Interventions to support the resilience and mental health of frontline health and social care professionals during and after a disease outbreak, epidemic or pandemic: a mixed methods systematic review

Augmentation of a Hospital Incident Command System to Support Continued Waves of the COVID-19 Pandemic

Stamford Hospital (SH) is a 305 bed Level II Trauma center located in Fairfield County, the epicenter of the coronavirus disease 2019 (COVID-19) pandemic in Connecticut. The COVID-19 pandemic was a fast paced, rapidly evolving crisis, presenting our leadership team with unique challenges related to resource availability, patient care, and staff safety. The existing Hospital Incident Command System (HICS) was activated in March 2020 to coordinate our operational emergency management planning, response, and recovery capability for this unplanned event. Although HICS lays the groundwork for hospital preparations and protocol implementation, it is not designed to withstand prolonged crisis circumstances. Given the conditions that the COVID-19 pandemic presented, the possibility for future waves became an impending reality, prompting the need for a long-term solution. To establish guidelines that promoted balance between necessary preparations in the case of additional surges of the pandemic and concurrent resumption then maintenance of routine hospital operations, the SH COVID-19 Playbook was created. The Playbook, presented here, is arranged in accordance with the evidence-based 4 S’s (Space, Staff, Systems, and Stuff) strategic critical care planning framework, to address surge capacity management within our hospital’s four main patient care areas and additional supportive services. Through feedback from frontline caregivers and leaders within SH, the Playbook captures our experience, best practices, and insight acquired during the first wave of the pandemic. Established with the intentions of equipping leadership and staff globally, guidelines are presented to aid in the navigation of future pandemic surges and successfully care for COVID-19 patients, ensure staff safety, allow for normal services to operate, and provide optimal communication and support for the community, patients, and staff.

Surviving the storm: A pragmatic non-randomised examination of a brief intervention for disaster-affected health and social care providers

Disasters affect the well-being of individuals, families and communities. Health and social care providers are essential in response and recovery efforts and are among the most vulnerable to negative physical and mental health impacts of a disaster. Few evidence-based interventions are available to address the psychological needs of providers. The aim of this study was to examine the psychological distress of health and social care providers before and after participating in the brief group intervention, Resilience and Coping for the Healthcare Community (RCHC) and its expanded version, RCHC+. We conducted a pragmatic non-randomised cluster trial with 762 health and social care providers in south Texas and Puerto Rico post-Hurricanes Harvey and Maria. Participants completed surveys assessing post-traumatic stress (PTSD), anxiety, burnout and secondary traumatic stress (STS) prior to intervention delivery and at two time points post-intervention. We calculated the frequency of symptom cut-off scores at baseline, then estimated multilevel ordinal models to examine changes in symptoms across time. Prior to participation in the RCHC (approximately 12 months after the hurricanes), providers reported high levels of PTSD, anxiety and STS symptoms. After participation, providers in both intervention conditions reported a significant reduction in PTSD symptoms from baseline that was sustained over both time points. The likelihood of a reduction in symptoms of anxiety and STS from baseline was sustained at both time points for participants in the RCHC+ condition. These findings indicate that both the RCHC and RCHC+ interventions may reduce psychological distress for health and social care providers and could be an important part of advance planning to support provider's mental health during and after a disaster. Further examination of the RCHC in other disaster contexts could provide additional insight into the responsiveness of the intervention to reducing psychological distress symptoms.

Workplace factors can predict the stress levels of healthcare workers during the COVID-19 pandemic: First interim results of a multicenter follow-up study

Background

Research is lacking on the long-term influence of workplace factors on the mental health of health care workers during the COVID-19 pandemic.

Methods

We distributed two online surveys to health care workers between May and October 2020 (T1) and between February and April 2021 (T2). Perceived stress, coronavirus-related risks, and workplace factors were measured via self-report questionnaires at both time points. We conducted hierarchical linear regression to investigate the predictive factors for high stress.

Results

A total of 2,110 participants from seven countries and 4,240 participants from nine countries were enrolled at T1 and T2, respectively. Among them, 612 participated in both surveys. We called this cohort T1 + T2. High stress was reported in 53.8 and 61.6% of participants at T1 and T2, respectively. In cohort T1 + T2, compared with the baseline, the level of stress rose significantly (6.0 ± 2.9 vs. 6.4 ± 3.1), as did health/safety in the workplace (3.9 ± 0.8 vs. 4.2 ± 0.7). Unfortunately, we did not detect any significant difference concerning support in the workplace. Among all factors at baseline, being older than 35 [β (95% CI) = -0.92 (-1.45, -0.40)], support [-0.80 (-1.29, -0.32)], and health/safety in the workplace [-0.33 (-0.65, -0.01)] were independent protective factors, while a positive history of mental disorders [0.81 (0.26, 1.37)] and rejection in private life [0.86 (0.48, 1.25)] were risk factors for high stress at T2.

Conclusion

To relieve the high stress of health care workers, organizational-level approaches should be implemented, especially measures designed to enhance support, health/safety in the workplace, and to reduce the rejection of the public.

How things changed during the COVID-19 pandemic's first year: A longitudinal, mixed-methods study of organisational resilience processes among healthcare workers

COVID-19 had a huge impact on healthcare systems globally. Institutions, care teams and individuals made considerable efforts to adapt their practices. The present longitudinal, mixed-methods study examined a large sample of healthcare institution employees in Switzerland. Organisational resilience processes were assessed by identifying problematic real-world situations and evaluating how they were managed during three phases of the pandemic's first year. Results highlighted differences between resilience processes across the different types of problematic situations encountered by healthcare workers. Four configurations of organisational resilience were identified depending on teams' performance and ability to adapt over time: "learning from mistakes", "effective development", "new standards" and "hindered resilience". Resilience trajectories differed depending on professional categories, hierarchical status and the problematic situation's perceived severity. Factors promoting or impairing organisational resilience are discussed. Findings highlighted the importance of individuals', teams' and institutions' meso- and micro-level adaptations and macro-level actors' structural actions.

A Narrative Inquiry into the Practices of Healthcare Workers' Wellness Program: The SEED Experience in New South Wales, Australia

The 2019-2020 Australian bushfires followed by the COVID-19 pandemic brought the significant mental health implications of working in healthcare to the fore. The importance of appropriate support services to ensure the resilience and recovery of healthcare workers has been highlighted. In response to healthcare staff experiences during the bushfires, the SEED Wellness Program was created in 2020 in the Illawarra Shoalhaven Local Health District in New South Wales, Australia. SEED used a participant-led design to engage healthcare staff in workplace-based restorative activities. Guided by practice theory, this study aimed to identify and describe SEED wellness practices that supported healthcare staff. Thirty-three healthcare workers participated in focus groups or individual interviews between June 2021 and March 2022. The analysis involved inductive thematic individual and collective exploration of SEED practices, including co-analysis with participants. Eight core practices that supported participants' wellbeing were identified, including responsive and compassionate leading, engaging staff at every stage of the recovery process, creating a sense of connection with others, and collective caring. The study found that workplace wellness initiatives are optimised when they are place-based and grounded in local knowledge, needs, and resources incorporating a collective and supportive team approach. Moreover, to ensure engagement in, and sustainability of these initiatives, both bottom-up and top-down commitment is required.

E-Health Psychological Intervention for COVID-19 Healthcare Workers: Protocol for its Implementation and Evaluation

(1) Background: Healthcare workers have been affected by the COVID-19 pandemic. Digital interventions have been carried out that have been effective with this population; however, few have been reported in Latin America. Our aim is to describe the components and methods to evaluate the feasibility and utility of an online multi-component psychological intervention for healthcare workers in Mexico during COVID-19. (2) Methods: This study is a randomized clinical trial with two arms: (1) self-applied intervention and (2) intervention delivered online by therapists. The participants are randomly assigned to one arm, receiving the same treatment contents in both groups. The "Personal COVID" intervention consists of an internet platform containing 9 nuclear and 3 complementary modules. The objectives of the intervention are: (1) to reduce anxiety, depressive symptoms, burnout, and compassion fatigue, and (2) to increase the quality of life, sleep quality, self-care, and their skills to give bad news. The protocol has been registered on ClinicalTrials.gov (identifier: NCT04890665). (3) Discussion: This protocol is designed according to the highest scientific standards following the SPIRIT guidelines. The "Personal COVID" intervention is expected to be of high efficacy in treating the emotional distress of healthcare workers and promoting their health during the COVID-19 pandemic.

Development and Cultural Adaptation of Psychological First Aid for COVID-19 Frontline Workers in American Indian/Alaska Native Communities

The coronavirus disease 19 (COVID-19) pandemic is broadly affecting the mental health and well-being of people around the world, and disproportionately affecting some groups with already pre-existing health inequities. Two groups at greater risk of physical and/or mental health detriments from COVID-19 and more profoundly impacted by the pandemic include frontline workers and American Indian/Alaska Native (AI/AN) communities. To provide support and prevent long-term mental health problems, we culturally adapted a psychological first aid guide specifically for COVID-19 frontline workers serving AI/AN communities. We engaged a diverse, collaborative work group to steer the adaptation content and process. We also held two focus group discussions with frontline workers in AI/AN communities to incorporate their perspectives into the adapted guide. Results from the group discussions and the collaborative work group were compiled, analyzed to extract themes and suggestions, and integrated into the adapted content of the guide. Main adaptations included updating language (i.e., to be more culturally appropriate, less prescriptive, and less text heavy), framing the guide from a harm-reduction lens, incorporating cultural activities, values, and teachings common across diverse AI/AN communities (e.g., importance of being a good relative), and validating feelings and experiences of frontline workers. The resulting adapted guide includes four modules and is available as a free online training. Our adaptation process may serve as a guiding framework for future adaptations of similar resources for specific groups. The adapted guide may stand as an enduring resource to support mental well-being, the prevention of mental health problems, and reduction of health inequities during the pandemic and beyond.

Stress and Resilient Coping among Nurses: Lessons Learned from the COVID-19 Pandemic

(1) Background: the COVID-19 pandemic is still taking over the world, and with new virus strains, the burden on the health systems and healthcare teams is yet to end. The study explored stress and employed resilient coping measures among nurses working with COVID-19 patients. (2) Methods: the current study used a convergent triangulation design using a qualitative and quantitative approach, with a sample of 113 nurses working at Beni-Suef University Hospital between November 2021 and April 2022 using an online form. Data were collected using a sociodemographic characteristics questionnaire, the Nursing Stress Scale, Brief Resilient Coping Scale, and a qualitative interview. (3) Results: the studied nurses experienced severe stress, with moderate-to-low resilient coping in total. There was a strong negative highly statistically significant correlation between stress and coping. Qualitative data analysis showed that attention to the spiritual side, communicating with friends and family, accepting the current situation, and helping others in need were key themes that emerged to moderate studied nurses’ stress. (4) Conclusions: nurses who work with COVID-19 patients experience high levels of stress regardless of their characteristics; spiritual coping strategies, communication with family, and helping others were the dominant resilient coping approaches employed by nurses to moderate stress.

Examining the Effectiveness of Web-Based Interventions to Enhance Resilience in Health Care Professionals: Systematic Review

BACKGROUND

Internationally, the impact of continued exposure to workplace environmental and psychological stressors on health care professionals' mental health is associated with increased depression, substance misuse, sleep disorders, and posttraumatic stress. This can lead to staff burnout, poor quality health care, and reduced patient safety outcomes. Strategies to improve the psychological health and well-being of health care staff have been highlighted as a critical priority worldwide. The concept of resilience for health care professionals as a tool for negotiating workplace adversity has gained increasing prominence.

OBJECTIVE

This systematic review aims to examine the effectiveness of web-based interventions to enhance resilience in health care professionals.

METHODS

We searched the PubMed, CINAHL, PsycINFO, and Ovid SP databases for relevant records published after 1990 until July 2021. We included studies that focused on internet-delivered interventions aiming at enhancing resilience. Study quality was assessed with the Risk of Bias 2 tool for randomized controlled trial designs and Joanna Briggs Institute critical appraisal tool for other study designs. The protocol was registered on PROSPERO (International Prospective Register of Systematic Reviews; CRD42021253190). PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed.

RESULTS

A total of 8 studies, conducted between 2014 and 2020 and involving 1573 health care workers, were included in the review. In total, 4 randomized controlled trial designs and 4 pre- and postdesign studies were conducted across a range of international settings and health care disciplines. All of these studies aimed to evaluate the impact of web-based interventions on resilience or related symptoms in health care professionals involved in patient-facing care. Interventions included various web-based formats and therapeutic approaches over variable time frames. One randomized controlled trial directly measured resilience, whereas the remaining 3 used proxy measures to measure psychological concepts linked to resilience. Three pretest and posttest studies directly measured resilience, whereas the fourth study used a proxy resilience measure. Owing to the heterogeneity of outcome measures and intervention designs, meta-analysis was not possible, and qualitative data synthesis was undertaken. All studies found that resilience or proxy resilience levels were enhanced in health care workers following the implementation of web-based interventions. The overall risk of bias of all 8 studies was low.

CONCLUSIONS

The findings indicate that web-based interventions designed to enhance resilience may be effective in clinical practice settings and have the potential to provide support to frontline staff experiencing prolonged workplace stress across a range of health care professional groups. However, the heterogeneity of included studies means that findings should be interpreted with caution; more web-based interventions need rigorous testing to further develop the evidence base.

TRIAL REGISTRATION

PROSPERO CRD42021253190; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=253190.

Effectiveness of a Mindful Compassion Care Program in reducing burnout and psychological distress amongst frontline hospital nurses during the COVID-19 pandemic: a study protocol for a randomized controlled trial

BACKGROUND

Recent studies have shown that nurses have been more affected by the COVID-19 pandemic than any other group of hospital workers in terms of anxiety, depression, and burnout. Several clinical studies had previously demonstrated the effectiveness of mindfulness and compassion interventions in reducing burnout and emotional distress amongst healthcare professionals.

METHODS AND ANALYSIS

A parallel-group randomized controlled trial will assess the feasibility, acceptability, and efficacy of a mindfulness and compassion-focused programme on frontline nurses who had been working during the COVID-19 pandemic. Seventy-two participants will be recruited from Verona University Hospital Trust (Veneto Region, north-east Italy) and will be divided equally into an intervention group and a control group. Primary outcome will be assessed using the Emotional Exhaustion subscale of the Maslach Burnout Inventory General Survey (MBI-GS). Secondary outcomes will be measured by the Cynicism and Professional Efficacy subscales of the MBI-GS, the Patient Health Questionnaire (PHQ-9), the Generalized Anxiety Disorder (GAD-7), the Insomnia Severity Index (ISI), the Impact of Stressful Events (IES-R), the Perceived Stress Scale (PSS), the Five Facet Mindfulness Questionnaire (FFMQ), and the Forms of Self-Criticising/attacking and Self-Reassuring Scale (FSCRS).

DISCUSSION

The study aims to fill a gap in the literature and present a scientifically validated intervention for those healthcare professionals most exposed to the stressful conditions of working during the COVID-19 pandemic.

TRIAL REGISTRATION

ClinicalTrials.gov; Identifier: NCT05308537.

Effects of the COVID-19 Crisis on Resident Well-Being in a Community Teaching Hospital

OBJECTIVES

The coronavirus disease 2019 (COVID-19) pandemic has been an unexpected crisis that continues to challenge the medical community at large. Healthcare environments have been forced to change dramatically, including for medical residents, who are vital members of the innovative emergency response teams. Articles have previously been published on the effects of crises on the well-being of healthcare practitioners; however, there is a paucity of literature targeting medical residents' experiences and general wellness during devastating events. The objective of our study aimed at understanding the emotional impact of the COVID-19 pandemic on residents' stress, academics, and support systems.

METHODS

An anonymous, voluntary Likert scale questionnaire was sent via SurveyMonkey to Internal Medicine and Family Medicine residents in July 2020. Questions focused on residents' mood; stress levels; sense of support; and academics before, during, and immediately after the first surge of COVID-19 at our hospital between March 13 and June 15, 2020.

RESULTS

Residents felt sad, stressed, and overworked during the first wave, as opposed to feelings of neutrality and happiness before and immediately after. Levels of concern for personal and loved ones' safety were significantly increased during and after our first wave. The impact on educational training was rated as neutral. Residents noted that institutional support could be improved by the provision of wellness activities and sponsored social events.

CONCLUSIONS

This study provides insight on resident well-being during the initial months of the pandemic and identifies areas that could be improved. Our results demonstrated that the pandemic affected many aspects of residents' well-being and education, and the lessons learned can help guide healthcare institutions when implementing wellness activities for trainees during subsequent crises.

Emotional exhaustion and unhealthy eating among COVID-19 front-line healthcare workers during recuperation: A cross-sectional study

Objective

Thousands of healthcare workers on the frontlines who have been battling the COVID-19 pandemic could face emotional and mental health risks even after their critical pandemic work. This study examined the impact of affective rumination on emotional exhaustion and the spillover effect of affective rumination on unhealthy food consumption among healthcare workers during recuperation.

Methods

A total of 418 frontline healthcare workers from 10 Chinese medical institutions were recruited through random cluster sampling. A linear mixed model in SPSS25.0 was performed for hierarchical regression to analyze the effect of affective rumination on unhealthy food consumption via emotional exhaustion. A conditional process analysis was employed to investigate the moderating role of family support in the mediating effect of emotional exhaustion.

Results

Front-line healthcare workers scored at a medium level on an emotional exhaustion scale (2.45 ± 0.88). Affective rumination mediated by emotional exhaustion had a significant positive predictive effect on unhealthy food consumption. The indirect effect accounted for ~43.9% of the total effect. Family support amplified the effect of emotional exhaustion on unhealthy food consumption (β = 0.092, p < 0.05).

Conclusion

Affective rumination could be a cause of emotional exhaustion and unhealthy food consumption. First-line healthcare workers could be screened for possible emotional exhaustion through the evaluation of affective rumination in order to provide them with targeted interventions. Family support did not prove to be beneficial in all cases as it enhanced the positive effect of emotional exhaustion on unhealthy eating in the current study. Therefore, family support should be carefully integrated in future interventions.

Willingness to Work during Public Health Emergencies: A Systematic Literature Review

The identification of the factors underlying the willingness or lack thereof to respond to public health emergencies is paramount to informing more capable health services. The interest in this topic appears renewed with each surge of threat, either referring to natural disasters, man-made violence, or epidemic and pandemics. However, there is no systematic approach to the research patterns and related main findings concerning individual and contextual determinants. The present article contributes to this theme through a systematic literature review of a sample of 150 articles published in the last 30 years on the subject of willingness and preparedness of health professionals to deal with public health threats. Our findings show that the research is mainly phenomena and contextual driven, responding to whichever emergency threat is more salient in a given period. Geographically, research on this topic is led by USA and China, mostly solely, while European countries invest in collaborations that are more international. Universities, including health institutes and schools, and researchers at hospitals conduct most of the research on the topic. The main research areas are medicine, psychology, and psychiatry. Pandemics, including COVID-19, influenza, and natural disasters, are the phenomena gauging more attention as opposed to terrorism events and biological accidents. The specific role of health professionals within the institution, their belief in ethical duties, preparation training, and concerns regarding infection of self and family are the main variables influencing the willingness and ability to report to work in public health emergencies.

COVID-19 Lockdown in New Zealand: Perceived Stress and Wellbeing among International Health Students Who Were Essential Frontline Workers

This study examined the stresses and wellbeing of international postgraduate health and nursing students at a tertiary education institute in New Zealand who were mainly essential frontline healthcare workers during the COVID-19 lockdown. Quantitative and qualitative data were collected by purposeful sampling (n = 43). The study utilised a cross-sectional survey, along with the Short Form of Cohen's Perceived Stress Scale (PSS-10), adapted for the COVID-19 lockdown, and followed by semi-structured individual interviews. This study is the first in New Zealand to demonstrate that, with a mean PSS-10 score of 21.7 (±7.1), international health students experienced higher than optimal levels of stress, with supporting qualitative data identifying four themes for the sources of stress: (1) familial relationships, (2) essential work, (3) finances, and (4) study. However, these students coped because of the extensive support provided by their education institute and employers. These students played a critical role in the pandemic's response and made a significant public health contribution by working in the frontline of the COVID-19 outbreak. Considering the global shortage of healthcare workers and understanding the key challenges, means of coping and support provisions, as we have here, offer insights for building and maintaining a resilient and resourceful health workforce through international health and nursing students in New Zealand and elsewhere.

Are Organizational Interventions Effective in Protecting Healthcare Worker Mental Health during Epidemics/Pandemics? A Systematic Literature Review

It is unclear how to effectively protect healthcare workers' mental health during infectious disease epidemics. Targeting the occupational determinants of stress may hold more promise than individual stress management, which has received more focus. Through a systematic review of the 2000-2021 English- and French-language scientific literature, we evaluated the effectiveness of organizational and psychosocial work environment interventions to protect healthcare workers' mental health in an epidemic/pandemic context. Evidence from medium- and high-quality studies was synthesized using GRADE. Among 1604 unique search results, 41 studies were deemed relevant, yielding 34 low-quality and seven medium-quality studies. The latter reported on promising multi-component prevention programs that combined staffing adjustments, work shift arrangements, enhanced infection prevention and control, recognition of workers' efforts, psychological and/or logistic support during lockdowns (e.g., accommodation). Our confidence in the effectiveness of reviewed interventions is low to very low, however, owing to methodological limitations. We highlight gaps in the reporting of intervention process and context elements and discuss theory and implementation failure as possible explanations for results. We conclude by urging authors of future studies to include and document detailed risk assessments of the work environment, involve workers in solution design and implementation and consider how this process can be adapted during an emergency.

Public health emergency and psychological distress among healthcare workers: a scoping review

Background

Pandemics and natural disasters are immensely stressful events for frontline healthcare workers, as they provide patient care to a population undergoing the impacts of the disaster while experiencing such impacts to their personal lives themselves. With increased stressors to an already demanding job, frontline healthcare workers are at a higher risk of adverse effects to their mental health. The current COVID-19 pandemic has already shown to have had significant impact on the mental health of healthcare workers with increased rates of burnout, anxiety and depression. There is already literature showing the utility of individual programs at improving mental health, however, interventions at the organizational level are not well explored. This scoping review aims to provide an overview and determine the utility of a systematic review of the current body of literature assessing the effectiveness of mental health interventions at the organizational level for healthcare workers during or after a public health emergency.

Methods

Electronic databases such as Medline on OVID, CENTRAL, PsycINFO on OVID and Embase on OVID were searched. A targeted search of the grey literature was conducted to identify any non-indexed studies. The population, concept and context approach was used to develop the eligibility criteria. Articles were included if (1) they assessed the impact of interventions to improve wellbeing or reduce the distress on healthcare personnel, first responders or military actively providing medical care; (2) provided quantitative or qualitative data with clearly defined outcomes that focused on established mental health indicators or qualitative descriptions on distress and wellbeing, validated scales and workplace indicators; (3) focused on organizational level interventions that occurred in a public health crisis.

Results

The literature search resulted in 4007 citations and 115 potentially relevant full-text papers. All except 5 were excluded. There were four review articles and one experimental study. There were no other unpublished reports that warranted inclusion.

Conclusions

There is a distinct lack of research examining organizational interventions addressing mental resilience and well-being in healthcare workers in disaster settings. A systematic review in this area would be low yield. There is a clear need for further research in this area.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13761-1.

Mental Health Support for Hospital Staff during the COVID-19 Pandemic: Characteristics of the Services and Feedback from the Providers

French authorities created mental health support services to accompany HCWs during the pandemic. We aimed to obtain feedback from staff providing these mental health support services within French hospitals to identify positive and negative features and avenues for improvement. A mixed-methods study was performed between 1 April and 30 June 2020. We contacted 77 centres to identify those providing mental health support services. We developed a questionnaire containing questions about the staff providing the service (quantitative part), with open questions to enable feedback from service providers (qualitative part). Of the 77 centres, 36 had mental health support services; 77.8% were created specifically for the epidemic. Services were staffed principally by psychologists, mainly used a telephone platform, and had a median opening time of 8 h/day. Thirty-seven professionals provided feedback, most aged 35-49 years. For 86.5%, it was their first time providing such support. Median self-reported comfort level was 8 (interquartiles 3-10), and 95% would do it again. Respondents reported (i) difficulties with work organisation, clinical situations, and lack of recognition and (ii) a desire for training. This study suggests that mental health support needs to be adapted to the needs of HCWs, both in terms of the content of the service and the timing of delivery.

Characteristics of Hospital Workers Using a Wellbeing Center Implemented During the COVID-19 Pandemic to Prevent the Emotional Impacts of the Crisis

Introduction

The COVID-19 pandemic has posed an unprecedented challenge worldwide for healthcare workers (HCWs) and other hospital employees. Disruptions in work and personal life may have led to mental health problems. To prevent or limit the severity of such issues, a local initiative has been implemented in a French hospital: a dedicated lounge, also called “Bulle” (literally bubble and meaning safe space) has been created to provide a quiet caring environment and health support. Other similar wellbeing centers have been implemented in other countries, but very little data are available on their practical effectiveness. The purpose of our study was to assess what type of hospital workers have frequented the Bulle and to describe their psychological state in terms of anxiety, depression, and post-traumatic stress disorder (PTSD) just after the first wave, compared to those who had not come to the Bulle.

Methods

From 15 July to 1 October 2020, a cross-sectional survey was conducted among all workers, collecting demographic information, professional data (experience and satisfaction), emotional experience during the first wave of COVID-19, and psychological specificities, including a history of burnout or symptoms of anxiety, depression, and PTSD. We asked them if they had accessed the Bulle or not.

Results

A total of 675 employees (out of 2,408; 28.0%) fully completed the survey. Approximately 199 respondents (29%) reported having accessed the Bulle during the first wave of the pandemic. Significant symptoms of anxiety, depression, and PTSD were reported by, respectively, 41, 20, and 14% of the participants. Logistic regression analysis showed no relationship between the use of the Bulle and the prevalence of later psychological symptoms. However, employees who benefit from the solicitation of the psychological support team in their hospital unit were secondarily more prone to come to the Bulle [odds ratio (OR), 2.24; 95% confidence interval (95% CI): 1.09; 4.59].

Conclusion

Anxiety, depression, and PTSD were common after the first part of the COVID-19 pandemic, and the attendance in quiet and wellbeing spaces seemed easier with direct internal proactive intervention by psychological teams.

Assessment of Resilience Training for Hospital Employees in the Era of COVID-19

IMPORTANCE

Health care workers face serious mental health challenges as a result of ongoing work stress. The COVID-19 pandemic exacerbated that stress, resulting in high rates of anxiety, depression, and burnout. To date, few evidence-based programs targeting mental health outcomes in health care workers have been described.

OBJECTIVE

To assess the feasibility, acceptability, and preliminary outcomes of a skills-based coaching program designed to reduce stress and build resilience.

DESIGN, SETTING, AND PARTICIPANTS

A pilot cohort study was conducted between September 2020 and April 2021 using preprogram and postprogram assessments and a mixed-methods analysis. Duration of follow-up was 7 weeks. The coaching program was delivered via video conferencing. Participants were health care workers and staff from a large urban health system.

INTERVENTION

The Promoting Resilience in Stress Management (PRISM) program, a manualized, skills-based coaching program originally developed for adolescents and young adults with serious/chronic illness, was adapted to support health care workers and staff ("PRISM at Work"). It included 6 weekly 1-hour group sessions.

MAIN OUTCOMES AND MEASURES

Feasibility was defined a priori as 70% completion rates. Acceptability was defined quantitatively (satisfaction scores) and qualitatively (open-ended questions regarding experience with program). Preliminary outcomes were assessed with preprogram and post program assessments of self-reported resilience, stress, anxiety, and burnout using validated instruments. Descriptive statistics summarized demographic variables and feasibility and acceptability. Linear mixed effects regression models examined preliminary outcomes, controlling for relevant covariates.

RESULTS

A total of 153 participants (median [SD] age, 40.6 [10.1] years; 142 [92%] were female; 128 [84%] identified as having White race; 81 [53%] were in patient-facing roles) enrolled. Of the 132 health care workers who provided follow-up surveys, 120 (91%) had completed the program, and 116 (88%) reported being satisfied. Answers to open-ended questions suggested that participants wanted more PRISM either with longer or additional sessions. Participant-reported resilience (β = 1.74; 95% CI, 1.00-2.48), stress (β = -2.40; 95% CI, -3.28 to -1.51), anxiety (β = -2.04; 95% CI, -2.74 to -1.34), and burnout-exhaustion (β = -0.37; 95% CI, -0.56 to -0.18) improved after the program.

CONCLUSIONS AND RELEVANCE

Results of this study suggest that PRISM at Work may have utility for health care workers and staff in that the program was found to be feasible, acceptable, and associated with improved outcomes.

COVID-19-Related Trajectories of Psychological Health of Acute Care Healthcare Professionals: A 12-Month Longitudinal Observational Study

The COVID-19 pandemic hit healthcare professionals (HCPs) hard, potentially leading to mental health deterioration. This longitudinal study investigated the 1-year evolution of psychological health of acute care HCPs during the COVID-19 pandemic and explored possible differences between high and low resilient HCPs. From April 2020 to April 2021, a convenience sample of 520 multinational HCPs completed an online survey every 3 months, up to five times. We used mixed linear models to examine the association between resilience and the variation of COVID-19-related anxiety, depressiveness, perceived vulnerability, and psychological trauma symptomatology. We demonstrated "u-shaped" trajectories for all mental health symptoms. We also explored differences in the abovementioned variables between front-line and second-line acute care HCPs. In contrast to HCP.s with lower levels of resilience (-1SD), those with higher levels of resilience (+1SD) showed increased COVID-19 anxiety and perceived vulnerability over time. Front-line and second-line HCPs differed in their depressiveness and psychological trauma variation during the 1-year analysis. High and average resilient second-line HCPs showed steeper depressiveness increases with time than high and average resilient front-line HCPs. Acute care HCPs reported their most elevated clinical symptoms of depressiveness (5-7%) and psychological trauma symptomatology (26-46%) in April 2020. During the first year of the COVID-19 pandemic, second-line HCPs with more resilience showed a steeper worsening of their depressiveness than more resilient front-line HCPs. HCPs with low resilience may benefit from interventions at the beginning of a pandemic, whereas HCPs with high resilience might benefit from resilience-enhancing interventions at later phases.

Trial Registration

The study protocol was pre-registered with the International Standard Randomised Controlled Trial Number (ISRCTN13694948) published (Fuchs et al., 2020).

Sustainable Leadership, Environmental Turbulence, Resilience, and Employees' Wellbeing in SMEs

Drawing on the conservation of resources theory and contingency theories of leadership, this study aims to investigate how sustainable leadership (SL) influences employees' wellbeing (WB) through employee resilience (ER) and to examine the moderating effect of environmental turbulence (ET) on the “sustainable leadership-employees' wellbeing” relationship. Data were collected from 593 employees and 373 supervisors adopting two-wave design among small and medium-sized enterprises (SMEs) in China. The authors used structural equation modeling to empirically test the hypothesized model in this study. The research shows that SL is significantly related to the employees' WB in SMEs. Regarding mediating effect, SL also indirectly influences employees' WB through ER. Moreover, the impact of SL on employees' WB becomes more prominent in the presence of lower ET. To the best of the authors' knowledge, no prior study is available about the integrated relationship of SL, ER, ET, and employee WB.

Dimensions of emotional distress among Brazilian workers in a COVID-19 reference hospital: A factor analytical study

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic is an unprecedented challenge for public health and has caused the loss of millions of lives worldwide. Hospital workers play a key role in averting the collapse of the health system, but the mental health of many has deteriorated during the pandemic. Few studies have been devoted to identifying the needs of workers on frontline duty.

AIM

To investigate dimensions of common emotional symptoms and associated predictors among Brazilian workers in a COVID-19 reference hospital.

METHODS

This is an observational study of the mental health of professionals in a COVID-19 hospital in the city of São Paulo. We invited all hospital employees to respond to an online survey between July and August 2020, during the first peak of the pandemic. Data of 1000 participants who completed the survey were analyzed (83.9% were women and 34.3% were aged 30 to 40). Hospital workers self-reported the presence of symptoms of depression, anxiety, trauma-related stress, and burnout through the Patient Health Questionnaire-9, the Generalized Anxiety Disorder-7, the Impact of Event Scale-Revised and the Mini-Z Burnout Assessment respectively. Responses were assembled and subjected to exploratory factor analysis to reveal workers’ core emotional distress. Multiple linear regression models were subsequently carried out to estimate the likelihood of dimensions of distress using questions on personal motivation, threatening events, and institutional support.

RESULTS

Around one in three participants in our sample scored above the threshold of depression, anxiety, post-traumatic stress disorder, and burnout. The factor analysis revealed a three-factor structure that explained 58% of the total data variance. Core distressing emotional domains were avoidance and re-experience, depression-anxiety, and sleep changes. Regression analysis revealed that institutional support was a significant protective factor for each of these dimensions (β range = -0.41 to -0.20, P < 0.001). However, participants’ personal motivation to work in healthcare service was not associated with these emotional domains. Moreover, the likelihood of presenting the avoidance and re-experience dimension was associated with having a family member or close friend be hospitalized or die due to COVID-19 and having faced an ethical conflict.

CONCLUSION

Distressing emotional domains among hospital workers were avoidance and re-experience, depression and anxiety, and sleep changes. Improving working conditions through institutional support could protect hospital workers' mental health during devastating public health crises.

How Can We Help Healthcare Workers during a Catastrophic Event Such as the COVID-19 Pandemic?

Healthcare workers (HCWs) have significantly suffered during the COVID-19 pandemic, reporting a high prevalence of anxiety, depression and post-traumatic stress disorder (PTSD). We investigated with this survey whether HCWs benefitted from supportive measures put in place by hospitals and how these measures were perceived. This cross-sectional survey, which was conducted during the first wave of COVID-19 at the Geneva University Hospitals, Switzerland, between May and July 2021, collected information on the use and perception of practical and mental health support measures provided by the hospital. In total, 3461 HCWs participated in the study. Regarding the practical support measures, 2896 (84%) participants found them useful, and 2650 (76%) used them. Regarding the mental health support measures, 3149 (90%) participants found useful to have the possibility of attending hypnosis sessions, 3163 (91%) to have a psychologist within hospital units, 3202 (93%) to have a medical nursing psychiatric permanence available seven days a week, and 3171 (92%) to have a hotline available seven days a week. In total, 436 (13%) HCWs used at least one of the available mental health support measures. During the COVID-19 pandemic, the support measures were valued by HCWs. Given the high prevalence of psychiatric issues among HCWs, these measures seem necessary and are likely to have alleviated the suffering of HCWs.

Job stress among workers who telecommute during the coronavirus disease (COVID-19) pandemic in Japan: a cross-sectional study

OBJECTIVES

The work system reform and the COVID-19 pandemic in Japan have prompted efforts toward telecommuting in Japan. However, only a few studies have investigated the stress and health effects of telecommuting. Therefore, this study aimed to clarify the relationship between telecommuting and job stress among Japanese workers.

MATERIAL AND METHODS

This was a cross-sectional study. In December 2020, during the "third wave" of the COVID-19 pandemic, an Internet-based nationwide health survey of 33 087 Japanese workers (The Collaborative Online Research on Novel-coronavirus and Work, CORoNaWork study) was conducted. Data of 27 036 individuals were included after excluding 6051 invalid responses. The authors analyzed a sample of 13 468 office workers from this database. The participants were classified into 4 groups according to their telecommuting frequency, while comparing scores on the subscale of the Job Content Questionnaire (JCQ) and subjective job stress between the high-frequency, medium-frequency, low-frequency, and non-telecommuters groups. A linear mixed model and an ordinal logistic regression analysis were used.

RESULTS

A significant difference in the job control scores of the JCQ among the 4 groups was found, after adjusting for multiple confounding factors. The high-frequency telecommuters group had the highest job control score. Further, after adjusting for multiple confounding factors, the subjective job stress scores of the high- and medium-frequency telecommuters groups were significantly lower than those of the non-telecommuters group.

CONCLUSIONS

This study revealed that high-frequency telecommuting was associated with high job control and low subjective job stress. The widespread adoption of telecommuting as a countermeasure to the public health challenges associated with the COVID-19 pandemic may also have a positive impact on job stress. Int J Occup Med Environ Health. 2022;35(3):339-51.

Symptoms of Anxiety, Depression, and Post-Traumatic Stress Disorder in Health Care Personnel in Norwegian ICUs during the First Wave of the COVID-19 Pandemic, a Prospective, Observational Cross-Sectional Study

Background: The COVID-19 pandemic has induced demanding work situations in intensive care units (ICU). The objective of our study was to survey psychological reactions, the disturbance of social life, work effort, and support in ICU nurses, physicians, and leaders. Methods: From May to July 2020, this cross-sectional study included 484 ICU professionals from 27 hospitals throughout Norway. Symptoms of anxiety and depression were measured on Hopkins Symptom Checklist-10 (HSCL-10). Symptoms of post-traumatic stress disorder (PTSD) were measured on the PCL-5. Results: The study population were highly educated and experienced professionals, well prepared for working with COVID-ICU patients. However, 53% felt socially isolated and 67% reported a fear of infecting others. Probable cases of anxiety and depression were found in 12.5% of the registered nurses, 11.6% of the physicians, and 4.1% of the leaders. Younger age and <5 years previous work experiences were predictors for high HSCL-10 scores. Reported symptom-defined PTSD for nurses 7.1%; the leaders, 4.1%; and 2.3% of physicians. Conclusions: ICU health care professionals experienced talking with colleagues as the most helpful source of support. The COVID-ICU leaders reported a significantly higher mean score than physicians and nurses in terms of pushing themselves toward producing high work effort.

'Unheard,' 'uncared for' and 'unsupported': The mental health impact of Covid -19 on healthcare workers in KwaZulu-Natal Province, South Africa

As a direct consequence of the Covid-19 pandemic, due to being exposed to chronic and multiple sources of psychological stress, healthcare workers constitute a vulnerable population. Despite the potential impact of Covid-19 on their psychological and physical health, insufficient attention has been given to their mental well-being. The primary objective of this study was to measure and understand this psychological impact on public sector doctors and nurses in KwaZulu-Natal Province, South Africa. The secondary objective was to ascertain their perceptions of psychosocial support, specific to Covid-19, within the workplace. This cross-sectional electronic survey was conducted from August to October 2020, following the first surge of the pandemic in the country, and included 312 participants. Depression, anxiety and stress symptoms were assessed with the Depression Anxiety and Stress Scale-21 item and post-traumatic stress was measured by the Impact of Events Scale-Revised version. Measures of employer support were assessed using an adapted closed-ended questionnaire. The participants’ mean age was 36.6± 9.3 years with three quarters being male (n = 234, 75.0%) and predominantly (n = 214, 72.3%) medical doctors. Numbers of participants with depression, anxiety and stress were 121 (51.5%), 111 (47.2%) and 104 (44.3%) respectively, with 38 (16.2%), 50 (21.3%) and 38 (16.2%) in the combined severe/extremely severe range, respectively. On the Impact of Events Scale-Revised, 34 (13.7%) participants were in the severe range. Subjectively, 63.0% felt that their concerns were not ‘heard’, 75.1% did not feel ‘cared for’ and 81.1% and 74.0% did not feel ‘physically’ or ‘psychologically’ supported, respectively. High levels of depression, anxiety, stress and traumatic stress, combined with poor perceptions of employer support, highlight the need to identify and address the psychosocial support needs and expectations of healthcare workers for the duration of the pandemic, as well as for the mental health sequelae post-pandemic.

Distress and Wellbeing among General Practitioners in 33 Countries during COVID-19: Results from the Cross-Sectional PRICOV-19 Study to Inform Health System Interventions

Emerging literature is highlighting the huge toll of the COVID-19 pandemic on frontline health workers. However, prior to the crisis, the wellbeing of this group was already of concern. The aim of this paper is to describe the frequency of distress and wellbeing, measured by the expanded 9-item Mayo Clinic Wellbeing Index (eWBI), among general practitioners/family physicians during the COVID-19 pandemic and to identify levers to mitigate the risk of distress. Data were collected by means of an online self-reported questionnaire among GP practices. Statistical analysis was performed using SPSS software using Version 7 of the database, which consisted of the cleaned data of 33 countries available as of 3 November 2021. Data from 3711 respondents were included. eWBI scores ranged from -2 to 9, with a median of 3. Using a cutoff of ≥2, 64.5% of respondents were considered at risk of distress. GPs with less experience, in smaller practices, and with more vulnerable patient populations were at a higher risk of distress. Significant differences in wellbeing scores were noted between countries. Collaboration from other practices and perception of having adequate governmental support were significant protective factors for distress. It is necessary to address practice- and system-level organizational factors in order to enhance wellbeing and support primary care physicians.

Calidad de vida del personal de salud durante la pandemia de COVID-19: revisión exploratoria

Objetivo.

Describir la calidad de vida del personal de salud, el ambiente laboral y la interacción entre el empleado y ambiente laboral durante la pandemia.

Métodos.

Se realizó una revisión exploratoria. Se utilizaron las bases de datos electrónicas PubMed, Cumulative Index of Nursing and Allied Literature Complete, Google Scholar y los repositorios de la Organización Mundial de la Salud y los Centro para el Control y Prevención de Enfermedades. Se incluyeron estudios primarios, secundarios y literatura gris publicados entre diciembre de 2019 y marzo de 2021 en idioma español, inglés y portugués. La calidad metodológica fue evaluada por la lista de verificación de Autoridad, exactitud, cobertura, objetividad, fecha e importancia (AACODS, por su sigla en inglés) A measurement tool to assess systematic reviews (AMSTAR) y Critical Appraisal Checklist for Text and Opinion Papers. Se efectuó un análisis temático basado en el modelo de calidad de vida y bienestar.

Resultados.

De un total de 208 artículos, se incluyeron 11. La calidad de vida del personal de salud durante pandemia por COVID-19 estuvo influenciada por las características del personal de salud, el ambiente laboral y la interacción entre el empleado y el ambiente laboral; se observaron falencias relacionadas con factores psicosociales y ocupacionales.

Discusión.

La calidad de vida del personal de salud estuvo caracterizada por estigmatización, estrés, ansiedad y fatiga. La gestión organizacional y la aplicación de intervenciones psicológicas evidencian un efecto en la interacción entre el empleado y el ambiente laboral, e influyen en su calidad de vida.

Mental Health Support of Frontline Medical Personnel in the Javits New York Medical Station Federal COVID-19 Treatment Center

BACKGROUND

The federal government responded to the early epicenter of the COVID-19 pandemic in the United States by mobilizing uniformed services and other federal medical personnel to treat patients at the Javits New York Medical Station. Deployment of large numbers of personnel required flexible psychiatric and psychological support.

OBSERVATIONS

This report details the establishment of mental health support services for frontline personnel in a large convention center and explores lessons learned to encourage future mental health professionals to apply creative and assertive mental health interventions in disaster settings.

CONCLUSIONS

Timely and effective interventions included securing safe therapeutic space in high-traffic areas, developing relationships with leadership and frontline workers in their own work environments, and disseminating services throughout the civilian medical system. We suggest mental health supplementation during the medical response mission strengthened morale in frontline workers in a disaster scenario.

Healthcare workers use of psychological support resources during COVID-19; a mixed methods approach utilising Pillar Integration Analysis

Objectives

We sought to examine healthcare workers (HCWs) utilisation of formal and informal psychological support resources in the workplace during the first and third waves of the COVID-19 pandemic in Ireland.

Methods

A convergent mixed methods approach was undertaken. Four hundred and thirty HCWs in the Mid West and South of Ireland responded to an online survey in terms of their use of psychological support resources during Wave 1 (April/May 2020) of COVID-19. Thirty-nine HCWs undertook in depth interviews at Wave 3 (January/February 2021), and a further quantitative survey was distributed and completed by 278 HCWs at this time. Quantitative data arising at Wave 1 and Wave 3, were synthesised with Qualitative data collected at Wave 3. A Pillar Integration Process (PIP) was utilised in the analysis of the quantitative and qualitative data.

Results

Five pillars were identified from the integration of results. These were: a) the primacy of peer support, b) the importance of psychologically informed management, c) a need to develop the organisational well-being ethos, d) support for all HCWs, and e) HCWs ideas for developing the well-being path. These pillars encapsulated a strong emphasis on collegial support, an emphasis on the need to support managers, a questioning of the current supports provided within the healthcare organisations and critical reflections on what HCWs viewed as most helpful for their future support needs.

Conclusions

HCWs who utilised supportive resources indicated ‘in house’ supports, primarily collegial resources, were the most frequently used and perceived as most helpful. While formal psychological supports were important, the mechanism by which such psychological support is made available, through utilising peer support structures and moving towards psychologically informed supervisors and workplaces is likely to be more sustainable and perceived more positively by HCWs.

Psychological first aid for workers in care and nursing homes: systematic review

BACKGROUND

The Covid-19 pandemic has produced unprecedented challenges across all aspects of health and social care sectors globally. Nurses and healthcare workers in care homes have been particularly impacted due to rapid and dramatic changes to their job roles, workloads, and working environments, and residents' multimorbidity. Developed by the World Health Organisation, Psychological First Aid (PFA) is a brief training course delivering social, emotional, supportive, and pragmatic support that can reduce the initial distress after disaster and foster future adaptive functioning.

OBJECTIVES

This review aimed to synthesise findings from studies exploring the usefulness of PFA for the well-being of nursing and residential care home staff.

METHODS

A systematic search was conducted across 15 databases (Social Care Online, Kings Fund Library, Prospero, Dynamed, BMJ Best Practice, SIGN, NICE, Ovid, Proquest, Campbell Library, Clinical Trials, Web of Knowledge, Scopus, Ebsco CINAHL, and Cochrane Library), identifying peer-reviewed articles published in English language from database inception to 20th June 2021.

RESULTS

Of the 1,159 articles screened, 1,146 were excluded at title and abstract; the remaining 13 articles were screened at full text, all of which were then excluded.

CONCLUSION

This review highlights that empirical evidence of the impact of PFA on the well-being of nursing and residential care home staff is absent. PFA has likely been recommended to healthcare staff during the Covid-19 pandemic. The lack of evidence found here reinforces the urgent need to conduct studies which evaluates the outcomes of PFA particularly in the care home staff population.

The impact of the COVID-19 pandemic on pediatric developmental services: a cross-sectional study on overall burden and mental health status

BACKGROUND

The COVID-19 outbreak has taken a heavy toll on the mental well-being of healthcare workers, even those who have not been directly involved in the care of acutely ill patients. The aims of this study were to identify the overall burden and mental health status of healthcare workers in pediatric developmental services under the influence of the COVID-19 pandemic, and to identify the risk and protective factors associated with mental health.

METHODS

This cross-sectional web-based study was part of a large multicenter VOICE study conducted among employees ((neuro-)pediatricians, psychologists, speech therapists, occupational therapists, etc.) from various pediatric developmental services between June and July 2020. A total of 1291 questionnaires regarding overall burden, mental health status (depression, generalized anxiety disorder and emotional exhaustion) and risk and protective factors for mental health (working conditions, potential problems during the COVID-19 pandemic and psychological resources) were analyzed. Descriptive statistics and multiple linear regression were used for data analysis.

RESULTS

A total of 44.5% (574/1291) participants felt a high or very high overall burden during the COVID-19 pandemic. Of all the participants, 14.6% (171/1173) reported clinically significant levels of depressive symptoms, 17.0% (199/1173) reported generalized anxiety disorder symptoms and 44.6% (532/1192) reported emotional exhaustion. Multiple linear regression analyses identified several common risk and protective factors for mental health status variables. The burden of an increase in the quantity of work, fear of work and fear of becoming infected showed the strongest negative associations, whereas psychological resources and sufficient relaxation in leisure time exhibited the strongest positive associations.

CONCLUSION

Employees who were not directly involved in the care of acutely ill patients were also exposed to considerable stress, some of which was not different from that experienced by professionals who were directly affected. These employees should not be lost sight of and must be offered appropriate support.

Data on the Impact of Epidemic on Nursing Staff's Mental Health in the Context of Wireless Network

The research was aimed to analyze the impact of epidemic pneumonia on nursing personnel's mental health under wireless network background and to improve the selection of random forest classification (RFC) algorithm parameters by the whale optimization algorithm (WOA). Besides, a total of 148 in-service nursing personnel were selected as the research objects, and 148 questionnaires were recycled effectively. The collected data were analyzed by the improved RFC algorithm. In addition, the research investigated the impacts of demographic factors on nursing personnel's mental health by the one-way variance method. The results demonstrated that the accuracy of the improved algorithm in training samples and test samples reached 83.3% and 81.6%, respectively, both of which were obviously higher than those of support vector machine (SVM) (80.1% and 79.3%, respectively) and back-propagation neural network (BPNN) (78.23% and 77.9%, respectively), and the differences showed statistical meanings (P < 0.05). The Patient Health Questionnaire-9 (PHQ-9) showed that the depression levels of 9.46% of the included personnel were above moderate. The Generalized Anxiety Disorder (GAD-7) demonstrated that the anxiety levels of 3.38% of the included personnel were above moderate. The insomnia severity index (ISI) indicated that the insomnia levels of 3.38% of the included personnel were above moderate. The average score of male personnel (3.65) was obviously lower than that of female personnel (3.71). Besides, the average scale score of married personnel (3.78) was significantly higher than that of unmarried personnel (3.65). The average scale scores of personnel with bachelor's (3.66) and master's degrees (3.62) were obviously lower than those of personnel with junior college (3.77) and technical secondary school (3.75) diplomas. The average scale score of personnel with over 5-year work experience (3.68) was significantly lower than that of personnel working for less than five years (3.72). The average scale score of personnel with experience in responding to public emergencies (3.65) was obviously lower than that of personnel without related experience (3.74). The differences all showed statistical meaning (P < 0.05). The results of this research revealed that the accuracy of the improved RFC algorithm was remarkably higher than that of the SVM and BPNN algorithms. Furthermore, many nursing personnel suffered from mental diseases at different levels with the impact of the epidemic. Gender, marital status, education level, and experience in responding to public emergencies were the main factors affecting nursing personnel's mental health.

Modulating Elements of Nurse Resilience in Population Care during the COVID-19 Pandemic

COVID-19 has significantly affected the work environment of nurses. In the face of the challenges posed by stressors in clinical practice, some nurses adapt and prove to be resilient. In the face of the COVID-19 pandemic, the nature of care itself and the new ways of working are potentially very stressful. We aim to analyze the resilience of care nurses to the psychological impact of the COVID-19 pandemic. This study is a systematic review of nurse caregiver resilience to the COVID-19 pandemic in 2021. Our search was conducted in the WOS, Medline/PubMed, Cochrane, BVS/LILACS, and Cuiden databases. The inclusion criteria were: studies published in Spanish or English; carried out from March 2020 to May 2021 on nurses caring for patients with COVID-19; and investigating the factors influencing the psychological impact, resilience, strategies to develop it, and interventions to promote it during this pandemic and others, such as SARS, MERS, or ebola. The quality of the studies and the risk of bias were evaluated following ICROMS, STROBE and AMSTAR-2 criteria. Twenty-two studies were selected. Most of the studies highlighted the presence of stressors in nurses, emphasizing those of the environment, which converged in dysfunctional responses that hurt their resilience. The most persuasive factors were social and organizational support. Coping strategies developed by nurses and especially interventions by organizations were detected as instruments to foster resilience, but have not been well researched. Resilience has a key moderating role in mitigating the psychological impact of nurses in the face of the COVID-19 pandemic.

Job Demands, Work Functioning and Mental Health in Dutch Nursing Home Staff during the COVID-19 Outbreak: A Cross-Sectional Multilevel Study

COVID-19 posed enormous challenges for nursing home staff, which may have caused stress and mental health problems. This study aimed to measure the prevalence of mental health problems among nursing home staff and investigate the differences in job demands, work functioning and mental health between staff with and without COVID contact or COVID infection and across different levels of COVID worries. In this cross-sectional study, 1669 employees from 10 nursing home organizations filled in an online questionnaire between June and September 2020. The questionnaire measured the participants’ characteristics, COVID contact, infection and worries, job demands, work functioning, depressive symptoms and burnout. Differences were investigated with multilevel models to account for clustering at the organization level. Of the participants, 19.1% had high levels of depressive symptoms and 22.2% burnout. Job demands, work functioning, depressive symptoms and burnout differed between participants who never worried and participants who often or always worried about the COVID crisis. Differences were smaller for participants with and without COVID contact or infection. Most models improved when clustering was accounted for. Nursing homes should be aware of the impact of COVID worries on job demands, work functioning and mental health, both at the individual and organizational level.

Complementary and integrative medicine intervention in front-line COVID-19 clinicians

OBJECTIVE

To assess the impact of a multidisciplinary complementary and integrative medicine (CIM) intervention on physical and emotional concerns among front-line COVID-19 healthcare providers (HCPs).

METHODS

A multimodality CIM treatment intervention was provided by integrative practitioners to HCPs in three isolated COVID-19 departments. HCPs' two main concerns were scored (from 0 to 6) before and following the CIM intervention using the Measure Yourself Concerns and Wellbeing questionnaire. Postintervention narratives identified reflective narratives specifying emotional and/or spiritual keywords.

RESULTS

Of 181 HCPs undergoing at least one CIM treatment, 119 (65.7%) completed post-treatment questionnaires. While HCPs listing baseline emotional-related concerns benefited from the CIM intervention, those who did not express emotional or spiritual concerns improved even more significantly following the first session, for both leading concerns (p=0.038) and emotional-related concerns (p=0.023). Nevertheless, it was shown that following subsequent treatments HCPs who expressed emotional and spiritual concerns improved more significantly than those who did not for emotional-related concerns (p=0.017).

CONCLUSIONS

A CIM intervention for front-line HCPs working in isolated COVID-19 departments can significantly impact emotional-related concerns, more so after the first treatment and among HCPs not using emotional-spiritual keywords in post-treatment narratives. Referral of HCPs to CIM programmes for improved well-being should avoid referral bias to those not expressing emotional/spiritual concerns.

Internal Medicine Residency Program Director Support and Burnout During the COVID-19 Pandemic: Results of a National Survey

Background

Burnout is common among physicians and physician leaders, including residency program directors (PDs). The effects of the COVID-19 pandemic and other stressors in 2020 on PDs is unknown.

Objective

To measure the prevalence of burnout among internal medicine (IM) residency PDs 6 months into the COVID-19 pandemic.

Methods

A total of 429 IM PDs, representing 83% of accredited residency programs, were surveyed from August to December 2020. Burnout, using a 2-item screening tool, and self-reported consideration of resigning in 2020, were compared to their annual prevalence since 2012 and tested for possible associations with pandemic stressors and program characteristics.

Results

The survey response rate was 61.5% (264 of 429). One-third (33.6%, 87 of 259) of PD respondents met burnout criteria, and 45.1% (110 of 244) reported considering resigning in the past year, which were within the range of preceding years. PDs who reported feeling highly supported by institutional leadership were less likely to meet burnout criteria and to have considered resigning. There were no associations between burnout or consideration of resigning and the amount of clinical time PDs spent in their roles, duration of maximum stress on programs, budget cuts to programs, or geographic region.

Conclusions

The prevalence of burnout among PDs in fall 2020 was similar to the prevalence of burnout in pre-pandemic years despite uniquely extreme stressors. PDs' perception of being highly supported by institutional leadership was associated with lower prevalence of burnout and consideration of resigning. Perceived leadership support may be a protective factor against burnout during periods of high stress.

Analysis of the Predictive Role of Self-Compassion on Emotional Distress during COVID-19 Lockdown

Research has shown that the COVID-19 pandemic has caused a mental health burden worldwide. Most studies have focused on the factors associated with a higher risk of mental health problems, and only a few studies have looked at the potential protective factors. The general objective of this study was to determine whether self-compassion has a protective effect against the risk of mental health problems and especially on perceived infectability. If so, we intended to determine which of the three specific facets of self-compassion (i.e., mindfulness vs. over-identification; self-kindness vs. self-judgment; common humanity vs. isolation;) has the greatest weight in predicting emotional distress. We conducted a cross-sectional study through an online survey completed by 855 participants in Spain. Results confirmed that the three facets of self-compassion reduce the negative correlation between perceived infectability and emotional distress, diminishing its role in predicting emotional distress. These results are discussed in relation to the protective role of self-compassion and the need to further explore the variables associated with a lower risk of mental problems derived from the SARS-CoV-2 pandemic.

Help Seeking of Highly Specialized Mental Health Treatment before and during the COVID-19 Pandemic among Health Professionals

(1) Background: Ongoing specialized programs for health professionals (HPs) adapted their treatment services during the COVID-19 pandemic. (2) Methods: We conducted a retrospective observational study of medical e-records of HPs with mental disorders working in Catalonia that were consecutively admitted to the Galatea Care Program Clinical Unit. The sample (N = 1461) was divided into two periods: 21.5 months before (n = 637) and after (n = 824) 14 March 2020. (3) Results: There was a significant increase (29.4%) in the number of referrals to the specialized Clinical Unit during the pandemic, especially with respect to physicians compared to nurses. The percentage of HP women at admission and the clinical severity of the first treatment episode remained without changes before and after the COVID-19 pandemic. The most prevalent main diagnoses also remained similar: adjustment disorders (41.5%), mood disorders (24.9%), anxiety disorders (14.4%), and substance use disorders (11.8%). (4) Conclusions: HPs, particularly physicians, more frequently sought voluntary help from specialized mental health programs during the COVID-19 pandemic. Future studies are needed to analyze the reasons behind this finding and the evolution of referrals to these types of programs after the COVID-19 outbreak.

The Elephant in the Room: A Cross-Sectional Study on the Stressful Psychological Effects of the COVID-19 Pandemic in Mental Healthcare Workers

Despite extensive research on COVID-19’s impact on healthcare workers, few studies have targeted mental health workers (MHWs) and none have investigated previous traumatic events. We investigated psychological distress in MHWs after the first lockdown in Italy to understand which COVID-19, sociodemographic, and professional variables represented greater effects, and the role of previous trauma. The survey included sociodemographic and professional questions, COVID-19 variables, and the questionnaires Life Events Checklist for DSM-5 (LEC-5), Impact of Event Scale—Revised (IES-R), and Depression Anxiety Stress Scales 21 (DASS-21). On the 271 MHWs who completed the survey (73.1% female; mean age 45.37), we obtained significant effects for contagion fear, experience of patients’ death, increased workload, and worse team relationship during the first wave. Nurses were more affected and showed more post-traumatic stress symptoms, assessed by IES-R, and more depressive, anxiety, and stress symptoms, assessed by DASS-21. The strongest risk factors for distress were greater age, professional role, increased workload, worse team relationship, and separation from family members. Previous experience of severe human suffering and unwanted sexual experiences negatively impacted IES-R and DASS-21 scores. Being a psychiatrist or psychologist/psychotherapist and good team relationships were protective factors. Recent but also previous severe stressful events might represent relevant risk factors for distress, reducing resilience skills. Identifying vulnerable factors and professional categories may help in the development of dedicated measures to prevent emotional burden and support psychological health. Highlights: Psychological distress in mental health workers in the COVID-19 pandemic is more frequent in nurses, who experience more depression, anxiety, and post-traumatic stress symptoms. Previous and recent stressful events are risk factors for distress and should guide intervention strategies.

Predictors of the Occupational Burnout of Healthcare Workers in Poland during the COVID-19 Pandemic: A Cross-Sectional Study

The study aims at analysing the occupational burnout phenomenon, the level of anxiety and depression, as well as the quality of life (QOL) of healthcare workers (HCW) during the COVID-19 pandemic. There were 497 healthcare workers examined across Poland. The Maslach Burnout Inventory (MBI), Hospital Anxiety Depression Scale (HADS) and World Health Organization Quality of Life Instrument Short Form (WHOQOL BREF) were used. A total of 71.63% (356) of the respondents presented high and moderate levels of emotional exhaustion during the pandemic, 71.43% (355) reported low and moderate job satisfaction levels, whereas 40.85% (203) displayed high and moderate levels of depersonalization. A group of 62.57% (n = 311) demonstrated clear or borderline states of anxiety disorders, while 38.83% (n = 193) suffered from depression or its borderline symptoms. Direct predictors of occupational burnout included: escalating depression; quality of life domains such as the physical, psychological and social; being provided personal protective equipment (PPE) by an employer; age; medical profession; and material status. Emotional exhaustion appeared to be much higher in nursing and ‘other’ medical professionals than in physiotherapists (p = 0.023). In the times of pandemic, the occupational burnout prophylaxis ought to be focused on early recognition of depression like symptoms and their treatment, as well as providing the staff with PPE and satisfying earnings.

[COVID-19 response capacity implementation in a Brazilian hospital]

After the declaration of a public health emergency of international importance, hospitals have become a benchmark in the response to the pandemic. It is important to assess health professionals' response capacity to the COVID-19 pandemic at a referral hospital in Pernambuco, in northeastern Brazil. This study deals with qualitative evaluative research, of the case study type. Three methods were used to identify critical events: interviews with 18 healthcare professionals who had worked on the "front line" of care for people with COVID-19; direct observation in the sectors of this hospital; and literature review. The interviews were transcribed and analyzed using MaxQDA Analytics pro 2020® software, using the Actor-Network Theory for analysis; and to interpret the critical events the categories of resilience: absorption, adaptation and transformation. It was found that the response capacity of professionals was influenced by five critical events: the arrival of cases, new ways to connect the patients with their social support network, social and personal impact on the daily life of professionals, insufficient supplies, essential equipment and confirmatory tests, and shortage and illness of professionals. In everyday experiences, the response capacity of professionals has led to a process of priority adaptation, which can accelerate important changes in the health system.

Evaluating the Effect of Supported Systematic Work Environment Management During the COVID-19 Pandemic: Protocol for a Mixed Methods Study

BACKGROUND

The work environment is a complex phenomenon in which many factors interact. Scientific research indicates a relation between the work environment and employee health, staff turnover, patient satisfaction, and patient safety. There is a great need for knowledge on how to conduct work environment interventions and practical work environment management to maximize benefits to the employees.

OBJECTIVE

The aim of this study is to explore how Occupational Health Service (OHS) support will affect the work environment, sick leave, staff turnover, patient satisfaction, and patient safety during and following the COVID-19 pandemic in a medical ward setting.

METHODS

A mixed methods evaluation of a concurrent work environment quality improvement project at the Department of Internal Medicine and Geriatrics in a local hospital in the south of Sweden will be performed.

RESULTS

The mixed methods evaluation of the quality improvement project received funding from Futurum-Academy for Health and Care, Jönköping County Council and Region Jönköping County, and the study protocol was approved by the Swedish Ethical Review Authority. The work environment quality improvement project will continue between May 2020 and December 2021.

CONCLUSIONS

The study might contribute to increased knowledge of how work environment interventions and practical work environment management can impact the work environment, and employee health, staff turnover, patient satisfaction, and patient safety. There is a need for knowledge in this area for OHS management to provide increased benefits to employees, employers, and society as a whole.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/34152.

The fear of COVID-19 and job insecurity impact on depression and anxiety: An empirical study in China in the COVID-19 pandemic aftermath

The employees' psychological health and resilience in times of emergency and general uncertainty was chosen due to the immense implications for economics, entrepreneurs, psychologists and psychiatrists, and policymakers. This study aims to provide an insight into uncertainty-induced anxiety and depression among Chinese employees in the aftermath of the COVID-19 outbreak. Analysis performed in the context of China in the COVID-19 pandemic aftermath is significant due to the universal nature of external shock impact on psychological welfare, applicable across nations and business sectors and in similar contexts. The statistical analysis was performed with SEM software AMOS version 23. The research model consisting of fear of COVID-19, job insecurity, anxiety, depression, was empirically tested. A purposive sampling technique was applied with the online questionnaire shared with employees in companies located in China. Respondents were working in educational services, information technology, engineering, electronics, and other sectors on white-collar jobs. The data collection was conducted from May to August 2020, in the aftermath of the COVID-19 pandemic in China. The research sample consisting of 283 respondents was used for analysis. Path analysis was performed, and standardized parameter estimates, standard errors, and p-values were calculated. The results indicate a positive and significant impact of job insecurity on depression and anxiety. Furthermore, results indicate that the fear of COVID-19 significantly impacts anxiety and depression but does not impact job insecurity. The findings can be used in a multidisciplinary effort to mitigate the psychological damage. Furthermore, they complement the ongoing epidemiological and scientific discourse on people's personal health and choice of coping.

COVID-19 Induced Economic Slowdown and Mental Health Issues

The COVID-19 pandemic has pressed a pause button on global economic development, and induced significant mental health problems. In order to demonstrate the progressed relationship between the pandemic, economic slowdown, and mental health burden, we overviewed the global-level gross domestic product changes and mental problems variation since the outbreak of COVID-19, and reviewed comprehensively the specific sectors influenced by the pandemic, including international trade, worldwide travel, education system, healthcare system, and individual employment. We hope to provide timely evidence to help with the promotion of policymakers’ effective strategies in mitigating economic losses induced by the pandemic; we suggest different governments or policy makers in different countries to share information and experience in dealing with COVID-19-induced economic slowdown and promote COVID-19 vaccine popularization plan to protect every individual worldwide against the coronavirus essentially; and we appeal international information share and collaboration to minimize stigmatization related to adverse mental consequences of COVID-19 and to increase mental health wellbeings of people all over the world.

COVID-19 Pandemic Support Programs for Healthcare Workers and Implications for Occupational Mental Health: A Narrative Review

This narrative review aims to summarize initiatives developed during the COVID-19 pandemic to support healthcare workers' emotional well-being within the context of a pre-existing framework of occupational mental health guidelines. This occupational mental health framework integrates principles from multiple disciplines to optimize prevention and management of mental health issues among employees. We conducted an online search on Medline/PubMed, Cochrane Library, and Embase for studies that reported on design or execution of medical institution-based interventions, aiming to support healthcare worker mental health during the COVID-19 pandemic. Inclusion criteria was intentionally broad in order to incorporate as many types of interventions at varying stages of development or evaluation. We included 31 studies in our review that reported on newly designed psychological support interventions for healthcare workers (HCW) during the COVID-19 pandemic. We found that most programs commonly supported HCW mental health through offering one or more of the following initiatives: expanded basic need resources/services, additional workplace training programs that bolstered professional preparedness while also indirectly boosting HCW emotional health, and/or expanded psychological support programs, such as peer support programs, psychoeducational or counseling services. Most programs, however, did not consider methods to ensure program longevity or sustainability. The COVID-19 pandemic has underscored the acuity of HCW mental health issues and is likely to leave long lasting mental health strains among HCW. This pandemic is a critical point in time to catalyze much needed progress in reducing stigma and expanding HCW mental health care access.