenlere göre (OR=0.662, 95% CI=0.461-0.951; p

Healthcare Workers' Emotions, Perceived Stressors, and Coping Strategies at Workplace during the COVID-19 Pandemic in Palestine

Evidence about the impact of the COVID-19 pandemic on the mental health of Palestinian healthcare professionals is lacking and has been disregarded during the COVID-19 pandemic. This study aims to describe Palestinian healthcare workers (HCWs) emotions and factors causing stress, and factors used to reduce the stress experienced at the workplace and to examine the relationships between HCWs level of stress and their coping strategies and motivational factors during the COVID-19 pandemic. A self-reported online survey was completed by 506 doctors and nurses working in healthcare facilities that provide COVID-19 care. Descriptive statistics, bivariate, and multivariate regression models were developed to adjust for the association between HCWs coping and motivation factors with HCWs' perceived stressors. The findings showed that 24.1% of the participants had a high-stress level, and 25.7% had a low level of stress. The participant's main coping strategy was avoidance and the key emotional factor was the ethical and professional obligation to continue working. Additionally, a major cause of their stress was their personal safety and having the COVID-19 infection. Findings showed a positive association between stress and the younger age of participants, with physicians being less stressed than nurses. In addition, receiving no training on the treatment of COVID-19 was strongly associated with stress levels. Furthermore, there was a significant positive correlation between stress scoring and coping strategies scoring but not with motivation score. In conclusion, this study shows that Palestinian healthcare workers experienced emotional turmoil during the COVID-19 pandemic. These results indicate the necessity of providing supervision, psychological counseling and intervention to professional healthcare workers who work directly with COVID-19 patients in health settings during the current pandemic or in the event of future outbreaks. Policymakers and managers must also conduct training and provide interventions on how to cope with stress in pandemics, in order to assist HCWs in developing their adaptive coping strategies and increase their motivation.

EVALUATION OF PHYSICAL ACTIVITY LEVELS, SLEEP QUALITY AND NUTRITIONAL HABITS OF PARAATHLETES DURING THE PANDEMIC PROCESS

Background: Cancellation or postponement of sports organizations due to the Covid 19 pandemic has caused great stress for athletes. There are limited studies on how physical activity levels, nutritional habits and sleep quality are affected, especially in physically disabled athletes(paraathletes) during the pandemic process. Purpose: the aim of the research is to examine the physical activity, nutritional habits and sleep quality levels of paraathletes during the pandemic process. Method: Eighty- seven male paraathletes were included in the study. The personal data form required to determine the characteristics within the study subject International Physical Activity Questionnaire Short Form (IPAQ Short Form), the Pittsburg Sleep Quality Index Questionnaire were used in a way consistent with the study. In addition to these sections, changes in participants' nutritional habits were questioned. Results: Total MET values of paraathletes were determined as 3233 ± 1421. The sleep quality index total score averages of the participants were 5.83 ± 0.80 points, indicating the level of 'poor sleep quality'. Food consumption of the participants It was found that 56% of them increased their food consumption, 28% did not change, and 18% decreased. Conclusion: The results of the study showed that physical activity, nutrition and sleep processes, which have an important place in the life cycle of paraathletes, were adversely affected during the pandemic process.

Transformative learning of medical trainees during the COVID-19 pandemic: A mixed methods study

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic has had a transformative effect on individuals across the world, including those in healthcare. Transformative learning is an educational theory in which an individual's worldview is fundamentally altered through conscious reflection (Cognitive Rational), insights (Extrarational), or social reform (Social Critique). We utilized transformative learning theory to characterize the experiences of medical trainees during the pandemic.

METHODS

We used the Transformative Learning Survey in September and October 2020 to evaluate the processes and outcomes of transformative learning in health professions students and housestaff at an academic medical center during the pandemic. We analyzed survey scores for three process domains and four outcome subdomains. We inductively coded the survey's two open-ended questions and performed qualitative and mixed-methods analyses.

RESULTS

The most prominent TL outcome was Self-Awareness, Acting Differently was intermediate, and Openness and Worldview Shifts were lowest. Cognitive Rational and Social Critique processes were more prominent than Extrarational processes. Students were more likely than housestaff to undergo transformative learning through the Social Critique process (p = 0.025), in particular the sub-processes of Social Action (p = 0.023) and Ideology Critique (p = 0.010). Qualitative analysis via the aggregation of codes identified four responses to the pandemic: negative change, positive change, existential change, or no change. Negative changes (67.7%) were most common, with students reporting more of these changes than housestaff (74.8% vs 53.6%; p < 0.01). Only 8.4% of reported changes could be defined as transformative.

CONCLUSIONS

Through the theoretical lens of transformative learning, our study provides insight into the lives of learners during the pandemic. Our finding that medical students were more likely to use Social Critique processes has multiple parallels in the literature. If leaders in academic medicine desire to create enlightened change agents through transformative learning, such education must continue throughout graduate medical education and beyond.

Psychological Distress and Risk Factors in Frontline Nurses Confronting COVID-19 in Less Severely Affected Areas

The current study investigated the prevalence and risk factors of somatization, depression, and anxiety among 374 frontline nurses in less severely affected areas during the initial period of the coronavirus disease 2019 (COVID-19) outbreak. The prevalence of somatization, depression, and anxiety among frontline nurses was 41.4%, 40.1%, and 37.4%, respectively. Nurses from provincial-level hospitals were less likely to report somatization (odds ratio [OR] = 0.50; p = 0.018), depression (OR = 0.52; p = 0.024), and anxiety (OR = 0.35; p < 0.001) than those from county-level hospitals. Longer service duration was significantly associated with a higher likelihood of reporting somatization (OR = 1.06; p = 0.008) and depression (OR = 1.06; p = 0.006). Psychological distress exists in frontline nurses in less severely affected areas, and hospital levels and service duration are independent risk factors for psychological stress in these nurses. Maintaining nurses' mental health is an important issue in addressing the COVID-19 pandemic in addition to sufficient distribution of medical resources between hospitals at different levels. [Journal of Psychosocial Nursing and Mental Health Services, 61(4), 37-44.].

Burnout, stress and resilience of an Australian regional hospital during COVID-19: a longitudinal study

Coronavirus disease 2019 (COVID-19) has placed huge strain on hospital staff around the world. The aim of the current longitudinal study was to investigate the resilience, stress and burnout of hospital staff located at a large, regional hospital in Victoria, Australia during the COVID-19 pandemic over time via cross-sectional surveys. The surveys were disseminated six times from August 2020 to March 2021, with the first three data collection points distributed during a state-wide lockdown. A total of 558 responses from various professional roles within the hospital over the survey period were included in the sample. Analysis of variance indicated significant main effects for the psychological variables across time, age, and workload. Hospital staff reported an increase in burnout levels throughout the eight-months. Significant negative relationships were observed between resilience and burnout, and between resilience and stress. A backward regression highlighted the contribution of resilience, stress, age, and nursing roles on burnout. Hierarchical regression analysis indicated that resilience contributed to the stress-burnout relationship. This study strengthens the evidence between resilience and burnout among healthcare workers and hospital staff and highlights the need for psychological wellbeing programs to be implemented for hospital staff impacted by a prolonged worldwide pandemic.

The Effect of Psychosocial Safety Climate on Engagement and Psychological Distress: A Multilevel Study on the Healthcare Sector

All work sectors have been affected by the impact of the COVID-19 pandemic. The perception of risk combined with the lack of safety and fear for their own safety have caused severe psychological discomfort in workers. Of all the work sectors, the most affected was certainly the healthcare sector. In hospitals, medical staff were at the forefront of the battle against COVID-19, providing care in close physical proximity to patients and had a direct risk of being exposed to the virus. The main objective of the study was to investigate the perception of a psychosocial safety climate and the effect on engagement and psychological stress in a sample of 606 healthcare workers (physicians 39.6%, nurses 41.3%, healthcare assistant 19.1%), belonging to six organisations and organised into 11 working groups. Furthermore, we wanted to investigate the mediating effect of workaholism at both individual and group level. The results partially confirmed our hypotheses and the mediating effect at the individual level of working compulsively. A psychosocial safety climate in healthcare workers led to a decrease in engagement through the mediation of working compulsively. The mediating effect of working compulsively might be due to a climate that did not guarantee or preserve the psychological health and safety of healthcare workers. In this research, the most important limit concerns the number of organisations and the number of groups.

How workplace violence correlates turnover intention among Chinese health care workers in COVID-19 context: The mediating role of perceived social support and mental health

AIM

To elucidate the effects of workplace violence on turnover intention among Chinese health care workers, and to identify the potential mediators in this relationship.

BACKGROUND

Workplace violence has emerged as a crucial determinant of turnover intention for health care workers.

METHODS

A cross-sectional survey was conducted among Chinese health care workers (N = 1,063) between 13 and 20 February 2020. Mediation effects were tested using structural equation modelling with weighted least squares mean and variance adjusted (WLSMV) estimator.

RESULTS

Workplace violence had both direct and indirect effects on turnover intention among Chinese health care workers. Specifically, perceived social support, mental health and perceived social support together with mental health partially mediated the relationship between workplace violence and turnover intention.

CONCLUSIONS

Chinese health care workers experiencing violence during the COVID-19 outbreak were more likely to report turnover intention. Enhancing social support and reducing mental health problems would be beneficial in decreasing the detrimental effects of workplace violence on turnover intention.

IMPLICATIONS FOR NURSING MANAGEMENT

Ensuring health care workers' health and safety is vital in reducing turnover intention, which in turn ascertains continuity of health care delivery. Health care managers should develop targeted interventions to improve social support and prevent post-violence mental health problems.

Psychotherapy and Follow-Up in Health Care Workers After the COVID-19 Epidemic: A Single Center's Experience

Objective

The present study aims to analysis the mental health of high-risk health care workers (HHCWs) and low-risk HCWs (LHCWs) who were respectively exposed to COVID-19 wards and non-COVID-19 wards by following up on mental disorders in HCWs in China for 6 months.

Methods

A multi-psychological assessment questionnaire was used to follow up on the psychological status of HCWs in the Affiliated Hospital of Xuzhou Medical University in Xuzhou City (a non-core epidemic area) at 6 months after the first evaluation conducted during the COVID-19 epidemic. Based on the risk of exposure to COVID-19 patients, the HCWs were divided into two groups: high-risk HCWs, who worked in COVID-19 wards, and low-risk HCWs, who worked in non-COVID-19 wards.

Results

A total of 198 HCWs participated in the study, and 168 questionnaires were selected for evaluation. Among them, 93 (55.4%) were in the HHCW group and 75 (44.5%) were in the LHCW group. Significant differences were observed in salary, profession, and altruistic behavior between the two groups (P < 0.05). There were no significant differences in the anxiety, depression, insomnia, or posttraumatic stress disorder (PTSD) scores between the two groups. Logistic regression revealed that work stress was a major joint risk factor for mental disorders in HCWs. Among all the HCWs, a total of 58 voluntarily participated in psychotherapy; the analysis showed a significant decrease in anxiety, depression, PTSD, work stress, and work risk after attending psychotherapy. There were also significant differences in positive and negative coping styles before and after psychotherapy.

Conclusion

In the present follow-up, work stress was the major contributing factor to mental disorders in HCWs. Psychotherapy is helpful in terms of stress management and should be provided to first-line COVID-19 HCWs.

Causal Model Analysis of Police Officers' COVID-19 Fear, Resistance to Organizational Change Effect on Emotional Exhaustion and Insomnia

Since the end of 2019, COVID-19 has continued to spread around the world. The police have performed various epidemic prevention and routine duties. This study explores how police officers' COVID-19 fear, resistance to organizational change, intolerance of uncertainty, and secondary trauma affect emotional exhaustion and insomnia in the context of COVID-19. A total of 205 valid police samples were collected in this study, and the established hypotheses were tested using confirmatory factor analysis and structural equation modeling. The results of the study confirmed that during the COVID-19 outbreak, secondary trauma of police officers positively affects emotional exhaustion and insomnia; intolerance of uncertainty positively affects emotional exhaustion; resistance to organizational change positively affects intolerance of uncertainty and emotional exhaustion; intolerance of uncertainty mediates the relationship between resistance to organizational change and emotional exhaustion; COVID-19 fear positively influences secondary trauma.