Psychological impact of COVID-19 on medical care workers in China

COVID-19 is having a destructive impact on health-care workers' mental well-being

Background

The coronavirus disease 2019 (COVID-19) may aggravate workplace conditions that impact health-care workers’ mental health. However, it can also place other stresses on workers outside of their work. This study determines the effect of COVID-19 on symptoms of negative and positive mental health and the workforce’s experience with various sources of support. Effect modification by demographic variables was also studied.

Methods

A cross-sectional survey study, conducted between 2 April and 4 May 2020 (two waves), led to a convenience sample of 4509 health-care workers in Flanders (Belgium), including paramedics (40.6%), nurses (33.4%), doctors (13.4%) and management staff (12.2%). About three in four were employed in university and acute hospitals (29.6%), primary care practices (25.7%), residential care centers (21.3%) or care sites for disabled and mental health care. In each of the two waves, participants were asked how frequently (on a scale of 0–10) they experienced positive and negative mental health symptoms during normal circumstances and during last week, referred to as before and during COVID-19, respectively. These symptoms were stress, hypervigilance, fatigue, difficulty sleeping, unable to relax, fear, irregular lifestyle, flashback, difficulty concentrating, feeling unhappy and dejected, failing to recognize their own emotional response, doubting knowledge and skills and feeling uncomfortable within the team. Associations between COVID-19 and mental health symptoms were estimated by cumulative logit models and reported as odds ratios. The needed support was our secondary outcome and was reported as the degree to which health-care workers relied on sources of support and how they experienced them.

Results

All symptoms were significantly more pronounced during versus before COVID-19. For hypervigilance, there was a 12-fold odds (odds ratio 12.24, 95% confidence interval 11.11–13.49) during versus before COVID-19. Positive professional symptoms such as the feeling that one can make a difference were less frequently experienced. The association between COVID-19 and mental health was generally strongest for the age group 30–49 years, females, nurses and residential care centers. Health-care workers reported to rely on support from relatives and peers. A considerable proportion, respectively, 18 and 27%, reported the need for professional guidance from psychologists and more support from their leadership.

Conclusions

The toll of the crisis has been heavy on health-care workers. Those who carry leadership positions at an organizational or system level should take this opportunity to develop targeted strategies to mitigate key stressors of health-care workers’ mental well-being.

Healthcare Worker's Mental Health and Their Associated Predictors During the Epidemic Peak of COVID-19

INTRODUCTION

The outbreak of the coronavirus disease 2019 (COVID-19) poses an unprecedented challenge to healthcare workers (HCWs) globally. This study investigated potential factors related to depression, anxiety, and stress in a sample of Chinese HCWs during the peak of the COVID-19 epidemic.

METHODS

An online survey was distributed to Chinese HCWs using respondent-driven sampling. Data were collected between February 13th and February 20th, 2020, immediately following the COVID-19 contagion peak in Hubei. A total of 1208 respondents were eligible for analysis. Mental health problems and social support were measured by the Depression Anxiety Stress Scales-21 (DASS-21) and the Perceived Social Support Scale (PSS).

RESULTS

The prevalence rates of depression, (DASS-depression > 9) anxiety (DASS-anxiety > 7) and stress (DASS-stress > 14) were 37.8%, 43.0% and 38.5%, respectively. Multivariate logistic regressions revealed that stress, anxiety, and depression were positively related to lower levels of social support, longer working hours, discrimination experience and workplace violence. The scarcity of medical equipment was correlated with increased stress and depression. Chinese HCWs working at COVID 19 designated hospitals were more likely to report anxiety. Additionally, volunteering to work in the frontline health facilities was inversely associated with depression.

CONCLUSION

Mental health problems among Chinese HCWs were alarming during the peak of the COVID-19 epidemic. Health facilities require appropriate and standing services that address the mental health of healthcare workers, particularly during epidemic outbreaks.

Mental health among healthcare personnel during COVID-19 in Asia: A systematic review

The COVID-19 pandemic has been associated with an insidious wave of psychological stress among healthcare personnel (HCP) in Asia. Mental exhaustion, burnout, fear, depression, anxiety, insomnia, and psychological stress among HCPs have intensified a daunting challenge during the COVID-19 pandemic. The consequences of such stress may negatively impact patient and HCP safety. This review article reports the associations of mental health status attributed to the COVID-19 pandemic among HCP and their impact on patient safety, and infection prevention and control practices during pandemics.

What We Have Learned from Two Decades of Epidemics and Pandemics: A Systematic Review and Meta-Analysis of the Psychological Burden of Frontline Healthcare Workers

In light of the current coronavirus disease 2019 (COVID-19) pandemic and potential future infectious disease outbreaks, a comprehensive understanding of the negative effects of epidemics and pandemics on healthcare workers' mental health could inform appropriate support interventions. Thus, we aimed to synthesize and quantify the psychological and psychosomatic symptoms among frontline medical staff. We searched four databases up to March 19, 2020 and additional literature, with daily search alerts set up until October 26, 2020. Studies reporting psychological and/or psychosomatic symptoms of healthcare workers caring for patients with severe acute respiratory syndrome, H1N1, Ebola, Middle East respiratory syndrome, or COVID-19 were eligible for inclusion. Two reviewers independently conducted the search, study selection, quality appraisal, data extraction, and synthesis and involved a third reviewer in case of disagreement. We used random effects modeling to estimate the overall prevalence rates of psychological/psychosomatic symptoms and the I2 statistic. We included 86 studies, reporting data from 75,991 participants. Frontline staff showed a wide range of symptoms, including concern about transmitting the virus to the family (60.39%, 95% CI 42.53-76.96), perceived stress (56.77%, 95% CI 34.21-77.95), concerns about own health (45.97%, 95% CI 31.08-61.23), sleeping difficulties (39.88%, 95% CI 27.70-52.72), burnout (31.81%, 95% CI 13.32-53.89), symptoms of depression (25.72%, 95% CI 18.34-33.86), symptoms of anxiety (25.36%, 95% CI 17.90-33.64), symptoms of posttraumatic stress disorder (24.51%, 95% CI 18.16-31.46), mental health issues (23.11%, 95% CI 15.98-31.10), and symptoms of somatization (14.68%, 95% CI 10.67-19.18). We found consistent evidence for the pervasive and profound impact of large-scale outbreaks on the mental health of frontline healthcare workers. As the CO-VID-19 crisis continues to unfold, guaranteeing easy access to support structures for the entire healthcare workforce is vitally important.

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

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

Anxiety in Frontline and Non-Frontline Healthcare Providers in Kelantan, Malaysia

In response to the coronavirus disease 2019 (COVID-19) pandemic, healthcare providers are exposed to psychological and mental health implications, including vicarious traumatization, anxiety, and depression. Gradual increases in the number of COVID-19 cases meant they were inadequately protected from contamination due to a shortage of protective equipment, excessive workloads, emotional exhaustion and frustration. These circumstances affect their work performance in delivering health services. This study aims to compare the levels of anxiety in frontline and non-frontline healthcare providers during the COVID-19 pandemic. This study applied a comparative cross-sectional design between May and July 2020 at the Hospital Raja Perempuan Zainab II. Convenient sampling was applied in the selection of eligible participants. The case report form contained two self-administered questionnaires, namely, The Hospital Anxiety and Depression Scale and Medical Outcome Study Social Support Survey. Descriptive analysis, analysis of variance, and analysis of covariance were conducted using SPSS version 26. The number of participants recruited was 306, including 160 healthcare providers in the frontline group and 146 in the non-frontline group. The non-frontline healthcare providers reported a significantly higher anxiety mean score of 1.7 than the frontline providers after adjusting for gender, duration of employment, and social support. It indicates that non-frontline healthcare providers require psychological support similar to that of frontline healthcare providers during the COVID-19 pandemic.

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

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

A Nosological Exploration of PTSD and Trauma in Disaster Mental Health and Implications for the COVID-19 Pandemic

The coronavirus disease of 2019 (COVID-19) pandemic rapidly spread around the world, resulting in massive medical morbidity and mortality and substantial mental health consequences. Post-traumatic stress disorder (PTSD) is an important psychiatric disorder associated with disasters, and many published scientific articles have reported post-traumatic stress syndromes in populations studied for COVID-19 mental health outcomes. American diagnostic criteria for PTSD have evolved across editions of the manual, and the current definition excludes naturally occurring medical illness (such as viral illness) as a qualifying trauma, ruling out this viral pandemic as the basis for a diagnosis of PTSD. This article provides an in-depth nosological consideration of the diagnosis of PTSD and critically examines three essential elements (trauma, exposure, and symptomatic response) of this diagnosis, specifically applying these concepts to the mental health outcomes of the COVID-19 pandemic. The current criteria for PTSD are unsatisfying for guiding the response to mental health consequences associated with this pandemic, and suggestions are made for addressing the conceptual diagnostic problems and designing research to resolve diagnostic uncertainties empirically. Options might be to revise the diagnostic criteria or consider categorization of COVID-19-related psychiatric syndromes as non-traumatic stressor-related syndromes or other psychiatric disorders.

Mental Disorders Among Health Care Workers at the Early Phase of COVID-19 Pandemic in Kenya; Findings of an Online Descriptive Survey

Background: Healthcare workers responding to the Corona Virus Pandemic (COVID-19) are at risk of mental illness. Data is scanty on the burden of mental disorders among Kenyan healthcare workers responding to the pandemic that can inform mental health and psychosocial support. The purpose of this study was to establish the frequency and associated factors of worry, generalized anxiety disorder, depression, posttraumatic stress disorder and poor quality of sleep among Kenyan health care workers at the beginning of COVID-19 pandemic. Methods: We conducted an online survey among 1,259 health care workers in Kenya. A researcher developed social demographic questionnaire and several standardized tools were used for data collection. Standardized tools were programmed into Redcap, (Research Electronic Data Capture) and data analysis was performed using R Core Team. In all analysis a p-value < 0.05 was considered significant. Results: 66% of the participants reported experiencing worry related to COVID-19. 32.1% had depression, 36% had generalized anxiety, 24.2% had insomnia and 64.7% scored positively for probable Post Traumatic Stress Disorder (PTSD). Depression was higher among females compared to men (36.5 vs. 26.9%, p = 0.003), workers <35 years old compared to older ones (38.1 vs. 26.4%, p < 0.001), and those who were not married compared to those who were married (40.6 vs. 27.6%, p < 0.001). Generalized anxiety was commoner among workers aged <35 years (43.5 vs. 29.3%, p < 0.001), females (41.7 vs. 29.2%, p < 0.001), those who mere not married compared to the married (45.2 vs. 31.2%, p < 0.001) and those with <10 years working experience (41.6 to 20.5%, p < 0.001). Younger health care professional had a higher proportion of insomnia compared to the older ones (30.3 vs. 18.6%, p < 0.001). Insomnia was higher among those with <10 years' experience compared to those with more than 20 years' experience(27.3 vs. 17.6%, p = 0.043) Conclusion: Many Kenyan healthcare workers in the early phase of COVID-19 pandemic suffered from various common mental disorders with young, female professionals who are not married bearing the bigger burden. This data is useful in informing interventions to promote mental and psychosocial wellbeing among Kenyan healthcare workers responding to the pandemic.

PTSD Among Healthcare Workers During the COVID-19 Outbreak: A Study Raises Concern for Non-medical Staff in Low-Risk Areas

Objective: To investigate the prevalence of sleep quality and post-traumatic stress disorder (PTSD) symptoms of healthcare workers (HCWs) and identify the determinants for PTSD symptoms among HCWs in high-risk and low-risk areas during the COVID-19 outbreak in China. Methods: The Pittsburgh Sleep Quality Index and the Impact of Event Scale were used to assess sleep quality and symptoms of PTSD of 421 Chinese HCWs, respectively, from January 30 to March 2, 2020. The influencing factors of PTSD symptoms were identified by univariate analysis and multiple regression. Results: The incidence of HCWs getting PTSD symptoms were 13.2%. HCWs from high-risk areas had significantly poorer sleep quality (p < 0.001). Poor sleep quality was the risk factor of PTSD symptoms for HCWs from high-risk (p = 0.018) and low-risk areas (p < 0.001). Furthermore, non-medical staff were found to be the risk factor for PTSD symptoms only in low-risk areas. Discussion: HCWs in Hubei had poorer sleep quality. Non-medical HCWs from low-risk areas were associated with more severe PTSD symptoms. Mental health programs should be considered for HCWs, especially those who are often overlooked.

Prevalence of posttraumatic stress disorder after infectious disease pandemics in the twenty-first century, including COVID-19: a meta-analysis and systematic review

Pandemics have become more frequent and more complex during the twenty-first century. Posttraumatic stress disorder (PTSD) following pandemics is a significant public health concern. We sought to provide a reliable estimate of the worldwide prevalence of PTSD after large-scale pandemics as well as associated risk factors, by a systematic review and meta-analysis. We systematically searched the MedLine, Embase, PsycINFO, Web of Science, CNKI, WanFang, medRxiv, and bioRxiv databases to identify studies that were published from the inception up to August 23, 2020, and reported the prevalence of PTSD after pandemics including sudden acute respiratory syndrome (SARS), H1N1, Poliomyelitis, Ebola, Zika, Nipah, Middle Eastern respiratory syndrome coronavirus (MERS-CoV), H5N1, and coronavirus disease 2019 (COVID-19). A total of 88 studies were included in the analysis, with 77 having prevalence information and 70 having risk factors information. The overall pooled prevalence of post-pandemic PTSD across all populations was 22.6% (95% confidence interval (CI): 19.9-25.4%, I²: 99.7%). Healthcare workers had the highest prevalence of PTSD (26.9%; 95% CI: 20.3-33.6%), followed by infected cases (23.8%: 16.6-31.0%), and the general public (19.3%: 15.3-23.2%). However, the heterogeneity of study findings indicates that results should be interpreted cautiously. Risk factors including individual, family, and societal factors, pandemic-related factors, and specific factors in healthcare workers and patients for post-pandemic PTSD were summarized and discussed in this systematic review. Long-term monitoring and early interventions should be implemented to improve post-pandemic mental health and long-term recovery.

Are We Coping Well with COVID-19?: A Study on Its Psycho-Social Impact on Front-line Healthcare Workers

BACKGROUND

Global pandemics have a profound psycho-social impact on health systems and their impact on healthcare workers is under-reported.

METHODS

We performed a cross-sectional survey with 13 Likert-scale responses and some additional polar questions pertaining to dressing habits and learning in a university hospital in the midwest United States. Descriptive and analytical statistics were performed.

RESULTS

The 370 respondents (66.1% response rate, age 38.5±11.6 years; 64.9% female), included 102 supervising providers [96 (25.9%) physicians, 6 (1.6%) mid-level], 64 (17.3%) residents/fellows, 73 (19.7% nurses, 45 (12.2%) respiratory therapists, 31 (8.4%) therapy services and others: 12 (3.2%) case-managers, 4 (1.1%) dietitians, 39 (10.5%) unclassified]. Overall, 200 (54.1%) had increased anxiety, 115 (31.1%) felt overwhelmed, 159 (42.9%) had fear of death, and 281 (75.9%) changed dressing habits. Females were more anxious (70.7% vs. 56%, X² (1, N=292)=5.953, p=0.015), overwhelmed (45.6% vs. 27.3%, X² (1, N=273)=8.67, p=0.003) and suffered sleep disturbances (52% vs. 39%, X² (1, N=312)=4.91, p=0.027). Administration was supportive; 243 (84.1%, N=289), 276 (74.5%) knew another co-worker with COVID-19, and only 93 (25.1%) felt healthcare employment was less favorable. Residents and fellows reported a negative impact on their training despite feeling supported by their program.

CONCLUSION

Despite belief of a supportive administration, over half of healthcare workers and learners reported increased anxiety, and nearly a third felt overwhelmed during this current pandemic.

Prevalence of psychological morbidities and their influential variables among nurses in a designated COVID-19 tertiary care hospital in India: A cross-sectional study

BACKGROUND

Nurses are the main part of the health workforce, performing their duties as frontline warriors against the novel coronavirus pandemic. Nurses involved in the care of infected (COVID-19) patients, may feel more discomfort physically and experience greater psychological morbidities.

AIMS AND OBJECTIVES

The main aim of the study is to evaluate the prevalence of anxiety and stress among nurses in a designated COVID-19 hospital and variables that influence these psychological problems.

METHODOLOGY

Nurses working in the designated tertiary care hospital were invited to participate in an online cross-sectional survey (dated, September 5-15, 2020). A self-administered questionnaire regarding sociodemographic characteristics, COVID-19-related experiences, perceived threat regarding COVID-19, and two scales (Generalized Anxiety Disorder-7 and Perceived Stress Scale-10) for the assessment of anxiety and stress was applied to nurses. Chi-square test and multiple regression analysis were used to investigate the predictors (risk and protective) of psychological morbidities in nurses.

RESULTS

On analysis of 209 participants, it was revealed that 65 (31.1%) participants have anxiety symptoms and 35.40% have moderate to the high level of stress. Being proud of working in this profession was the only protective factor from such psychological morbidities. The identified risk factors for greater anxiety symptoms and moderate-to-high-level stress were, working experience of >10 years (odds ratio [OR] = 3.36), direct involvement in the care of suspected/diagnosed patients (OR = 3.4), feeling worried about being quarantined/isolated (OR = 1.69,) and high risk of being infected at the job (OR = 2.3 for anxiety and OR = 2.1 for moderate-to-high stress).

CONCLUSIONS

Deteriorating the psychic health of nurses is one of the major outcomes during the COVID-19 pandemic in India which warrants the necessity of providing psychological support to nurses and controlling the risk factors related to these problems. Greater focus should be on the frontline and experienced nurses.