Factors Associated With Mental Health Outcomes Among Health Care Workers Exposed to Coronavirus Disease 2019

Evaluation of anxiety level and the factors Affecting Anxiety in health care workers in Shahid Dr. Gholipour Hospital, Bukan, Iran during COVID-19 pandemic

INTRODUCTION

The rapid and dangerous spread of Covid-19 has caused psychological problems, especially anxiety among health care workers. Due to the lack of accurate information on the prevalence of anxiety and the factors affecting it among health care workers, especially in developing countries, this study aimed to investigate the level of anxiety and the effective factors in health care workers in Shahid Dr. Gholipour Hospital in Bukan, Iran in Covid-19 pandemic.

METHODOLOGY

A descriptive cross-sectional study was carried out through census sampling among health care workers of the hospital. Totally, 358 participants entered the study. Data gathering tool consisted of a demographical information tool and Spielberger's Anxiety scale. To determine the effective variables on hidden and obvious anxiety use liner regression. significant predictors variable of anxiety was determined by logistic regression.

FINDINGS

Means score for obvious anxiety was 47.005 (5.4) CI: 46.47-47.54 and for hidden anxiety was 42.790 (4.88) CI: 42.43-43.29. Factors affecting participants' obvious anxiety based on the Unadjusted model were Work experience, Age group, Marital status and History of anxiety disorders and gender. In the Adjusted model, the age group and the anxiety history are considered as effective variables. One of the effective factors on hidden anxiety is the effect of gender variable in both Adjusted and Unadjusted models. Based on logistic regression test, job variables, age groups, marital status (are predicted variables of obvious anxiety. In hidden anxiety, marital status was introduced as a predictor variable.

CONCLUSION

The majority of personnel experienced a high level of anxiety during the pandemic. Psychological examination and interventions are essential for the health care workers.

Satisfaction and Workload as Predictors of Psychological Distress in Professionals of Psychosocial Care Centers During the COVID-19 Pandemic

BACKGROUND AND AIMS

The COVID-19 pandemic significantly impacted the mental health of healthcare professionals, especially those working in Psychosocial Care Centers (CAPS), which are crucial services in the Brazilian mental health system. This study aimed to investigate the association between job satisfaction, workload, and psychological distress among CAPS professionals during the pandemic.

METHODS

A cross-sectional study was conducted with 53 professionals from seven CAPS. The Workload Impact Scale (IMPACTO-BR) and Job Satisfaction Scale (SATIS-BR), the General Health Questionnaire (GHQ-12), and a sociodemographic questionnaire were used. Descriptive and analytical statistical analyses were performed. Multiple linear regression analysis was conducted to examine the relationship between job satisfaction, workload, and psychological distress.

RESULTS

Professionals reported moderate satisfaction (3.67 ± 0.45) and mild workload (1.82 ± 0.63). One-third of the sample showed scores indicative of psychological distress. Multiple linear regression analysis revealed that workload (p = 0.0025) and low job satisfaction (p = 0.0495) were significantly associated with psychological distress.

CONCLUSIONS

Low job satisfaction and high professional workload were predictive variables of psychological distress. These findings highlight the need for investments in promoting the quality of life at work for mental health professionals, especially during crises. The implications for human resource management and public policy development emphasize the importance of an integrated approach that considers the well-being of professionals for the effectiveness and sustainability of the psychosocial care model.

Enhancing hospital protection measures reduces frontline medical workers' stress during the pandemic

Frontline medical workers (FMWs) faced high stress levels in frontline clinics during the COVID-19 pandemic. This study aims to alleviate FMWs' psychological stress by enhancing protection measures, which includes refining the selection process, improving protective measures for their work in frontline clinics, and determining the appropriate time for evacuation. A Chinese-language-version stress questionnaire, covering stress-related issues and sociodemographic characteristics, was administered to FMWs in Shanghai during the COVID-19 pandemic in 2022, yielding 107 valid responses. The questionnaire's reliability and validity were subsequently confirmed. Exploratory factor analysis (EFA) was applied to the stress-related questions, with the KMO and Bartlett's test values of 0.886, 877.8522 (df = 120, p < 0.0001), respectively. Structure equation modeling (SEM) was used to confirm the factors and measure the relationships among the stress-related questions, factors and sociodemographic characteristics. The parameters of SEM named SOFAIDC were significant with SRMSR, RMSEA, AGFI, NFI, and PNFI being 0.0422, 0.0507, 0.9946, 0.9958, and 0.7615, respectively. Paired sample t-tests revealed the significant decrease in FMWs' stress score of the current week and the previous week, with all t-values being negative and significant (p < 0.01). A latent growth model (LGM) named LGM30 verified the overall decreasing stress trend over the weeks, with high R-squares (> 0.80), significant positive linear and negative quadratic time parameters. Based on the trajectory analysis, a stress scorecard with an AUC of 0.856 was developed. This study found that there are four factors for FMWs' psychological stress (anxiety about infection, exhaustion, lack of cognition for infection, and hesitant feeling), and improving targeted hospital protection could alleviate FMWs' psychological stress through SOFAIDC, as all the total effect of factors or items from the feeling of being protected by hospital were negative. Meanwhile, although overall FMWs' stress trend has decreased, 22.43% of FMWs have maintained or experienced a high stress trend, and the stress might increase over weeks in frontline clinics. To perfect hospital protection to alleviate FMWs' psychological stress, the scorecard could be used to select FMWs with low-stress trends, LGM30 could be used to determine the withdrawal time (such as week 8), and targeted hospital protections could be designed based on the relationships between feeling of being protected by the hospital and factors in SOFAIDC, such as providing adequate protective equipment, improving the rationality of FMWs' work schedules, recruiting personnel with higher education levels, and paying adequate monetary compensation.

Experience of moral distress among doctors at emergency departments in Stockholm during the Covid-19 pandemic: a qualitative interview study

PURPOSE

The COVID-19 pandemic and consequent strain on healthcare globally shed light on the concept of moral distress among healthcare workers, albeit to a smaller extent among doctors at emergency departments. This study aimed to examine moral distress as perceived by medical doctors working at emergency departments in Stockholm during the pandemic, with the purpose of investigating causes of moral distress and methods to manage moral distress.

METHODS

Semi-structured interviews were conducted with twelve doctors working at two emergency departments. A questionnaire was developed based on previous research and the interviews were analysed qualitatively through thematic analysis.

RESULTS

The themes "The factors that precipitated moral distress", "Experience of workplace support" and "Coping strategies" as well as seven subthemes and 15 codes were identified. The informants reported on various situations with different causes of moral distress. Common causes were resource depletion, such as hospital bed shortages, and following stricter triage criteria. Informants reported varying ways of managing moral distress.

CONCLUSIONS

Informants experienced moral distress when faced with challenges such as resource depletion, rules and regulations, and colleagues' decisions. The informants who chose to seek support received it from their workplace, which helped them cope with their experiences. Some informants chose to not seek support.

Assessing the Fear of Covid-19 in Psychiatric Patients: Results from an Italian Multicentric Study

Objective

Even though the COVID-19 emergency has concluded, its consequences are still relevant. Recent evidence suggests that a significant proportion of individuals experience persistent symptoms long after the initial infection has resolved, classified as "Long COVID" condition. Fear of COVID-19 increases anxiety and stress levels in healthy individuals and exacerbates the symptoms of those with pre-existing psychiatric disorders; therefore understanding the impact of the pandemic on psychiatric disorders remains of utmost importance. The present study aimed at assessing the prevalence and predictive factors of fear of COVID-19 in a sample of patients with different psychiatric conditions.

Method

A sample of 269 psychiatric patients were recruited from two different tertiary clinics in Italy and assessed with the Fear of COVID-19 Scale (FCV-19S). In order to compare patients with a significant fear of COVID-19 or without (Fear+ vs. Fear-) and to identify the main features in terms of clinical dimension, exploratory and predictive analysis were performed.

Results

Female gender, age at illness onset, and insight levels emerged as positive predictors of FCV-19S. Conversely, current substance abuse emerged as a negative predictor of fear levels. Moreover, significantly lower FCV-19S scores were observed in patients with a diagnosis of schizophrenia spectrum disorders.

Conclusions

Specific sociodemographic and clinical factors predicted higher levels of fear of COVID-19 in psychiatric patients. Further studies are warranted to determine the potential long-term consequences of the COVID-19 impact on mental health.

Investigating mental health outcomes of undergraduates and graduate students in Taiwan during the COVID-19 pandemic

Objective: This study is an exploration of the major stressors associated with the COVID-19 for students in higher education in Taiwan. Participants: The sample comprised 838 higher education students studying at various Taiwanese universities. Methods: A cross-sectional online survey was administered at different postsecondary institutions during the semi-lockdown period of COVID-19, which mandated online instruction. Machine learning was employed to determine the variables that most highly predicted students' mental health using R. Results: The findings revealed that COVID-19-related experiences, including social interactions, financial conditions, and educational experiences, were significantly associated with mental health outcomes. Particularly, loneliness are significantly related to social interactions and educational experiences. Conclusions: Findings revealed that Covid-19 impacted Taiwanese students' financial conditions, educational experiences, and social interactions, which were significant predictors of their mental health outcomes such as anxiety, loneliness and depression. The current study contributes to the gap in knowledge about mental health issues among postsecondary students during the pandemic.

Exploring the reasons behind nurses' intentions to leave their hospital or profession: A cross-sectional survey

Background

Multiple factors can fuel nurses' intention to leave their employing hospital or their profession. Job dissatisfaction and burnout are contributors to this decision. Sociodemographic and work context factors can also play a role in explaining nurses' intention to leave.

Objective

To investigate the role of sociodemographic and work context factors, including job resources, job demands, job dissatisfaction, depersonalization, and emotional exhaustion, on nurses' intention to leave their hospital or their profession.

Design

Multicentre cross-sectional study.

Settings

Eight European hospitals, two per each country, including Belgium, the Netherlands, Italy, and Poland.

Participants

From May 16 to September 30, 2022, we collected 1,350 complete responses from nurses working at the selected hospitals (13 % response rate).

Methods

The intention to leave was assessed through two 5-Likert scale outcomes, agreeing with the intention to leave the profession and the intention to leave the hospital. Logistic regression models were used for statistical analysis.

Results

At the multivariable analysis, a higher intention to leave the hospital was observed for: younger age, having served on the frontline against COVID-19, lack of quipment, living in the Netherlands, emotional exhaustion, dissatisfaction with work prospects, and dissatisfaction with the use of professional abilities. There was a higher intention to leave the profession for: younger age, living in the Netherlands, having work-related health problems, depersonalization, emotional exhaustion, low possibilities of professional development, dissatisfaction with work prospects, lack of use of professional abilities, overall ob issatisfaction, and dissatisfaction with salary. Nurses living in Italy expressed the lowest intention to leave.

Conclusion

While confirming the role of job dissatisfaction and burnout, we found higher intention to leave for young nurses, nurses with work-related health problems, and caregivers during the COVID-19 pandemic. Dissatisfaction with work prospects, professional development, and salary also increased the intention to leave. We call for educators, managers, and policymakers to address these factors to retain at-risk nursing categories, implementing strategies to mitigate intentions to leave.

Depression and anxiety between nurses and nursing assistants working in long-term care facilities during the COVID-19 pandemic

AIM

This study investigated the levels of depression and anxiety in nurses and nursing assistants working in long-term care facilities during the COVID-19 pandemic. We also explored the potential causes of depression and anxiety in nurses and nursing assistants working in long-term care facilities during the pandemic.

BACKGROUND

The COVID-19 pandemic has had a considerable impact on long-term care facilities. The high infection and mortality rates for COVID-19 have resulted in an increased workload for caregivers.

INTRODUCTION

The COVID-19 pandemic exposed caregivers working in long-term care facilities to higher risks of anxiety and depression. Additionally, the high risk of infection in the work environment and concerns about spreading COVID-19 to family members and long-term care facility residents led to various forms of stress among caregivers.

METHODS

The present study was a cross-sectional study. Questionnaires were used to investigate depression and anxiety among regarding nurses and nursing assistants working in long-term care facilities during the pandemic.

RESULTS

The depression and anxiety levels of the nurses were higher than nursing assistants, but had no statistically significant difference (p = 0.551). The factors influencing levels of depression and anxiety in nurses contained facility affiliation and experience working. In terms of nursing assistants, age, marital status, and facility affiliation were correlated with the levels of depression and anxiety.

DISCUSSION

The pandemic has severely impacted caregivers. In the process of implementing pandemic prevention measures and providing care for COVID-19 patients, safeguarding the psychological health of caregivers is also essential.

CONCLUSION

The levels of depression and anxiety in nurses were higher than in nursing assistants working in long-term care facilities during the pandemic.

IMPLICATION FOR NURSING AND HEALTH POLICY

Long-term care facilities managers are recommended to enhance the education and training process for caregivers. Managers are also recommended to ensure provision of sufficient amounts of pandemic prevention equipment and resources.

Zen Den: A Novel Approach to Promote Well-Being in the Workplace

Purpose: In response to the COVID-19 pandemic, holistic nurses at an academic level 1 trauma center in Hawaii utilized a novel holistic approach to combat stress and anxiety symptoms while promoting nurse's well-being. This assessment aimed to determine whether a brief session incorporating Reiki and meditation could decrease nurses' perceived stress and anxiety while increasing perceived happiness and coping ability. Methods: Two Reiki-certified holistic nurses developed a mobile 10-minute individual well-being session called "Zen Den." In each session, the holistic nurse provided hands-on Reiki concurrent with a meditation streamed by a free online application. Pre and post-self-assessments were measured using a Likert scale. Findings: Participants (N = 92) showed an average decrease in perceived stress by 46% and anxiety by 45%, and an increase in feelings of happiness by 17% and perceived coping ability by 18%. Conclusion: This novel approach to promote well-being in the workplace can be achieved using existing resources such as Reiki-trained staff, a quiet space, and a 10-minute well-being session with guided meditation using a free online application.

Influence of Nurses' Perceptions of Government Policies and COVID-19 Risks on Their Mental Health Status: A Web-Based Cross-Sectional Study

This study aimed to understand nurses' perceptions of COVID-19-related policies and risks during the outbreak of COVID-19 in Hong Kong and to determine how their perceptions influenced their mental health status. A web-based online survey among Hong Kong nurses was conducted. The questionnaire included a self-designed 5-point Likert scale with 17 items to assess the nurses' perceptions of COVID-19-related policies and risks, as well as the Davidson Trauma Scale (DTS), the Perceived Stress Scale (PSS), the Patient Health Questionnaire-2 (PHQ-2) and the Generalised Anxiety Disorder scale (GAD) for measurement of posttraumatic stress disorder (PTSD), stress, depression and anxiety, respectively. Of 592 nurses enrolled, 30.6% had PTSD (DTS total score ≥40), and 80.4%, 19.9% and 16.4% had moderate-to-high levels of stress (PSS-10 score ≥14), depression (PHQ-2 score ≥3) and anxiety (GAD score ≥3), respectively. The top three concerned aspects were 'worried about themselves and friends to suffer this disease' (84.5%), 'insufficient number of isolation wards' (81.8%) and 'insufficient number of personal protective equipment' (74.3%). Logistic regression analyses showed that more negative perception on 'personal protective equipment in the healthcare institutions', 'the confidence in HK's control of COVID-19', 'worried about themselves and friends to suffer this disease' and 'self-perceived risk of infection' indicated higher severity of the four mental health problems (all p < 0.01). The perception on 'public gathering ban', 'the number of isolation wards' and 'expected time to control COVID-19' were significantly associated with PTSD and stress (all p < 0.05). Nurses' perception on government policies and COVID-19 risks played an important role in predicting their mental health status. Policy makers should be aware of nurses' psychological responses and provide timely and targeted emotional support to nurses amid and after the COVID-19 pandemic.

Addressing Mental Health Symptoms Among COVID-19 Healthcare Workers: A Heart Rate Variability Biofeedback Pilot Study

Psychological stress among frontline healthcare workers (HCWs) increased during the COVID-19 pandemic, elevating mental health risks. Heart rate variability biofeedback (HRV-BF) is an evidence-based intervention with potential to reduce psychological burden on frontline HCWs; however, no studies have examined its use among this population since the pandemic began. We designed a trial to assess the effects of a brief HRV-BF intervention delivered via telemedicine on measures of anxiety, depression and stress, and heart rate variability, compared to an in-person intervention. We hypothesised that the telemedicine intervention would be non-inferior to the in-person intervention. Using a randomized comparison trial design, we tested a 10-day brief heart rate variability biofeedback intervention among frontline HCWs during the COVID-19 pandemic. They received remote, 30-min guided sessions every other day and were taught methods of heart rate variability biofeedback. Depression, anxiety and stress were assessed at baseline, 10 days, and 40 days with additional measures of anxiety measured before and after each session. HRV scores were collected at baseline, as well as during the course of the 10 days. Multilevel modelling was used to examine the change in depression, anxiety, stress and HRV scores across multiple time points and session types (telemedicine vs. in-person). There was no significant differences between telemedicine (n = 32) and in-person (n = 15) interventions on the main outcomes. Both session types showed a significant decrease in depression, anxiety and stress scores across the entire intervention, and HRV scores significantly increased across both groups. Anxiety levels also significantly decreased after each session. The non-inferiority of the telemedicine intervention to a comparable in-person intervention affirms its promise for decreasing anxiety, depression and stress among frontline HCWs and may offer a cost-effective and feasible tool to use in crises situations.

Factors associated with occurrence of workplace violence against healthcare workers during the COVID-19 pandemic: a meta-analysis

Objectives. Healthcare systems all over the world are increasingly alarmed by the prevalence of workplace violence (WPV) directed at healthcare workers (HCWs) during the COVID-19 pandemic. Therefore, the aim of the current review was to investigate the factors associated with WPV against HCWs during the COVID-19 pandemic. Methods. This study was conducted in December 2021. Four international databases along with two Iranian databases were searched. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement served as the foundation for the reporting procedure. Results. A total of 13 articles were included in the analysis. Results showed that females are less at risk of WPV (odds ratio [OR] 0.76, 95% confidence interval [CI] [0.67, 0.84], p = 0.000 based on a fixed-effects model). Moreover, significant association was found between education level (OR 1.09, 95% CI [1.05, 1.14]), age (correlation = 0.025, 95% CI [0.014, 0.036]) and work experience (correlation = 0.028, 95% CI [0.016, 0.016]) and WPV. Conclusion. The primary factors linked to WPV exposure were found to be gender, education level, age and work experience. Additional research is necessary to provide more accurate and detailed data.

Work-related flow and its correlates among frontline nurses during the COVID-19 pandemic

BACKGROUND

Ample evidence across non-healthcare fields highlights the role of work-related flow in enhancing resilience against work stress and work engagement. Understanding flow and its factors can support staff development and management.

AIMS

This study aimed to investigate the level of work-related flow and its associated factors among frontline nurses during the COVID-19 pandemic.

METHODS

A cross-sectional multicenter study included 336 nurses caring for COVID-19 patients between March and April 2022. Cluster random sampling was used to select 9 nurse groups from 29 Taiwanese hospitals specialized in COVID-19 care. A web survey link was shared on the selected nurses' social media. Hierarchical regression analyses examined predictor-outcome relationships, following the STROBE checklist for reporting findings.

RESULTS

Among demographic characteristics, sex (β = -0.11; p = 0.016) and living arrangement (β = -0.12; p = 0.017) reached statistical significance in model 3. Social support from family, friends, and significant others, managerial position, and sufficiency of personal protective equipment showed significant associations with work-related flow (all β > 0.12; p < 0.05). The variables included in the final model accounted for 35% of the variance in work-related flow for COVID-19 patient care tasks.

CONCLUSIONS

Flow experience is influenced by factors associated with demographics, work conditions, and social support. Nurse administrators should consider these factors when evaluating nurses' flow at work.

IMPLICATIONS FOR NURSING PRACTICE AND MANAGEMENT

Allocating care tasks to nurses based on their flow levels can be beneficial, particularly during healthcare crises. Ensuring a sufficient supply of personal protective equipment and offering social support to nurses are vital strategies for facilitating their flow experience in the workplace.

Network analysis of psychotic symptoms in schizophrenia

BACKGROUND

Schizophrenia with a wide range of psychotic symptoms which indicate the severity of disorders, risk of relapse, frequency and duration of hospitalization, and decreases social and occupational function. In clinical practice, Positive and Negative Systems Scale always used for assessment the severity of psychotic symptoms of patients with schizophrenia. This network analysis explores the inter-relationship of psychotic symptoms of patients with based on Positive and Negative Systems Scale (PANSS).

METHODS

The psychotic symptoms of the patients with schizophrenia were assessed by psychiatrist using PANSS when the first day in hospitalization. The network structure of psychotic symptoms was modelled with a graph and characterized using "Expected Influence" and "Bridge Expected Influence" as influential indices in the symptom network. Network stability was tested using a case-dropping bootstrap procedure. Network Comparison Test (NCT) was conducted to examine whether network characteristics differed on the basis of gender.

RESULTS

A total of 799 patients with schizophrenia were included. The mean age of the included participants was 39.51(standard deviation (SD)13.93). The main finding of the study was Preoccupation, Emotional instability and Anxiety were the most influential psychotic symptoms, while Active social avoidance, Emotional instability and Preoccupation were the most bridge influential psychotic symptoms within the interpret-able level of influential in the network. Gender did not significantly affect the overall network structure.

CONCLUSION

This influential (Preoccupation, Emotional instability and Anxiety) and bridge influential symptoms (Active social avoidance, Emotional instability and Preoccupation) dimension could be addressed in treatment target and treatment response for the patients with schizophrenia.

Emergency Services During the SARS-CoV-2 Pandemic: A Gender Comparison of Burnout Risk and Personality Traits in the Kharkiv City Sample

Introduction: The SARS-CoV-2 pandemic presented unique challenges to the health-care system and prehospital emergency medical services. An increasing prevalence of burnout has been described, which in turn is associated with mental illness. The aim of this paper was to evaluate burnout through a sex comparison and to analyze associations of burnout with personality traits during the SARS-CoV-2 pandemic. Methods: Eighty-eight emergency physicians and field shearers of Kharkiv City (Ukraine) emergency medical services (52% women) participated in the quantitative cross-sectional study. In addition to sociodemographic and occupational data, the Maslach Burnout Inventory (MBI) and the Freiburg Personality Inventory (FPI) were applied and analyzed in the sex comparison. Correlation analyses were performed to describe the relationships between the MBI dimensions and FPI traits. Results: The average age of the respondents was 35.1 ± 13.5 years. The prevalence of burnout during the pandemic was 6.5% in women and 2.4% in men. Only the scores on the MBI dimension cynicism were significantly (p = 0.027) higher in women than in men. Two personality traits differed between sexes: inhibition and male/female self-reports. Predominantly moderate correlations were found between the FPI traits and the MBI dimensions. Conclusions: Although the prevalence of burnout in this occupational group during the pandemic was similar to prepandemic figures reported in the literature, more than half of the male and female paramedics showed average-to-high scores on the three MBI dimensions. Because burnout is associated with other mental illnesses and prolonged incapacity, workplace-based interventions should be implemented.

Social distancing mediates clinical work and depression: impact of the COVID-19 pandemic on nurses

Background

The psychological well-being of nurses, during the COVID-19 pandemic has become a critical area of concern. This study examines the psychological impact of the pandemic on nurses, focusing on the mediating role of perceived social distance between work units and depression.

Methods

This study employed a cross-sectional design with respondent driven sampling. Anonymous questionnaire consisting of demographics, perceived social distancing and depression were distributed through email, Facebook, LINE, and other online platforms by key informants of nurses. A total of 1,064 volunteered questionnaires were collected, consisting of 1,032 females and 32 males.

Results

Data showed that 517 (48.9%) nurses may have depression. Results from the structure equation modeling indicated that perception of social distancing mediates between individuals in units of care and depression, while unit and tenure of nursing work were negatively associated with depression.

Conclusion

The study findings support that perceived social distancing due to COVID-19 pandemic from others toward nurses may have influential impact on elevated depression, especially for nurses worked in the acute critical care. Thus, emotional support should be emphasized, and avenues for stress relief should be provided as well as creating a supportive workplace environment is crucial to nurses and patient safety.

Assessing the impact of COVID-19 on outpatient psychiatric population well-being and symptomology utilizing COVID-19 Events Checklist (CEC) and Measurement Based Care

BACKGROUND

This study examines the impact of SARS-CoV-2 (i.e., coronavirus, COVID, COVID-19) using data from a measurement-based care (MBC) system utilized in an outpatient psychiatric clinic providing telemedicine care. A novel Patient Rated Outcome Measure (PROM), the COVID-19 Events Checklist (CEC) was administered in a hospital system based ambulatory clinic beginning April 2020 to track COVID-19-19's impact on patients' mental, emotional, and health-related behaviors during the pandemic. The study (1) provides descriptive CEC data, and (2) compares CEC results with PROMs evaluating anxiety (Generalized Anxiety Disorder-7; GAD-7), depression (Patient Health Questionnaire; PHQ-9), and psychological distress (Brief Adjustment Scale-6; BASE-6).

METHODS

This retrospective observational study included patient intake data collected from April 2020 to March 2021. Patient (N = 842) reports on the CEC's five domain questions were aggregated to calculate average reports of COVID-19 related impacts at intake over the initial 12 months of the pandemic. Trends in COVID-19 related impacts were examined, and non-aggregated scores on the PHQ-9, GAD-7, and BASE-6 were compared to primary dichotomous (yes/no) CEC survey questions via Wilcoxon rand sum testing.

RESULTS

Results capture the relationship between COVID-19 exposure, COVID-19- related sequelae and behaviors, and psychological symptom severity. Specifically, Wilcoxon rank-sum tests indicate that social determinants of health (SDOH), negative mental health impacts, and positive coping skill use were significantly associated with psychological symptomatology including overall psychological functioning via the BASE-6, anxiety via the GAD-7, and depressive symptoms via the PHQ-9. Results regarding SDOH were as follows: BASE-6 (w = 44,005, p < 0.001), GAD-7 (w = 44,116, p < 0.001), and PHQ-9 (w = 43,299, p < 0.001). Regarding negative mental health outcomes, the results were: BASE-6 (w = 38,374, p < 0.001), GAD-7 (w = 39,511, p < 0.001), and PHQ-9 (w = 40,154, p < 0.001). As the initial year of the pandemic elapsed, incoming patients demonstrated increased rates of suspected or confirmed exposure to COVID-19, (+2.29%, t = 3.19, p = 0.01), reported fewer negative impacts of COVID-19 on SDOH (-3.53%, t= -2.45, p = 0.034), and less engagement in positive coping strategies (-1.47%, t = -3.14, p = 0.010).

CONCLUSIONS

Psychosocial factors related to COVID-19 are discussed, as well as opportunities for further research on the relationship between psychological symptomatology and the impact of COVID-19 on health-related behaviors.

Burnout components, perceived stress and hair cortisol in healthcare professionals during the second wave of COVID 19 pandemic

This study evaluates the impact of the COVID-19 pandemic on healthcare workers in Argentina, during the second wave in 2021. The aim is to assess stress and burnout, incorporating the assessment of hair cortisol levels as a biomarker of chronic stress. A total of 496 healthcare workers from three different hospitals were included in this study. Two of these hospitals depend on the Buenos Aires City Ministry of Health and the third hospital belongs to Buenos Aires University. Hair samples were obtained using scissors from the posterior vertex, as close to the scalp as possible. Each sample was weighed, and cortisol was extracted and then measured using an automated chemiluminescent method. Notably, 10% of the population exhibited hair cortisol levels above 128 pg/mg. Associations were found between high hair cortisol levels and age, workload, emotional exhaustion, and depersonalization. In addition, burnout, identified in 11% of participants, correlated with higher perceived stress and lower social support. Binary logistic regression revealed associations between burnout and perceived stress, and age. Finally, mediation analysis showed depersonalization as a mediating variable in the relationship between hair cortisol concentration and emotional exhaustion. In conclusion, this study highlights the complex relationships between stress, cortisol levels, and burnout. Prioritizing interventions and research is essential to support the well-being of frontline healthcare professionals, ensuring their resilience during challenging times.

Longitudinal Insights into the Mental Health of Healthcare Workers: Emotional Shifts During Two Years of the COVID-19 Crisis

OBJECTIVE

Numerous studies have highlighted the prevalence of mental health disorders among healthcare professionals during the COVID-19 pandemic, with varying indications of emotional strain. This study compares the psychological functioning of healthcare workers at the onset of the pandemic and two years later, offering a comprehensive assessment of their emotional and mental health status in the evolving context of COVID-19.

METHODS

This longitudinal analysis examined the relationship between stress, emotional processing, and their positive/negative impacts on medical personnel working in Polish hospitals and outpatient clinics in 2020 (n = 285) and 2022 (n = 252). The study employed the Toronto Alexithymia Scale-20 (TAS-20), Cohen's Perceived Stress Scale (PSS-10), Mini-COPE, Acceptance of Illness Scale (AIS), Emotional Processing Scale (EPS), STAI, and PANAS to assess psychological responses and coping mechanisms.

RESULTS

Findings revealed a significant increase in denial, substance use, self-blame, negative mood, and impaired psychological and somatic functioning, alongside heightened symptoms of depression and anxiety. Conversely, a marked decrease in planning, positive reinterpretation, acceptance, religious coping, and seeking social support (both emotional and instrumental) was observed over the two-year period.

CONCLUSION

The prolonged nature of the COVID-19 pandemic has profoundly affected the psychological resilience of healthcare professionals, eroding critical emotional resources necessary for maintaining interpersonal relationships and mental well-being. These results underscore the need for targeted interventions to support the mental health of medical staff in the ongoing crisis.

Prevalence and Correlates of Likely Anxiety Disorder in Ghana During the COVID-19 Pandemic: Evidence From a Cross-Sectional Online Survey

BACKGROUND

The COVID-19 pandemic created stressors to daily living, leading to increased mental health problems. It is important to assess the influence of COVID-19 pandemic on mental health, specifically anxiety.

OBJECTIVES

The goal was to determine the prevalence and sociodemographic, clinical, and other correlates of likely Generalized Anxiety Disorder (GAD) among study subjects in Ghana.

DESIGN

This study employed a cross-sectional approach, using an online survey administered primarily through social media platforms. The survey questions included the GAD-7 scale, which was used to assess likely GAD in respondents. Data were analyzed using descriptive statistics, chi-square tests, and logistic regression analysis.

PARTICIPANTS

Overall, 756 respondents completed the survey, mainly from Ashanti and Greater Accra, which were the hardest hit by COVID-19.

RESULTS

The prevalence of likely GAD in our sample was 7.6%. Gender, loss of job due to COVID-19, and seeking mental health counseling were independently associated with increased likelihood of GAD.

CONCLUSIONS

The findings suggest that women, those who lost their jobs due to the COVID-19 pandemic, and those who sought mental health counseling were more likely to experience moderate to high anxiety symptoms as a result of the COVID-19 pandemic. Priority must be attached to psychological support measures for members of these groups.

Associations between self-compassion and moral injury among healthcare workers: A cross-sectional study

BACKGROUND

Healthcare workers (HCWs) can face situations that conflict with their moral beliefs, leading to moral injury, an adverse psychological consequence that was more frequent during the COVID-19 pandemic. Self-compassion is a potential coping mechanism for moral injury by encouraging acceptance of human limitations and suffering.

OBJECTIVES

This study aimed to examine the associations between self-compassion components and moral injury prevalence among HCWs in Quebec, Canada, during the COVID-19 pandemic.

RESEARCH DESIGN

A cross-sectional study design was employed. Participants: and research context: The sample of this study consisted of HCWs and leaders from the Quebec province. Participants completed validated self-administered questionnaires assessing both positive and negative self-compassion components (self-kindness vs self-judgment; common humanity vs isolation; and mindfulness vs overidentification) and moral injury dimensions (self-oriented and other-oriented). Prevalence ratios (PRs) and 95% confidence intervals (CIs) for the associations between self-compassion components and moral injury dimensions were modeled using Poison robust regressions. The models were adjusted for various covariates, including sex, age, gender, and socio-demographic and lifestyle factors.

ETHICAL CONSIDERATIONS

Ethical approval for this study was obtained from the ethics committee of the Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale in Quebec, Canada. All participants provided written informed consent prior to participating in the study. Additionally, permission was sought and obtained from the original authors of the tools used in this study, including the self-compassion and moral injury scales.

RESULTS

The study involved 572 HCWs (60.5% nurses) and leaders. Around half of the participants (50.70%) exhibited moderate levels of self-compassion, while the prevalence of low levels of self-compassion ranged from 21.68% to 48.08% for the positive subscales and from 23.78% to 44.41% for the negative subscales. Regarding moral injury, 10.14% of participants reported moderate to high self-oriented moral injury, 29.19% reported moderate to high other-oriented moral injury, and 13.81% demonstrated moderate to high total moral injury. Higher self-compassion levels were associated with lower moral injury prevalence. HCWs with high self-compassion had a 93% lower likelihood of experiencing moral injury (PR: 0.07, 95% CI: 0.03-0.19). Self-kindness demonstrated the strongest association with reduced moral injury (PR: 0.24, 95% CI: 0.11-0.52), followed by mindfulness (PR: 0.37, 95% CI: 0.18-0.75). However, common humanity did not show a statistically significant association with moral injury prevalence.

CONCLUSION

These findings suggest a potential association between self-compassion and reduced prevalence of moral injury among HCWs, highlighting promising interventions to manage moral injury during crises. Such initiatives could promote the mental wellbeing of HCWs and preventing the negative consequences of moral injury, including anxiety, depression, and burnout.

Development of the Japanese Version of Rushton Moral Resilience Scale (RMRS) for Healthcare Professionals: Assessing Reliability and Validity

Aim: To translate the Rushton Moral Resilience Scale (RMRS) into Japanese and validate its applicability among Japanese healthcare professionals. Background: To overcome daily challenges in the field of healthcare, in which moral difficulties are routinely encountered, the development of intervention methods to address moral suffering and moral distress is crucial. Methods: We conducted a cross-sectional survey using a web-based questionnaire. The RMRS-16 was translated into Japanese and confirmed through back-translation. Reliability analyses (Cronbach's alpha and intraclass correlation coefficient [ICC]), confirmatory factor analyses (CFAs), correlation analyses, t-tests, and analysis of variance (ANOVA) were used to assess the validity of the scale. Results: Participants comprised 1295 healthcare professionals, including 498 nurses. All subscales and the total scale had acceptable reliability values (α ≥ 0.70). CFA supported the original four-factor structure (response to moral adversity, personal integrity, relational integrity, and moral efficacy), with acceptable fit indices. The ANOVA results suggested that, among Japanese healthcare professionals, nurses and individuals from other professions showed lower average moral resilience scores compared to physicians, consistent with previous research on mental health and moral distress. In addition, women scored lower for moral resilience than men. However, the ICC values for the subscales of the RMRS were below acceptable levels, and the results of the standardized residual covariances also suggested a model misfit. Conclusion and Implications: The reliability, validity, and utility of the Japanese version of the RMRS were generally supported. However, there were areas at the item level that required structural examination. The current findings suggest that there are cultural differences in the concept of moral resilience. Therefore, for future cultural comparisons, the original four-factor structure was maintained in the Japanese version without modifications. Further conceptual development of moral resilience is needed in Japanese healthcare.

Burnout among intensive care nurses, physicians and leaders during the COVID-19 pandemic: A national longitudinal study

BACKGROUND

Burnout is frequent among intensive care unit (ICU) healthcare professionals and may result in medical errors and absenteeism. The COVID-19 pandemic caused additional strain during working hours and also affected off-duty life. The aims of this study were to survey burnout levels among ICU healthcare professionals during the first year of COVID-19, describe those who reported burnout, and analyse demographic and work-related factors associated with burnout.

METHODS

This was a national prospective longitudinal cohort study of 484 nurses, physicians and leaders working in intensive care units with COVID-19 patients in Norway. Burnout was measured at 6- and 12-month follow-up, after a registration of baseline data during the first months of the COVID epidemic. The Copenhagen Burnout Inventory (CBI), was used (range 0-100), burnout caseness defined as CBI ≥50. Bi- and multivariable logistic regression analyses were performed to examine baseline demographic variables and work-related factors associated with burnout caseness at 12 months.

RESULTS

At 6 months, the median CBI score was 17, increasing to 21 at 12 months (p = .037), with nurses accounting for most of the increase. Thirty-two per cent had an increase in score of more than 5, whereas 25% had a decrease of more than 5. Ten per cent reported caseness of burnout at 6 months and 14% at 12 months (n.s.). The participants with burnout caseness were of significantly lower age, had fewer years of experience, reported more previous anxiety and/or depression, more moral distress, less perceived hospital recognition, and more fear of infection in the bivariate analyses. Burnout was the single standing most reported type of psychological distress, and 24 out of 41 (59%) with burnout caseness also reported caseness of anxiety, depression and/or post-traumatic stress disorder (PTSD) symptoms. Multivariate analysis showed statistically significant associations of burnout caseness with fewer years of professional experience (p = .041) and borderline significance of perceived support by leader (p = .049).

CONCLUSION

In Norway, a minority of ICU nurses, physicians and leaders reported burnout 1 year into the pandemic. A majority of those with burnout reported anxiety, depression and/or PTSD symptoms combined. Burnout was associated with less years of professional experience.

Generalized Anxiety Disorder Among Physicians: A Cross-Sectional Study

BACKGROUND

Generalized anxiety disorder (GAD) is defined as excessive worry that occurs on most days for at least six months, causes significant distress or impairment, and is associated with increased use of health services.

METHODOLOGY

A cross‑sectional study was carried out among physicians working in Saudi Arabia through an online questionnaire. The questionnaire consisted of a sociodemographic part and the validated Arabic version of the Generalized Anxiety Disorder‑7 (GAD‑7) questionnaire.

RESULTS

The study included 110 physicians, 63 (57.3%) of whom were women with a mean age of 36.9 ± 10.0 years. Men represented 47 (42.7%) of the participants. The majority of the participants were non-Saudi (80, 72.7%). According to their scores on the GAD-7, 40 (36.4%) participants had no anxiety, 35 (31.8%) had mild anxiety, 25 (22.7%) had moderate anxiety, and 10 (9.1%) had severe anxiety. A score of 10 on the GAD-7 represented a reasonable cutoff point for identifying cases of anxiety. Accordingly, we found that 35 (31.8%) of the participating physicians had anxiety.

CONCLUSION

Physicians working in Saudi Arabia showed a significant rate of general anxiety disorder. Early detection, health education, and treatment are recommended.

Evaluating the General Health Risk Factors (Physical, Psychological, and Social Functions) of Hospital Staff a Year after COVID-19 Outbreak in 2020-2021, Isfahan Iran

Background

Healthcare workers are the first to be exposed to the virus and are at greater risk than the general public. This study aimed to examine the risk factors that affected hospital staff's general health during the COVID-19 pandemic in Isfahan, Iran.

Materials and Methods

This cross-sectional study was conducted on the staff of all hospitals in Isfahan one year after the COVID-19 outbreak (2021-2022). The General Health Questionnaire (GHQ) was used to determine social functioning, while the Patient Health Questionnaire (PHQ) was employed to assess physical and psychological health status.

Results

There was a significant positive relationship between work experience in the COVID-19 ward and the scores of physical health (r = 0.26, df = 298, p < 0.01), depressive symptoms (r = 0.24, df = 298, p < 0.01), and anxiety (r = 0.17, df = 298, p < 0.01). The job and income satisfaction score was negatively related to the scores of social function variables (r = -0.25, df = 298, p < 0.01) and depressive syndrome (r = -0.12, df = 298, p < 0.05). The fear of COVID-19 was related to social functioning (r = 0.12, df = 298, p < 0.01), physical health (r = 0.31, df = 298, p < 0.001), depressive symptoms (r = 0.36, df = 298, p < 0.001), panic attacks (r = 0.15, df = 298, p < 0.01), and generalized anxiety (r = 0.23, df = 298, p < 0.001). Gender and age significantly predicted general health.

Conclusions

The COVID-19 pandemic negatively affected all dimensions of hospital staff's health, particularly those with underlying physical conditions.

A Cross-Sectional Study on Social Isolation and Loneliness Related to COVID-19 Among Middle and Late-Stage Elderly in Jazan, Saudi Arabia

BACKGROUND

Precautionary measures implemented to reduce the spread of COVID-19, such as social distancing and stay-at-home orders, have inevitably affected the mental health of older adults. This study aimed to measure loneliness among the elderly living in the Jazan region, Saudi Arabia, during the COVID-19 pandemic.

METHODS

This cross-sectional study was conducted between February and April 2022 in the Jazan area, Saudi Arabia. A convenience sampling method was employed to recruit 100 elderly participants (≥ 60 years) from various public locations, including malls, social gatherings, parks, and beaches, across different neighborhoods in Jazan. Qualitative survey data was collected by interviewing each participant. Loneliness level was measured using the De Jong Gierveld Scale, complemented by self-made questions addressing sociodemographic information, communication means, frequency of contact with family and friends, and ability to perform daily activities. The chi-square test was utilized to identify factors associated with loneliness.

RESULTS

The De Jong Gierveld scale revealed that most study participants (80%) experienced moderate loneliness despite living arrangements, as 87% were living with their family members. In contrast, only 12% of participants reported severe loneliness. Of all sociodemographic variables, only age and housing companion showed statistically significant relations with loneliness levels (p = 0.005 and < 0.001, respectively). Additionally, loneliness levels were found to be significantly associated with the frequency of communication with family and/or friends (p = 0.002) and knowledge of modern communication means (p = 0.048).

CONCLUSION

This study highlights a high prevalence of social and emotional loneliness among elderly individuals in Jazan, Saudi Arabia, during the COVID-19 pandemic. It indicates that robust family living arrangements alone did not mitigate loneliness in this population. The findings suggest that limited adoption of digital communication and cultural factors contributed to loneliness. While these insights provide a foundation for understanding elderly loneliness in Saudi Arabia, further research is needed to explore these factors in greater depth and assess the effectiveness of potential interventions like mental health counseling and social support programs.

Prevalence and Risk Factors Associated with Depressive Symptoms Among Healthcare Professionals at a Tertiary Care Hospital in Mogadishu, Somalia: A Cross-Sectional Study

Background

Depression, a prevalent mental health issue, can significantly impact healthcare workers (HCWs), leading to decreased productivity, increased turnover, and high medical errors. However, there is a dearth of information regarding depression among healthcare professionals in Somalia. Therefore, this study aimed to assess the magnitude and risk factors associated with depressive symptoms among healthcare professionals in Mogadishu, Somalia.

Methods

A hospital-based cross-sectional study was conducted among HCWs at Erdogan Hospital, in the capital city of Somalia. Data was collected using questionnaires on socio demographic, work-related characteristics and Patient Health Questionnaire-9 (PHQ-9). Bivariate and multivariate logistic regression analyses were conducted to identify variables associated with depressive symptoms. A p-values of 0.05 as a cutoff for a significant association.

Results

The prevalence of depressive symptoms among healthcare professionals was 48.9% (95% CI: 45.4-56.9%). In multivariable analysis, being female (AOR = 2.05; 95% CI: 1.17-3.60), being a nurse (AOR = 3.11; 95% CI: 1.14-8.48), unmarried (AOR = 1.83; 95% CI: 1.04-3.21), having insufficient sleep (AOR = 2.61; 95% CI: 1.45-4.70), a family history of mental illness (AOR = 3.31; 95% CI: 1.49-7.36), lack of physical activity (AOR = 2.59; 95% CI: 1.19-5.62), and having low social support (AOR = 3.06; 95% CI: 1.17-7.98) were all associated with increased odds of experiencing depressive symptoms.

Conclusion

The study showed that nearly half of healthcare professionals experienced depressive symptoms. The study underscores the importance of efficient screening methods for identifying psychological symptoms in healthcare professionals, which is essential for enhancing their mental health and patient care. Therefore, we recommend that healthcare institutions and policymakers develop and implement screening measures to identify and improve the mental health well-being of HCWs, as well as provide high-quality patient care.

Real-world predictors of severe psychological distress during the COVID-19 pandemic in Japan: Insights from a large-scale internet-based cohort study

AIM

The COVID-19 pandemic has had negative physical and psychological impacts worldwide. However, there has been a lack of real-world evidence concerning the predictors of severe psychological distress (SPD) among the general population in Japan during the COVID-19 pandemic. The aim of this study was to examine predictors of SPD during the COVID-19 pandemic.

METHODS

We investigated the predictors of new-onset SPD in the general Japanese population using data from a large-scale internet-based cohort study.

RESULTS

We included 16 489 study participants (age range = 16-81, mean age = 52.7, percentage of male = 50%) in the analysis. Over the course of 1 year from baseline, the estimated proportion of participants who experienced SPD was 5.2% with inverse probability weighting. The predictors of SPD included younger age, being never married, being unemployed, having a higher education background, scoring higher on the Fear of Coronavirus-19 Scale, experiencing more adverse childhood experiences, reporting poorer subjective health status, and COVID-19 with oxygen therapy. Our internet-based survey of the Japanese population may have selection bias, limiting the generalizability to other countries and cultures.

CONCLUSION

This study revealed that being afflicted with COVID-19 requiring oxygen therapy is the most significant predictor of SPD. In addition, we found that vulnerability to social isolation, such as never being unmarried, anxiety toward COVID-19, and susceptibility to stress, are predictors of the emergence of SPD. Therefore, the implementation of online support systems and ensuring access to accurate information may protect against SPD during the COVID-19 pandemic in Japan.

Impact of social support on PTSD : Chain mediating effects of insomnia and anxiety

Objective

To reveal the chain mediating roles of insomnia and anxiety between social support and PTSD in nursing staff under the stage of COVID-19 regular pandemic prevention and control in China.

Methods

A total of 784 nurses were recruited using the convenience sampling method in Jiangsu Province, China. Demographic questionnaire, Perceived Social Support Scale, Impact of Event Scale-Revised, Generalized Anxiety Disorder-7 and Insomnia Severity Index were applied to collect data.

Results

Social support, PTSD, insomnia and anxiety were significantly correlated with each other. Insomnia and anxiety acted as chain mediators between social support and PTSD.

Conclusion

Insufficient social support may trigger PTSD through the chain mediating effects of insomnia and anxiety in nursing staff under the stage of COVID-19 regular pandemic prevention and control. Measures focusing on social support, insomnia and anxiety should be taken to reduce or even prevent PTSD in nursing staff in Chinese hospitals in similar crises in the future.

Effects of a mindfulness-based health promotion program on mindfulness, psychological capital, compassion fatigue, and affect in healthcare workers

Objective

This study aimed to examine the effects of the Mindfulness-Based Health Promotion program on mindfulness, psychological capital, compassion fatigue, and affect in a sample of healthcare workers at a hospital in Colombia.

Method

Randomized controlled study with pre-test and post-test measures, in which 33 workers participated (Mage = 35.01, SD = 10.0), assigned to the experimental group (EG, n = 16, Mage = 34.00, SD = 9.59) and the wait-list control group (CG, n = 17, Mage = 36.03, SD = 10.56). The contrast of the program effects was carried out through a mixed factorial ANOVA.

Results

We found significant effects on observing, non-reacting and mindfulness as a function of the group factor.

Conclusion

We concluded the Mindfulness-Based Health Promotion program showed positive effects on mindfulness, this was tested with a novel program designed for the Latin population. This study is pioneering in using this mindfulness program in Colombia. These findings offer valuable insights for leaders of healthcare institutions when developing intervention programs that promote the mental health in the workplace. Future studies with larger samples and mixed-methods are necessary to confirm our results and to identify factors that can predict these findings.

Job Satisfaction Among First-Generation Migrant Physicians in Anesthesiology and Intensive Care Medicine in Germany

BACKGROUND/OBJECTIVES

This study examines job satisfaction, burnout, and well-being among first-generation migrant physicians in anesthesiology and intensive care medicine in Germany, comparing them to their native German counterparts.

METHODS

A cross-sectional survey design was utilized, collecting data from 513 physicians, 110 of whom identified as having a migration background. Job satisfaction was measured using the Warr-Cook-Wall (WCW) Job Satisfaction Scale, burnout was assessed with the Copenhagen Burnout Inventory (CBI), and well-being was evaluated using the WHO-5 Well-Being Index.

RESULTS

The job satisfaction ratings revealed no significant differences between migrant and German physicians in most dimensions, including physical workload, freedom to choose work methods, satisfaction with colleagues, responsibility, income, skill utilization, and variety in work tasks. However, migrant physicians reported significantly higher satisfaction with recognition received for their work and lower dissatisfaction with working hours. Burnout assessments showed that migrant physicians experienced higher psychological strain, perceiving every work hour as more exhausting and having significantly less energy for family and friends. Migrant physicians reported higher difficulty and frustration in working with patients. Well-being items indicated that migrant physicians felt less energetic and active but found their daily life more filled with interesting activities. Notably, the multivariate analyses of the total scale scores did not show significant associations between migration background and the overall outcome scales.

CONCLUSIONS

The findings indicate unique challenges faced by migrant physicians, particularly in terms of recognition and patient-related burnout. These results highlight the need for targeted interventions to support migrant physicians, including cultural competence training and flexible working hours to enhance their job satisfaction and overall well-being. Addressing these issues is crucial for maintaining the quality of patient care and the occupational health of migrant physicians in Germany.

Burnout and turnover risks for healthcare workers in the United States: downstream effects from moral injury exposure

Moral injury has emerged as a construct of interest in healthcare workers' (HCW) occupational stress and health. We conducted one of the first multidisciplinary, longitudinal studies evaluating the relationship between exposure to potentially morally injurious events (PMIEs), burnout, and turnover intentions. HCWs (N = 473) completed surveys in May of 2020 (T1) and again in May of 2021 (T2). Generalized Linear Models (robust Poisson regression) were used to test relative risk of turnover intentions, and burnout at T2 associated with PMIE exposure, controlling for T1 covariates. At T1, 17.67% reported they had participated in a PMIE, 41.44% reported they witnessed a PMIE and 76.61% reported feeling betrayed by healthcare or a public health organization. In models including all T1 PMIE exposures and covariates, T2 turnover intentions were increased for those who witnessed a PMIE at T1 (Relative Risk [RR] = 1.66, 95% Confidence Interval [CI] 1.17-2.34) but not those that participated or felt betrayed. T2 burnout was increased for those who participated in PMIE at T1 (RR = 1.38, 95%CI 1.03-1.85) but not those that witnessed or felt betrayed. PMIE exposure is highly prevalent among HCWs, with specific PMIEs associated with turnover intentions and burnout. Organizational interventions to reduce and facilitate recovery from moral injury should account for differences in the type of PMIE exposures that occur in healthcare work environments.

Reliability, validity and dimensionality of the 12-Item General Health Questionnaire among South African healthcare workers

Healthcare workers (HCWs) were among the high-risk groups for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and suffer a high burden of challenges with mental health including depression, anxiety, traumatic stress, avoidance and burnout. The 12-Item General Health Questionnaire (GHQ-12) has shown the best fit in both a one-factor structure and a multidimensional structure for the screening of common mental disorders and psychiatric well-being. The aim was to test for reliability and validity and ascertain the factor structure of the GHQ-12 in a South African HCW population. Data were collected from 832 public hospital and clinic staff during the coronavirus disease 2019 (COVID-19) pandemic in Gauteng, South Africa. The factor structure of the GHQ-12 in this professional population was examined by exploratory factor analysis (EFA) to identify factors, confirmatory factor analysis (CFA) for construct validity and structural equation modelling (SEM) to establish model fit. The GHQ-12 median score was higher (n = 25) in women than in men (n = 24), p = 0.044. The assumptions for inferential statistics were tested: the determinant for the correlation matrix was 0.034, Bartlett's test of sphericity was p < 0.001, Chi-square 2262.171 and the Kaiser-Meyer-Olkin (KMO) of sampling adequacy was 0.877. The four factors identified were labelled as social dysfunction (37.8%), anxiety depression (35.4%), capable (24.9%) and self-efficacy (22.7%). The sample had a Cronbach's alpha and McDonald's Omega coefficient of 0.85.

Contribution

The study highlighted the gaps in the use of GHQ-12. The findings affirm the validity and reliability of the GHQ-12 in this group of professionals and the multidimensional structure for screening for psychological distress.

Pandemic scars: long-term impact of COVID-19 on work stress among healthcare workers in China

PURPOSE

This study mainly focused on the long-term effect of different risk exposure levels and prior anti-epidemic experience of healthcare workers in mitigating COVID-19 on their work stress in the post-COVID era.

DESIGN/METHODOLOGY/APPROACH

The study sample included 359 physicians, 619 nurses, 229 technicians and 212 administrators, for a total of 1,419 healthcare workers working in the Lanzhou area during the investigation. Data were analyzed by multivariate regression models.

FINDINGS

Our findings indicated that the interaction between pandemic effect mitigation experience and high-risk exposure significantly affected healthcare workers in the post-COVID era by increasing their work stress (p < 0.001) and reducing their rest time (p < 0.001). Healthcare workers may have experienced worse outcomes in the long term if they had higher levels of risk exposure and more experience in fighting epidemics. Furthermore, poor mental health (p < 0.001) and prior experience with SARS (p < 0.001) further amplified these adverse effects. However, surprisingly, we did not observe any effect of prior anti-epidemic experience or high-risk exposure on the mental health of healthcare workers in the post-COVID era (p > 0.1).

RESEARCH LIMITATIONS/IMPLICATIONS

The adverse impact of COVID-19 may have left long-lasting effects on Health professionals (HPs), particularly those with high Risk exposure (RE) and more mitigation experience. Poor Mental health (MH) and previous experience in mitigating previous similar outbreaks (such as SARS) are risk factors that should be considered. Support programs must be designed and promoted to help HPs respond and improve their performance.

ORIGINALITY/VALUE

Our study presents compelling evidence that the COVID-19 pandemic will have long-term detrimental effects on the work stress of healthcare workers.

Gender sensitivity of the COVID-19 mental health research in Europe: a scoping review

BACKGROUND

The integration of sex and gender aspects into the research process has been recognized as crucial to the generation of valid data. During the coronavirus pandemic, a great deal of research addressed the mental state of hospital staff, as they constituted a population at risk for infection and distress. However, it is still unknown how the gender dimension was included. We aimed to appraise and measure qualitatively the extent of gender sensitivity.

METHODS

In this scoping review, we searched MEDLINE, EMBASE, CINAHL PsycINFO and Social Sciences Citation Index (SSCI) from database inception to November 11, 2021. All quantitative studies with primary data published in English, German, or Spanish and based in the European Union were selected. Included studies had to have assessed the mental health of hospital staff using validated psychometric scales for depression, anxiety, PTSD symptoms, distress, suicidal behavior, insomnia, substance abuse or aggressive behavior. Two independent reviewers applied eligibility criteria to each title/abstract reviewed, to the full text of the article, and performed the data extraction. A gender sensitivity assessment tool was developed and validated, consisting of 18 items followed by a final qualitative assessment. Two independent reviewers assessed the gender dimension of each included article.

RESULTS

Three thousand one hundred twelve studies were identified, of which 72 were included in the analysis. The most common design was cross-sectional (75.0%) and most of them were conducted in Italy (31.9%). Among the results, only one study assessed suicidal behaviors and none substance abuse disorders or aggressive behaviors. Sex and gender were used erroneously in 83.3% of the studies, and only one study described how the gender of the participants was determined. Most articles (71.8%) did not include sex/gender in the literature review and did not discuss sex/gender-related findings with a gender theoretical background (86.1%). In the analysis, 37.5% provided sex/gender disaggregated data, but only 3 studies performed advanced modeling statistics, such as interaction analysis. In the overall assessment, 3 papers were rated as good in terms of gender sensitivity, and the rest as fair (16.7%) and poor (79.2%). Three papers were identified in which gender stereotypes were present in explaining the results. None of the papers analyzed the results of non-binary individuals.

CONCLUSIONS

Studies on the mental health of hospital staff during the pandemic did not adequately integrate the gender dimension, despite the institutional commitment of the European Union and the gendered effect of the pandemic. In the development of future mental health interventions for this population, the use and generalizability of current evidence should be done cautiously.

RePAIRing the student nurse journey: empowering interrupted students through innovative support strategies

This article reports on a study that evaluated an innovative 6-week summer returners' programme, part of the Health Education England RePAIR project, designed to support nursing students who have interrupted their studies. Held from May to July 2022, the programme addressed diverse needs through academic guidance, mental health and resilience workshops, creative arts, professional identity development, and practical nursing skills training. The programme ran alongside support from the programme team, student engagement services, and ongoing communication via phone and email. Despite non-mandatory sessions leading to varying attendance, the combined efforts facilitated the return of 67 out of 135 interrupted students. Thematic analysis identified four key themes: anticipation and fear, making contact and reaching out, preparing for return, and psychological wellbeing. The programme's effectiveness underscores the necessity of tailored support strategies to enhance retention and wellbeing. This innovative approach highlights the importance of personalised support in aiding nursing students' return to education and addressing nursing workforce shortages.

The aftermath of COVID-19: generalized anxiety disorder and burnout among radiology practitioners and interns in Saudi Arabia

Background

The coronavirus disease (COVID-19) pandemic has presented unprecedented stressors and difficulties for healthcare professionals. This study explored the prevalence of generalized anxiety disorders and burnout among radiology practitioners and interns in various hospitals in Saudi Arabia after the end of the COVID-19 global public health emergency.

Methods

A cross-sectional survey of 230 radiology practitioners and interns was conducted between October and November 2023. This study utilized the Generalized Anxiety Disorder 7-item (GAD-7) scale and Maslach Burnout Inventory-Human Services Survey for Medical Personnel (MBI-HSS-MP) 22-item questionnaire, employing a non-probability convenience sampling method. The average scores of the individual components constituting the GAD-7 scale and each burnout scale were calculated, and statistical analyses were conducted using the Mann-Whitney U and Kruskal-Wallis H nonparametric tests.

Results

Of 382 radiology practitioners and interns, 230 (60.2%) responded to the survey. Notably, 42.6% of the participants reported experiencing GAD. Regarding burnout, 82.3% were at moderate-to-high risk for emotional exhaustion, 93.5% for depersonalization, and 52.1% for personal achievement. The 31-40 years age group showed significantly higher burnout rates (p = 0.001) compared with the other age groups. Those with more than three years of experience had notably higher emotional exhaustion scores (p = 0.002) and a nearly significant increase in depersonalization scores (p = 0.051) than those with less experience.

Discussion

Our study revealed that 42.6% of radiology practitioners and interns experienced GAD, with the majority facing significant burnout. Furthermore, our research indicates a decline in GAD levels among radiology practitioners and interns compared with the peak COVID-19 pandemic period. It also showed a significant increase in both the incidence and severity of burnout, surpassing pre-pandemic levels in a comparable cohort. These findings emphasize the pressing challenges of GAD and burnout among healthcare workers, especially radiology professionals.

Depression, anxiety and coping mechanisms among mental healthcare practitioners during COVID-19

Background

The coronavirus disease 2019 (COVID-19) pandemic has placed the psychological functioning of mental healthcare practitioners under severe strain. Coping methods may affect mental health outcomes.

Aim

The study examined the relationship between depression, anxiety, stress, and coping styles utilised by mental healthcare practitioners during the COVID-19 pandemic.

Setting

Three private and one public mental healthcare facility in Bloemfontein, South Africa.

Methods

Respondents completed the Depression, Anxiety and Stress Scale (DASS-21) and Brief Coping Orientation to Problems Experienced (Brief-COPE) inventories. An ordinal regression model was used to assess the relationship between coping styles, anxiety and depression.

Results

A total of 212 practitioners were included in the analysis. According to DASS-21 measures, approximately 41% and 28% of respondents had moderate to severe depressive and anxiety symptoms, respectively, with the highest prevalence among younger female respondents and nurses. The association between stress severity, anxiety and depression was significant. Avoidant coping methods and two approach coping strategies (planning and acceptance) were associated with depression and anxiety. Anxiety was linked to an increased likelihood of transitioning to higher avoidant categories, while participants with depression were less likely to move to higher avoidant or approach categories.

Conclusion

Mental healthcare practitioners, especially nurses, experienced significant COVID-19-related psychological distress during the pandemic. Avoidant coping mechanisms may increase the risk of poor mental health outcomes.

Contribution

This study added data on the mental health effects of COVID-19 on mental healthcare practitioners, as well as psychological methods used to cope during the pandemic.

Factors Associated with Stress among Healthcare Personnel after COVID-19 in Northeast Thailand: A Cross-sectional Study

Background

The coronavirus disease (COVID-19) has affected people psychologically worldwide, particularly healthcare personnel. Even though the COVID-19 pandemic situation has eased, healthcare personnel must still perform their duties, which has resulted in psychological impacts, particularly stress.

Objectives

This study aimed to examine the risk factors associated with stress among healthcare personnel post-COVID-19 pandemic in northeast Thailand.

Methods

A cross-sectional analytic design was conducted from January to April 2023. One thousand and three hundred healthcare workers were selected from primary, secondary, and tertiary hospitals across 16 districts within Chaiyaphum province. The questionnaires were used to collect data, and the stress test 5 (ST-5) questionnaire was used to investigate stress among healthcare personnel.

Results

The overall stress rate for healthcare workers was 15.47%, including very severe (8.85%) and severe (6.62%). The factors associated with stress consisted of work position, environment of work, personal life such as education level and income, and responsibility for taking care of family members, in addition to experiencing quarantine from COVID-19 were more likely to have a high risk of stress problems among healthcare workers.

Conclusion

This result highlighted that the mental health of personnel should be in critical situations, and those found severely afflicted should undergo professional care. To prevent psychological issues, particularly stress, health organizations should be concerned with strong organizational management, which includes supporting bonuses and providing high-quality personal protective equipment (PPE) to healthcare staff.

Evaluation of the mental health status of intensive care unit healthcare workers at the beginning of COVID-19 pandemic

Objective

During pandemic periods, mental health issues are highly prevalent, particularly among healthcare workers who are at a higher risk of developing psychiatric disorders. The aim of this study is to evaluate the mental health status of the intensive care unit (ICU) healthcare workers, who play a vital role in managing the COVID-19 pandemic, in terms of the quality of sleep, levels of depressive and anxiety symptoms, stress and to determine the factors that affect their mental health.

Methods

The research was conducted in April 2020 and incorporated a total of 79 participants working in an university hospital ICUs in Turkey. Pittsburgh Sleep Quality Index (PSQI), Depression Anxiety Stress Scale 42 (DASS-42), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI) were applied.

Results

Among the participants, 58 individuals comprising 73.4% of the cohort were working in the ICUs, managing patients infected with COVID-19. Those working in ICUs with COVID-19 patients had significantly higher DASS-S, BAI, and BDI scores. Doctors' BDI scores were significantly lower compared to both nurses and other healthcare workers. Participants exhibiting COVID-19 symptoms manifested significantly higher BAI scores in compared to those without such symptoms.

Conclusion

Healthcare workers involved in ICUs with COVID-19 patients were more significantly affected psychologically, doctors had lower depressive symptoms as compared to other healthcare workers. In addition, individuals with COVID-19 symptoms demonstrated significantly higher levels of anxiety. The findings of our study emphasize the significance of providing psychological support to healthcare workers throughout pandemics.

Women's mental health and COVID-19: increased vulnerability and inequalities

Introduction

The impact of COVID-19 on mental health has become a relevant object of research. Studies have demonstrated that women have experienced greater mental health challenges, highlighting the importance of public health systems to address women's specific needs.

Methods

This literature review explores the effects of the coronavirus pandemic on psychological distress among women, aiming to provide a comprehensive understanding of the subject and to explore how these research findings can guide public mental health care responses in crisis settings. A total of 131 studies were analyzed and four dimensions were discussed: study characteristics, factors impacting women's mental health in the pandemic setting, particularities of pregnancy and the postpartum period, and proposed interventions. Most studies exclusively addressed populations of adult women, predominantly during pregnancy and the postpartum period.

Results

Anxiety, depression, and stress were the most common outcomes. Lower education and income, preexisting mental health problems, and living alone or with children were risk factors for higher levels of anxiety and depression.

Discussion

A comprehensive care approach supported by public health policies and focused on intersectional factors, including race, socioeconomic status, and access to resources, is necessary to improve women's mental health care response in future crises.

Anxiety and stress among Vietnamese health workers during the emergence of the SARS-CoV-2 Omicron variant: a cross-sectional study

The prevalence and contributing factors of mental health issues among health workers in Vietnam during the early 2022 Omicron wave remain underexplored. This study investigated the prevalence and factors associated with anxiety and stress among health workers in a Vietnamese hospital during this period. A cross-sectional study, conducted from February 28 to April 14, 2022, at Hanoi Medical University Hospital, assessed anxiety and stress among 754 frontline health workers using the DASS-21 questionnaire via a Google survey. Logistic regression models were used to identify factors linked to anxiety and stress. Among healthcare workers, 22% experienced stress, and 33% anxiety. Multivariable logistic regression analysis revealed that direct contact with COVID-19 patients significantly increased the likelihood of experiencing stress (OR = 2.12, P < 0.01). Additionally, discrimination from relatives and friends was associated with higher odds of having anxiety (OR = 2.45, P < 0.001). Furthermore, a heavy workload significantly increased the odds of having anxiety (OR = 1.95, P < 0.001). Lastly, a lack of support from colleagues was linked to higher odds of experiencing stress (OR = 2.77, P < 0.05). The prevalence of mental health issues among Vietnamese health workers remained significant during the initial Omicron wave. Identified factors associated with these problems hold important policy implications for enhancing pandemic preparedness in Vietnam and worldwide.

Enhancing Sleep and Reducing Occupational Stress Through Forest Therapy: A Comparative Study Across Job Groups

OBJECTIVE

The coronavirus disease-2019 (COVID-19) pandemic radically shifted occupational patterns, leading to increased telecommuting and related stressors. Healthcare providers, among the most impacted group, faced heightened risks and workplace changes. Our study examined the efficacy of forest therapy in alleviating work-induced stress across various professions, exploring the need for profession-specific stress-relief strategies in the post-pandemic workplace.

METHODS

To examine the impact of COVID-19 on professionals, 62 participants were recruited, consisting of 20 healthcare providers, 21 information technology (IT) specialists, and 21 teachers. Instruments such as Pittsburgh Sleep Quality Index and Hospital Anxiety and Depression Scale, along with salivary tests for cortisol and melatonin, were used to assess the participants' sleep and stress levels. A specialized forest healing program was implemented among these participants. Data analysis was conducted using SPSS Win Ver. 22.0, utilizing paired t-tests and a repeated measures analysis of variance.

RESULTS

Significant improvements were observed in the participants' sleep metrics, depression scales, and stress levels after the forest healing program. Physiological measures indicated an increase in melatonin and a decline in cortisol and dehydroepiandrosterone sulfate levels, with only cortisol changes being statistically significant. Teachers, participating during school vacations, exhibited minimal stress-related physiological changes. Overall, the program demonstrated widespread health benefits regardless of occupation or gender.

CONCLUSION

This study showed that forest therapy reduced stress equally across professions, including healthcare providers, IT specialists, and teachers. Individual physiological responses may play a greater role in stress relief than the specific occupation.

Exploring views of South African research ethics committees on pandemic preparedness and response during COVID-19

South African research ethics committees (RECs) faced significant challenges during the COVID-19 pandemic. Research ethics committees needed to find a balance between careful consideration of scientific validity and ethical merit of protocols, and review with the urgency normally associated with public health emergency research. We aimed to explore the views of South African RECs on their pandemic preparedness and response during COVID-19. We conducted in-depth interviews with 21 participants from RECs that were actively involved in the review of COVID-19 related research, at seven academic institutions across South Africa. Interviews were conducted remotely using an in-depth interview guide that included questions regarding REC preparedness and response to COVID-19. Interviews were conducted until data saturation, and audio-recordings were transcribed verbatim and coded. An inductive approach to thematic analysis was used to organise data into themes and sub-themes. This study focused on three main themes: coping during COVID-19, building REC capacity during pandemic times and a consistently cautious approach to mutual recognition of REC reviews. Despite an initial sense of unpreparedness, RECs were able to adapt and maintain careful ethical oversight of both COVID and non-COVID research, and the rigour of REC reviews. Several important lessons for preparedness and response to future pandemics were identified, including heightened awareness of publication, funding and political pressures, the importance of regular training for RECs and researchers, and strategies to enhance moral resilience of REC members. Incremental steps are needed to build trust and authentic partnerships among RECs in inter-pandemic times, to facilitate collaboration during future public health emergencies.

Psychopathology symptoms of frontline nurses under sudden public health crisis: A network analysis

Public health crises can significantly impact the emotional well-being of healthcare workers. Network analysis is a novel approach to exploring interactions between mental disorders at the symptom level. This study aimed to elucidate the characteristics of post-traumatic stress disorder (PTSD), anxiety, depression, and insomnia symptoms network among frontline nurses under sudden public health crisis. A cross-sectional survey was conducted online among 556 frontline nurses through convenience sampling in Hubei Province, China, from 21 February 2020, to 10 March 2020. Symptoms of PTSD, anxiety, depression, and insomnia were assessed by the Post-Traumatic Stress Disorder Checklist (PCL-5), Generalized Anxiety Disorder scale (GAD-7), Patient Health Questionnaire (PHQ-9) and Insomnia Severity Index, respectively. Central symptoms (the most important symptoms, activation has the strongest influence the other nodes) and bridge symptoms (nodes where deactivation can prevent activation from spreading from one disorder to another) were identified via centrality and bridge centrality indices, respectively. Network stability was examined using the case-dropping procedure. We found that the correlation between PHQ-9 item 9 'suicidal thoughts' and PCL-5 item 16 'reckless or self-destructive behaviour' was the strongest. Moreover, 'reckless or self-destructive behaviour' was the strongest central symptom, and PHQ-9 item 3 'sleep problems' was the most important bridge symptom. Other major symptoms included GAD-7 item 6 'uncontrollable anxiety' and PHQ-9 item 2 'depressed or sad mood'. Timely, systemic targeting interventions on central symptoms and bridge symptoms may effectively alleviate co-occurring experiences of psychopathological symptoms among frontline nurses.

Hospital-Based Healthcare Workers' Experiences of Involvement in Perinatal Child Protection Processes: A Scoping Literature Review

As the number of infants entering Out-of-Home Care at birth internationally continues to rise, Hospital-based healthcare workers (HBHCWs) are increasingly likely to become involved in ethically, morally, and legally complex child protection processes. This scoping review aimed to identify and synthesize qualitative literature pertaining to the perspectives of HBHCWs with experiences of involvement in child protection processes occurring in the perinatal period. JBI Methodology for Scoping Reviews guided this review. Databases Ovid MEDLINE, CINAHL Plus, PsycINFO, ProQuest, Web of Science, SCOPUS, and Informit were searched between March 1 and April 30, 2023. Eighteen sources were identified as meeting the criteria for inclusion following screening by two independent reviewers. Data extracted from the included sources are presented in narrative and tabular formats. Involvement in child protection processes is an inherently conflictual experience for HBHCWs and gives rise to internal, interpersonal, and interorganizational tensions. Involvement can have an enduring impact on the HBHCWs, particularly when an infant is removed from hospital by child protection authorities. Appropriate peer, managerial, and organizational level responses are essential to ameliorate risk to HBHCWs themselves and subsequently their practice with women, infants, and families. HBHCWs can provide valuable insight into the challenges of delivering healthcare at the interface of child protection. Future research should focus on building understanding of experiences across disciplines to ensure that interventions designed to prepare and support HBHCWs are effective and evidence-based.

Sense of coherence moderates job demand-resources and impact on burnout among nurses and midwives in the context of the COVID-19 pandemic: A cross-sectional survey

AIM

This study aimed to test the propositions using the job demands-resources (JD-R) model for main/moderation/mediation effects of a sense of coherence and practice environment support on mental well-being (anxiety, depression and burnout) outcomes in nurses and midwives in Australia during the COVID-19 pandemic.

DESIGN

Cross-sectional quantitative survey.

DATA SOURCES

The study was a cross-sectional design using self-report questionnaires reported as per the Reporting of Observational Studies in Epidemiology Guidelines. Following human research ethics approval (2020.ETH.00121) participants were recruited to take part in an online anonymous survey using self-report instruments to test the JD-R model in Australia.

RESULTS

156 participant nurses and midwives experienced anxiety, depression and emotional burnout during COVID-19. While a considerable proportion of participants indicated high levels of emotional exhaustion, their responses showed low levels of depersonalization (detached response to other people) and high levels of personal accomplishment (high levels of work performance and competence). A sense of coherence was a significant protective factor for mental health well-being for the participants, which is to say, high levels of sense of coherence were predictive of lower levels of anxiety, depression and burnout in this study sample.

CONCLUSION

It is evident that both nursing and midwifery professions require psychosocial support to preserve their health both in the short and long term. Ensuring individualized tailored support will require a layered response within organizations aimed at individual self-care and collegial peer support.

PATIENT OR PUBLIC CONTRIBUTION

There was no patient or public contribution in this study, as the focus was on nurses and midwives.

Associations between maternal early pregnancy depression and longitudinal fetal growth

BACKGROUND

The impacts of maternal depression during mid-to-late pregnancy on fetal growth have been extensively investigated. However, the association between maternal depression during early pregnancy and fetal intrauterine growth are less clear.

METHODS

A prospective study comprised 23,465 eligible pregnant women and their offspring was conducted at a hospital-based center in Shanghai. Prenatal depression was assessed used using Patient Health Questionnaire (PHQ-9) before 14 gestational weeks. Differences in fetal growth trajectory of different maternal depressive statuses during three periods (16-23, 24-31, and 32-41 gestational weeks) were compared using a multilevel model with fractional polynomials.

RESULTS

Women with depressive symptoms during early pregnancy had higher longitudinal fetal trajectories, with an estimated increase in fetal weight (β = 0.33; 95 % CI, 0.06-0.61), compared to those without depressive symptoms. Increases in fetal abdominal circumference among women with depressive symptoms were observed before 23 gestational weeks. Offspring born to mothers with early pregnancy depression had a significantly higher birth weight of 14.13 g (95 % CI, 1.33-27.81 g) and an increased risk of severe large size for gestational age (adjusted odds ratio [aOR], 1.64; 95 % CI, 1.32-2.04) and macrosomia (aOR, 1.21; 95 % CI, 1.02-1.43).

LIMITATIONS

Self-rated scale was used to assess depressive symptoms rather than clinical diagnosis. And Long-term effects of early pregnancy depression on offspring were not explored.

CONCLUSIONS

The study revealed an association between maternal depression during early pregnancy and increased fetal biometrics, higher birth weight, and an elevated risk of severe large size for gestational age and macrosomia.

Learning, internalisation and integration of the COVID-19 pandemic in healthcare workers: A qualitative document analysis

The COVID-19 pandemic triggered an unprecedented health crisis that impacted healthcare systems worldwide. This study explores how Spanish healthcare workers learned, internalised and integrated values and work behaviours during the COVID-19 pandemic and their impact on the personal sphere. This documentary research, using images, narratives and audiovisual content, was framed within the interpretative hermeneutic paradigm. Categories and subcategories emerged after a final theoretical sampling that focused on the analysis. Data triangulation between researchers favoured theoretical saturation. A total of 117 images and 27 texts were selected. The analysis identified three stages: bewilderment, seeking functionality in the chaos and integrating chaos into care. The data reflects how the need for security and knowledge, and the exhaustion and frustration caused by the initial working conditions, prompted adaptive responses. These responses involved focusing on problem-solving and strengthening group sentiments and solidarity. Subsequently, the data indicates the acceptance of new structural, organisational and communication aspects. The findings of the analysis will contribute towards finding a framework that can help understand community health crisis events.

Lost in the pandemic: COVID-19's impact on health professions educators

BACKGROUND

Minimal research has explored the pandemic's impact on health professions educators (HPEs). Given that health professions educator academies provide centralised support and professional development to HPEs through communities of practice and promoting education at their institutions, it is important to examine how academies met HPEs' needs during the pandemic. This study investigates the COVID-19 pandemic's effects on HPEs and examines how academies supported HPEs' educational roles during the pandemic.

METHODS

Using a mixed-methods approach, the authors surveyed United States educator academy members on changes in HPEs' activities, emphasising clinical and educational tasks and work-life integration. Participants shared their academies' innovations and support responses. Data were analysed using chi-square and content analyses.

FINDINGS

Twenty percent of 2784 recipients (n = 559) completed the survey. Most respondents indicated the pandemic caused them to spend more time on clinical and education leadership/administration than before the pandemic. HPEs integrated innovative instructional strategies, yet many shifted away from teaching, mentoring and scholarship. Over half were dissatisfied with work-life integration during the pandemic. Females, especially, reported that professional work was compromised by personal caregiving. Academies increased their range of member services; however, they did not fully meet their members' needs, including providing expanded professional development and advocating on HPE's behalf for increased protected time dedicated to educator responsibilities.

DISCUSSION

HPEs faced unprecedented challenges in their personal and professional lives during the COVID-19 pandemic. Neglecting the needs of HPEs amidst global crises poses a substantial threat to the quality of education for upcoming generations of health care professionals.