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

COVID-19 infection prevention and control procedures and institutional trust: Perceptions of Palestinian healthcare workers

Background

Lack of trust in institutional control measures during Coronavirus disease 2019 (COVID-19) outbreaks may affect healthcare workers' (HCWs) levels of stress and wellbeing, and as a consequence, may influence their trust and confidence in their organization. This study aims to understand factors associated with healthcare workers perceptions of trust in organizational preparedness, communication, and infection risk during the COVID-19 pandemic.

Methods

A cross-sectional study was conducted among HCWs (n = 876) in 16 COVID 19 healthcare facilities between October and December 2020 in Palestine (Gaza Strip, West Bank and East Jerusalem). A stratified purposive sample using an online self-administered Arabic version of a questionnaire was used for data collection. The questionnaire used for this study was adapted from the World Health Organization Blueprint Novel Coronavirus Perceptions of healthcare workers regarding local infection prevention and control procedures for a COVID-19 research protocol.Data were analyzed using Statistical Package for Social Sciences software version 23. In the bivariate analysis, T-test, one-way ANOVA and χ2 test were used at a significant p-value < 0.05. In the multivariable logistic regression analyses, the adjusted odds ratios and its 95% confidence intervals are presented.

Results

Findings showed that confidence in the systems' ability to manage COVID-19 cases, encouragement and support from senior medical/nursing staff to apply recommended IPC measures, and good levels of mental health increased trust in the organization. Additionally, receiving proper training on IPC procedures for other communicable diseases, having access to clear policies and procedures related to IPC procedures for COVID-19, and providing PPE during the previous clinical shift also increased trust. However, the intention to use recommended PPE when treating patients with suspected or confirmed COVID-19 when having access to it and feeling emotional was negatively correlated with this trust.

Conclusions

HCWs should be provided with clear, accessible communications about policies and protocols, as well as training about infection prevention and control, personal protective equipment, and support during pandemics to increase their trust in the healthcare system. Additionally, the improvement in HCWs' wellbeing can be attributed to a greater sense of trust in institutions.

Psychological effects and associated factors among vaccinated and unvaccinated general population against COVID-19 infection in Bangladesh

Background

The global effort to develop herd immunity in the general public against the COVID-19 pandemic is currently ongoing. However, to the best of our knowledge, there have been no studies on how the COVID-19 vaccine affects mental health in the context of the COVID-19 pandemic in Bangladesh. The present study investigated the psychological effects and associated factors among vaccinated and unvaccinated general populations against COVID-19 infection in Bangladesh.

Methods

A nationwide online cross-sectional survey was conducted in Bangladesh from June 23 to December 25, 2021. The frequency of symptoms of psychological distress, depression, anxiety, stress, post-traumatic stress disorder (PTSD), insomnia, and fear was assessed using the Bangla versions of the GHQ-12, PHQ-2, GAD-2, PSS-4, PC-PTSD-5, ISI, and FCV-19S scales, respectively.

Results

The study included 3,013 persons from all eight divisions of Bangladesh, with 1,272 (42.2%) being vaccinated and 1,741 (57.8%) being unvaccinated. Compared with unvaccinated populations, vaccinated populations had significantly lower prevalence rates of psychological distress (36.4 vs. 51.5%), depression (21.1 vs. 37.9%), anxiety (25.1 vs. 44.9%), stress (19.4 vs. 30.4%), PTSD (29.4 vs. 38.3%), insomnia (18.7 vs. 39.4%), and fear symptoms (16.1 vs. 27.5%). Among vaccinated populations, respondents who lived in nuclear families were significantly associated with higher risk of psychological distress (AOR, 1.38; 95% CI, 1.09-1.78), depression (AOR, 1.49; 95% CI, 1.11-1.98), anxiety (AOR, 1.77; 95% CI, 1.21-1.98), and fear (AOR, 1.43; 95% CI, 1.11-1.83) symptoms. Participants who lost family members, friends, or colleagues due to the COVID-19 pandemic had significantly higher risk of symptoms of psychological distress (AOR, 1.35; 95% CI, 1.02-1.79), anxiety (AOR, 1.41; 95% CI, 1.11-1.87), and PTSD (AOR, 1.76; 95% CI, 1.24-2.19). On the other hand, unvaccinated populations who lived in the Dhaka division were significantly associated with an increased risk of depression (AOR, 2.06; 95% CI, 1.40-2.52), anxiety (AOR, 1.86; 95% CI, 1.15-2.47), stress (AOR, 1.92; 95% CI, 1.12-2.88), and insomnia (AOR, 1.88; 95% CI, 1.20-2.94) symptoms. Except for PTSD and fear symptoms, unemployed participants had considerably higher rates of psychological distress, depression, anxiety, stress, and insomnia symptoms (e.g., psychological distress: AOR, 1.83; 95% CI, 1.10-2.62; depression: AOR, 1.74; 95% CI, 1.37-2.19).

Conclusions

This study recommends immunizing unvaccinated populations as soon as possible to prevent infection and boost mental health. Vulnerable people needed special care, health-related education, and psychological assistance.

Impact of the coronavirus pandemic on mental prosperity of medical care laborers in tertiary consideration hospital: A case report

Since the outbreak of the Corona pandemic in December 2019, many people affected, especially medical care laborers, who deal with the treated cases. Coronavirus disease 2019 not only affects the body parts, but also extends to the psychological symptoms. The purpose of this research is to explore the impact of the pandemic on the mental prosperity of the laborers. Clinical staff members from the administration emergency clinic, Lahore, were enlisted. A poll was used to collect data on the segment information, a sleeping disorder, despondency and stress manifestations. Correlation of the segment information and the mental factors were done among the sleeping and non-sleeping disorder samples. All 356 medical service laborers were selected for this investigation. There were manifestations of misery in 222 (62.35%), nervousness in 227 (64.76%), stress in 197 (55.33%) and sleep deprivation in 190 (53.37%) of members. Gentle to extreme side effects of melancholy (91.65% vs 28.9%), nervousness (83.1% vs 41.6%) and stress (84.26% vs 22.22%) were seen predominately in the sleep deprivation gathering (P < .001). Insomnia was more pronounced in the members with low training levels (78.08%) versus post-advanced education (30.9%). Paramedics, attendants, and medical service laborers in confinement/serious consideration units were more inclined to the sleep deprivation (P < .001). Mental prosperity of medical care laborers was influenced because of Coronavirus pandemic. Attendants, paramedics, and those working in the detachment unit showed a critical sleeping disorder. The results and indicators have proven that there is a relationship between the infection with the Corona pandemic and occurrence of disorders in psychological behavior. Therefore, the psychological rehabilitation sessions must be conducted for those infected and those in contact with the Corona cases to relieve the burden of that patients to raise their psychological conditions and support the immune system such that resist against the infection.

Anxiety, Depression and Post-Traumatic Stress Disorder in Physicians Compared to Nurses during the COVID-19 Pandemic: An Observational, Cross Sectional, Multicentric Study

(1) Background: The coronavirus pandemic has highlighted the precarious health situation of our country, thanks to the grueling workloads caused by understaffing and fear of contracting COVID-19. By considering this critical situation, frontline healthcare professionals who have been directly involved in the diagnosis, treatment, and care of SARS-CoV-2 patients are now at risk of developing psychological distress and other mental health symptoms, accomplices of the fear of contracting the COVID-19 and the exhausting workloads. (2) Methods: An observational, cross-sectional, multicenter study was conducted by administering an online questionnaire to all Italian physicians and nurses who worked during the COVID-19 pandemic. The questionnaire consists of socio-demographic characteristics, an assessment of anxiety levels with the State-Trait Anxiety Inventory (STAI), which also assessed trait and state anxiety, the Beck Depression Inventory (BDI) to evaluate the condition of depressive severity, and, finally, the Impact of Event Scale–Revised (IES–R), which was administered in order to quantify the post-traumatic stress disorder (PTSD) among the participants. (3) Results: A total of 770 Italian healthcare workers were enrolled in this study. Of these, 95 (12.30%) were physicians and 675 (87.70%) were nurses. By considering PTSD, anxiety, and depression levels between the physicians and nurses recruited, a significant difference was reported in the STAI-1 assessment, as both physicians and nurses reported slight and moderate levels (p = 0.033). (4) Conclusions: Physicians and nurses, who have been subjected to physical impoverishment, with the infinite physical forces spent to support the pace of work at the limits of the possible, but above all mental capacity, with the anxiety of having to face an unknown enemy, such as COVID-19. This has resulted in a significant increase in anxiety, depression, post-traumatic symptoms, and sleep disturbances, with possible repercussions not only on the quality of life of the physicians and nurses but also on the quality of assistance provided.

Mental Health Research During the COVID-19 Pandemic: Focuses and Trends

Background

The COVID-19 pandemic has profoundly influenced the world. In wave after wave, many countries suffered from the pandemic, which caused social instability, hindered global growth, and harmed mental health. Although research has been published on various mental health issues during the pandemic, some profound effects on mental health are difficult to observe and study thoroughly in the short term. The impact of the pandemic on mental health is still at a nascent stage of research. Based on the existing literature, we used bibliometric tools to conduct an overall analysis of mental health research during the COVID-19 pandemic.

Method

Researchers from universities, hospitals, communities, and medical institutions around the world used questionnaire surveys, telephone-based surveys, online surveys, cross-sectional surveys, systematic reviews and meta-analyses, and systematic umbrella reviews as their research methods. Papers from the three academic databases, Web of Science (WOS), ProQuest Academic Database (ProQuest), and China National Knowledge Infrastructure (CNKI), were included. Their previous research results were systematically collected, sorted, and translated and CiteSpace 5.1 and VOSviewers 1.6.13 were used to conduct a bibliometric analysis of them.

Result

Authors with papers in this field are generally from the USA, the People's Republic of China, the UK, South Korea, Singapore, and Australia. Huazhong University of Science and Technology, Hong Kong Polytechnic University, and Shanghai Jiao Tong University are the top three institutions in terms of the production of research papers on the subject. The University of Toronto, Columbia University, and the University of Melbourne played an important role in the research of mental health problems during the COVID-19 pandemic. The numbers of related research papers in the USA and China are significantly larger than those in the other countries, while co-occurrence centrality indexes in Germany, Italy, England, and Canada may be higher.

Conclusion

We found that the most mentioned keywords in the study of mental health research during the COVID-19 pandemic can be divided into three categories: keywords that represent specific groups of people, that describe influences and symptoms, and that are related to public health policies. The most-cited issues were about medical staff, isolation, psychological symptoms, telehealth, social media, and loneliness. Protection of the youth and health workers and telemedicine research are expected to gain importance in the future.

Sleep Disorders and Mental Stress of Healthcare Workers during the Two First Waves of COVID-19 Pandemic: Separate Analysis for Primary Care

Background: During the recent pandemic, Healthcare Professionals (HCPs) presented a significant prevalence of psychological health problems and sleep disturbances. The aim of this study was to assess the impact of COVID-19 on HCPs’ sleep and mental stress with a separate analysis for primary care HCPs. Methods: A cross-sectional observational study with an online anonymized, self-reported questionnaire was conducted in May 2020 (1st wave) and repeated in December 2020 (2nd wave). Patient health questionnaire-4 (PHQ-4), dimensions of anger reactions-5 (DAR-5) scale, 3-item UCLA loneliness scale (LS) and sleep condition indicator (SCI) were used. Results: Overall, 574 participants were included from the 1st wave, 514 from the 2nd and 469 were followed during both. Anxiety and depression were significantly higher during the 2nd wave vs. the 1st (32.8% vs. 12.7%, p < 0.001 and 37.7% vs. 15.8%, p < 0.001). During the 2nd wave, HCPs scored significantly higher in DAR-5 (9.23 ± 3.82 vs. 7.3 ± 3.3, p < 0.001) and LS (5.88 ± 1.90 vs. 4.9 ± 1.9, p < 0.001) with worse sleep quality SCI (23.7 ± 6.6 vs. 25.4 ± 3.2, p < 0.001). This was more evident in primary care HCPs. Significant correlations were found between SCI and PHQ4, DAR5 and LS. Conclusion: There is a need to support HCPs’ mental health and sleep, especially in those working in primary care.

'COVID-Somnia' in healthcare workers during the pandemic

OBJECTIVES

Sleep disorders associated with COVID-19 pandemic are termed as 'COVID-somnia.' In this study, we sought to assess the prevalence of COVID-somnia in healthcare workers, establish the factors that trigger this condition, and to investigate its relationship with anxiety and depression symptoms.

METHODS

This cross-sectional study was conducted between April 2021 and June 2021, and it included healthcare workers who served during the pandemic. Participants' demographic data, Beck Depression and Anxiety Inventories, Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and Insomnia Severity Index (ISI) were used, and the results were statistically analyzed. Multiple analyses of factors affecting ESS and ISI scores were evaluated using binary logistic regression model and PSQI score were analyzed using a multiple linear regression model.

RESULTS

A total of 1,111 healthcare workers who served during the pandemic voluntarily enrolled to the study. The mean age was 37.3 ± 8.48 years, and 63.5% were females. Our study showed that the healthcare workers, evaluated with the PSQI, experienced a deterioration of sleep quality. Primary factors affecting this are working on the front line, the presence of chronic diseases, depression, and anxiety. Regression analyses identified depression and anxiety as the common factors affecting ESS, ISI, and PSQI scores.

CONCLUSION

Raising awareness regarding COVID-somnia among healthcare workers, who play a leading role in curbing the pandemic, would reduce sleep disturbances, depression, and anxiety. It would also contribute to the planning and implementation of preventive and therapeutic mental health programs with a multidisciplinary approach.

Global Trends in Nursing-Related Research on COVID-19: A Bibliometric Analysis

Background

Coronavirus disease 2019 (COVID-19) has significantly impacted healthcare, especially the nursing field. This study aims to explore the current status and hot topics of nursing-related research on COVID-19 using bibliometric analysis.

Methods

Between 2019 and 2022, publications regarding nursing and COVID-19 were retrieved from the Web of Science core collection. We conducted an advanced search using the following search query string: TS = (“Novel coronavirus 2019” or “Coronavirus disease 2019” or “COVID 19” or “2019-nCOV” or “SARS-CoV-2” or “coronavirus-2”) and TS = (“nursing” or “nurse” or “nursing-care” or “midwife”). Bibliometric parameters were extracted, and Microsoft Excel 2010 and VOSviewer were utilized to identify the largest contributors, including prolific authors, institutions, countries, and journals. VOSviewer and CiteSpace were used to analyze the knowledge network, collaborative maps, hotspots, and trends in this field.

Results

A total of 5,267 papers were published between 2020 and 2022. The findings are as follows: the USA, China, and the UK are the top three prolific countries; the University of Toronto, the Harvard Medical School, the Johns Hopkins University, and the Huazhong University of Science &amp; Technology are the top four most productive institutions; Gravenstein, Stefan, and White, Elizabeth M. from Brown University (USA) are the most prolific authors; The International Journal of Environmental Research and Public Health is the most productive journal; “COVID-19,” “SARS-CoV-2,” “nurse,” “mental health,” “nursing home,” “nursing education,” “telemedicine,” “vaccine-related issues” are the central topics in the past 2 years.

Conclusion

Nursing-related research on COVID-19 has gained considerable attention worldwide. In 2020, the major hot topics included “SARS-CoV-2,” “knowledge,” “information teaching,” “mental health,” “psychological problems,” and “nursing home.” In 2021 and 2022, researchers were also interested in topics such as “nursing students,” “telemedicine,” and “vaccine-related issues,” which require further investigation.

Changes in the Work Schedule of Nurses Related to the COVID-19 Pandemic and Its Relationship with Sleep and Turnover Intention

Background: This study aimed to investigate whether different types of changes in the work schedule of nurses working rotating shifts during the COVID-19 pandemic were associated with sleep duration, sleep quality, and turnover intention. Methods: Cross-sectional questionnaire data from 694 nurses participating in the SUrvey of Shift work, Sleep and Health (SUSSH) were collected between the first and the second wave of the COVID-19 pandemic in Norway. A total of 89.9% were female, and mean age was 44.6 years (SD = 8.6 years). Changes in the shift work schedule related to the pandemic comprised reports of more long workdays (>8 h), less days off between work periods, more night shifts, more quick returns (i.e., 11 h or less between two consecutive shifts), more day shifts, and more evening shifts compared to no change in the respective shift characteristics. Change in sleep duration, sleep quality, and turnover intention as well as demographics were also assessed. Logistic regression analyses were performed to investigate whether changes in the specific work schedules were associated with sleep duration, sleep quality, and turnover intention, controlling for sex, age, cohabitation, children living in household, percentage of full time equivalent and other changes in the work schedule. Results: A total of 17% reported experiencing one or more changes in their work schedule during the pandemic. Experiencing any change in the work schedule predicted worse sleep quality (OR = 2.68, p < 0.001), reduced sleep duration (OR = 4.56, p < 0.001), and higher turnover intention (OR = 1.96, p = 0.006) compared to experiencing no change in work schedule. Among the specific changes in work schedules, experiencing an increase in quick returns had the highest odds ratio for worse sleep quality (OR = 10.34, p = 0.007) and higher turnover intention (OR = 8.49, p = 0.014) compared to those who reported no change in quick returns. Nurses experiencing an increase in long workdays were more likely to report higher turnover intention (OR = 4.37, p = 0.003) compared to those experiencing no change in long workdays. Conclusions: Change in work schedule related to the pandemic was associated with worse sleep quality, reduced sleep duration, and higher turnover intention. Increase in quick returns emerged as especially problematic in terms of sleep quality and turnover intention, along with long workdays, which were associated with higher turnover intention.

Trends in Insomnia, Burnout, and Functional Impairment among Health Care Providers over the First Year of the COVID-19 Pandemic

Background

COVID-19 pandemic has negatively impacted the psychological well-being and quality of life of health care providers (HCPs).

Objectives

This study assessed the trends in prevalence and predictors of insomnia, burnout, and functional impairment among HCPs over the first year of the pandemic.

Methods

An online survey was conducted one month after the pandemic's onset (onset group) and a year later (one-year group). The demographic features of participants were collected. Insomnia, burnout, and functional impairment were assessed using Insomnia Severity Index (ISI), Mini-Z survey, and Sheehan Disability Scale (SDS), respectively.

Results

The onset group included 211 HCPs (mean (SD) age 34.7 (9.3) years and 73% men), while 212 HCPs participated in the one-year survey (mean (SD) age 35.9 (10.5) years and 69% men). High prevalence estimates were found in both onset and one-year groups of symptoms of insomnia (52% vs. 49%), of diagnosis of clinical insomnia (15% vs. 18%), with a high mean ISI score (8.4 vs. 8.7), but with no significant difference between the onset and one-year groups. Risk factors for clinical insomnia included age in both groups, lower income and contact level with COVID-19 patients/samples in the onset group, and lower Mini-Z scores and higher SDS scores in the one-year group. Approximately one-third of respondents reported at least one or more burnout symptoms, with a higher percentage in the one-year group (35.4%) than in the onset group (24.2%) (p=0.012). Younger age, lower monthly income, and higher ISI and SDS scores were risk factors for burnout in both groups. Greater perceived changes in social life were associated with burnout in the onset group. In contrast, higher weekly working hours, worse participants' evaluation of their institution's preparation, and more changes in workload were risk factors for burnout in the one-year group. The SDS score and its subscales scores were higher in the one-year group than in the onset group. Changes in workload and social life predicted higher SDS scores among both groups. Living with older people predicted higher SDS scores among the onset group, while contact level and estimated number of COVID-19 patients that participants engaged in during caring predicted higher SDS scores among the one-year group. ISI scores were significantly correlated with the Mini-Z scores and SDS scores in both groups, while the Mini-Z and SDS scores were significantly correlated only in the one-year group.

Conclusion

This study demonstrated high rates of insomnia, burnout, and functional impairment among HCPs during the pandemic. It reveals a significant rise in job burnout and functional impairment of HCPs overtime during the pandemic. Furthermore, high-risk subgroups are also highlighted for whom comprehensive psychosocial and occupational interventions might be warranted.

Occupational Stress and Insomnia Symptoms Among Nurses During the Outbreak of COVID-19 in China: The Chain Mediating Effect of Perceived Organizational Support and Psychological Capital

Background

Nurses play an important role in medical and health services and insomnia symptoms were relatively high among nurses, especially during the epidemic of 2019 coronavirus disease. Insomnia not only damages the physical and mental health of the individual, but also reduces the efficiency of their work and the quality of care, ultimately impacting on patient care.

Objective

The purpose of this study was to explore the role of perceived organizational support and psychological capital in the relationship between occupational stress and insomnia among Chinese nurses.

Methods

A cross-sectional study has been carried out in a tertiary grade A hospital in Shandong Province, China from March 2021 to May 2021. The self-administered questionnaires were distributed to 810 nurses, which including Chinese Effort-Reward Imbalance Scale, Athens Insomnia Scale, Perceived Organizational Support Questionnaire, Chinese Psychological Capital Questionnaire, gender, age, education level and other demographic characteristics. Effective respondents were 658 (81.2%). Descriptive analysis, independent-samples t-test, one-way analysis of variance, Pearson correlation analyses, ordinary least-squares regression and the bootstrap method were used for data analysis.

Results

The prevalence of insomnia symptoms in this study was found to be 57.3%. There were significant differences in insomnia symptoms in weekly working hours (t = -2.027, P = 0.043), with chronic disease (t = -2.825, P = 0.005), negative life events (t = -5.340, P < 0.001), departments (F = 3.077, P = 0.006) and position (t = 2.322, P = 0.021) among nurses. Overall, the serial-multiple mediations of perceived organizational support and psychological capital in the relationship between occupational stress and insomnia were found to be statistically significant.

Conclusions

The prevalence of insomnia symptoms was comparatively high among Chinese nurses, and occupational stress had direct negative influence on it. Perceived organizational support and psychological capital acted as chained mediating factor could partially relieve insomnia symptoms related to occupational stress. Supportive working environment should be provided, and improving psychological capital levels to help nurses coping with insomnia symptoms.

A cross-sectional survey of sleep patterns and quality and its association with psychological symptoms among doctors working in a COVID-19 care facility

CONTEXT

The coronavirus disease 2019 (COVID-19) outbreak has led to several psychological symptoms among frontline doctors of which sleep disturbances are common. Stress due to isolation and disease-related factors are known to be associated with sleep disturbances.

AIM

The aim of this study is to establish the prevalence of poor sleep and its association with psychological symptoms among doctors working in COVID-19 tertiary hospital.

SETTINGS AND DESIGN

A cross-sectional online survey was conducted among 150 doctors who were treating COVID-19 patients.

MATERIALS AND METHODS

The survey contained a semi-structured questionnaire including sociodemographic details, Depression Anxiety Stress Scale 21, and Pittsburgh Sleep Quality Index scale. Analysis was done using the SPSS v20.

RESULTS

Of 150 doctors, we found 67 (44.67%) and 83 (55.33%) doctors were poor sleepers and good sleepers, respectively. Those who were married (P = 0.001), had higher working hours per month (P = 0.001), the presence of family history of psychiatric illness (P = 0.008), and history of substance use (P = 0.007) were associated with poor sleep. Furthermore, poor sleep was associated with higher stress (P = 0.001), anxiety (P = 0.001), and depression (P = 0.001). A multiple logistic regression revealed that family history of psychiatric illness (odds ratio [OR]-5.44, P = 0.01) and the presence of substance use (OR-7.77, P = 0.01) predicted poor sleep.

CONCLUSION

Sleep pattern abnormalities were present in 45% of the frontline COVID-19 doctors studied. Family history of psychiatric illness and substance use was associated with higher chances of having poor sleep. It is important to recognize and manage sleep abnormalities as these could be initial signs of a psychiatric disorder or manifestations of underlying stress, especially in the vulnerable population.

Sleep of Healthcare Workers During the COVID-19 Pandemic and the Role of Atypical Work Schedules: A Scoping Review

The COVID-19 pandemic has negatively impacted the well-being of healthcare workers (HCWs). HCWs are highly exposed to shift work and their work schedules have been subject to increasing unpredictability since the start of the pandemic. This review aims to: (1) map the studies providing information about factors associated with sleep characteristics in HCWs working in the context of the COVID-19 pandemic during the first and second waves and (2) examine the state of the evidence base in terms of the availability of information on the influence of atypical work schedules. A literature search was performed in PubMed. Studies containing information about factors (demographic; psychological; occupational; COVID-19-specific; work schedule; lifestyle; medical; or other) associated with various sleep characteristics among HCWs working in the context of the COVID-19 pandemic were included. Particular attention was paid to the availability of information on the role of atypical work schedules on HCW sleep. Fifty-seven articles met the inclusion criteria. Most studies were reports of quantitative cross-sectional surveys using self-report measures. Associations between female sex, frontline HCW status, psychological factors, and poorer sleep were observed. Six studies included a measure of shift work in their analyses, 5 of which reported an association between shift work status and sleep. A wide range of factors were investigated, with female sex, frontline HCW status, and psychological factors repeatedly demonstrating associations with poorer sleep. Sleep was predominantly measured in terms of self-reported sleep quality or insomnia symptoms. Few studies investigated the influence of atypical work schedules on HCW sleep in the context of the COVID-19 pandemic. Research on this topic is lacking in terms of reliable and consistent measurements of sleep outcomes, longitudinal data, and knowledge about the influence of covariates such atypical work schedules, comorbidity, and medical history on HCW sleep.

Increased sleep duration and delayed sleep timing during the COVID-19 pandemic

Many studies have examined how the 2019 Coronavirus Disease (COVID-19) has impacted sleep health. Early evidence suggests that lockdown policies worldwide have led to changes in sleep timing, duration, and quality; however, few studies have attempted to look at the longer-term effects across multiple countries in a large data set. This study uses self-reported data from 64,858 users of the Sleep As Android smartphone application from around the world over a 24-month period in 2019 to 2020. We found a significant but modest increase in time in bed (TIB), as well as a significant delay in sleep timing that was especially prominent on weekdays. While this effect persisted throughout the year, differences in sleep timing were more widespread and pronounced in the earlier months of the pandemic. We observed a small overall increase in TIB when comparing 2020 to 2019, but these changes depended on location and time of year, suggesting that sleep duration may have more closely tracked the progression of the pandemic in each country. Our findings suggest that pandemic-induced changes in lifestyle, such as remote work and lockdown policies, may have facilitated later sleep timing but that these changes may diminish as restrictions are lifted.

Assessment of perceived support in the context of emergency: Development and validation of the psycho-social support scale

In research and clinical contexts, it is important to briefly evaluate perceived Psychological and Social Support (PSS) to plan psychological interventions and allocate efforts and resources. However, an appropriate brief assessment tool for PSS was lacking. This study aimed at developing a brief and accurate scale to specifically measure PSS in clinical and emergency contexts, with specific, relevant, targeted, and irredundant items. Experienced clinicians developed the perceived Psycho-Social Support Scale (PSSS) and administered it to a clinical sample (N = 112) seeking psychological help during the COVID-19 emergency. A Confirmatory Factor Analysis examined the PSSS internal structure, and a Multiple Indicator and Multiple Causes model investigated its association with the number of sessions and emotional symptoms. The PSSS showed good psychometric properties and the Confirmatory Factor Analysis provided acceptable fit indexes for a unidimensional structure. The Multiple Indicators and Multiple Causes revealed that more sessions and emotional symptoms were associated with lower PSSS scores. The PSSS is a reliable brief tool to measure PS and could be useful to individualize treatments (i.e., number of sessions) to efficiently allocate efforts and resources in clinical contexts and emergencies (e.g., earthquake, COVID-19 pandemic).

Supplementary Information

The online version contains supplementary material available at 10.1007/s12144-022-03344-z.

Long Coronavirus Infection is Associated with Significant Sleep Disturbances as Detected by Wearable Health Devices

Background

Patients with COVID-19 have increased sleep disturbances and decreased sleep quality during and after the infection. The current published literature focuses mainly on qualitative analyses based on surveys and subjective measurements rather than quantitative data.

Objective

In this paper, we assessed the long-term effects of COVID-19 through sleep patterns from continuous signals collected via wearable wristbands.

Methods

Patients with a history of COVID-19 were compared to a control arm of individuals who never had COVID-19. Baseline demographics were collected for each subject. Linear correlations among the mean duration of each sleep phase and the mean daily biometrics were performed. The average duration for each subject’s total sleep time and sleep phases per night was calculated and compared between the 2 groups.

Results

This study includes 122 patients with COVID-19 and 588 controls (N=710). Total sleep time was positively correlated with respiratory rate (RR) and oxygen saturation (SpO₂). Increased awake sleep phase was correlated with increased heart rate, decreased RR, heart rate variability (HRV), and SpO₂. Increased light sleep time was correlated with increased RR and SpO₂ in the group with COVID-19. Deep sleep duration was correlated with decreased heart rate as well as increased RR and SpO₂. When comparing different sleep phases, patients with long COVID-19 had decreased light sleep (244, SD 67 vs 258, SD 67; P=.003) and decreased deep sleep time (123, SD 66 vs 128, SD 58; P=.02).

Conclusions

Regardless of the demographic background and symptom levels, patients with a history of COVID-19 infection demonstrated altered sleep architecture when compared to matched controls. The sleep of patients with COVID-19 was characterized by decreased total sleep and deep sleep.

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.

The Impact of COVID-19 on the Physical Well-being of Nursing and Medical Personnel: An Integrative Review

Objective: To highlight the impact of responding to COVID-19 on the physical well-being of nursing and medical personnel. Method: This integrative literature review includes Spanish, English, and Portuguese articles. From July 10 to 16, 2020, the search was carried out in the Cumulative Index to Nursing and Allied Health Literature, Latin American and Caribbean Health Sciences Literature, Web of Science, SciVerse Scopus, and National Library of Medicine databases. Twenty-five studies were analyzed, and the results are presented descriptively and in tables. Results: Of the total number of articles, 52 % addressed coronavirus infection and related factors as an impact on nursing and medical personnel’s physical well-being resulting from responding to COVID-19, 28 % addressed sleep quality and predictors, and 20 % addressed damage stemming from the use of personal protective equipment or other preventive measures. Conclusions: Responding to COVID-19 has been conducive to coronavirus infection among personnel due to the work process and prevention measures, poor sleep quality due to mental disorders and lack of social support, and physical harm, such as headaches and skin injuries, due to the use of protective equipment and hand disinfection.

Personal growth initiative moderates the mediating effect of COVID-19 preventive behaviors between fear of COVID-19 and satisfaction with life

This study focused on a moderated mediation model. First, it determined the mediating effect of COVID-19 preventive behaviors between fear of COVID-19 and satisfaction with life. Next, it examined whether personal growth initiative moderated the mediation effect. The study comprised 461 Pakistani university students (52% men and 48% women) between 18 and 35 years (M = 24.66, SD = 3.51). Results indicated that higher levels of fear of COVID-19 were linked to greater adherence to COVID-19 preventive behaviors, which in turn were related to higher levels of satisfaction with life (mediation model). With regard to the hypothesized moderated mediation model, results showed that personal growth initiative moderated the mediating path from fear of COVID-19 to satisfaction with life and from COVID-19 preventive behaviours to satisfaction with life. Further, results suggested that fear of COVID-19 and COVID-19 preventive behaviours had stronger effects on satisfaction with life when personal growth initiative was high, but not when it was low or moderate. It was therefore concluded that personal growth initiative may play a protective role in buffering the negative effect of higher levels of fear of COVID-19 on satisfaction with life and an enabling role in strengthening the relationship between COVID-19 preventive behaviors and satisfaction with life. Theoretical contribution and practical implications of the results are discussed as well as the study limitations and future research prospects.

C, Boland P, Doherty A, Benedetto V, Gita BE, Clegg AJ. The prevalence of mental health conditions in healthcare workers during and after a pandemic: Systematic review and meta-analysis

AIMS

This review aims to explore the prevalence and incidence rates of mental health conditions in healthcare workers during and after a pandemic outbreak and which factors influence rates.

BACKGROUND

Pandemics place considerable burden on care services, impacting on workers' health and their ability to deliver services. We systematically reviewed the prevalence and incidence of mental health conditions in care workers during pandemics.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

Searches of MEDLINE, Embase, Cochrane Library and PsychINFO for cohort, cross-sectional and case-control studies were undertaken on the 31 March 2020 (from inception to 31 March 2020).

REVIEW METHODS

Only prevalence or incidence rates for mental health conditions from validated tools were included. Study selection, data extraction and quality assessment were carried out by two reviewers. Meta-analyses and subgroup analyses were produced for pandemic period (pre- and post), age, country income, country, clinical setting for major depression disorder (MDD), anxiety disorder and post-traumatic stress disorder (PTSD).

RESULTS

No studies of incidence were found. Prevalence estimates showed that the most common mental health condition was PTSD (21.7%) followed by anxiety disorder (16.1%), MDD (13.4%) and acute stress disorder (7.4%) (low risk of bias). For symptoms of these conditions there was substantial variation in the prevalence estimates for depression (95% confidence interval [CI]:31.8%; 60.5%), anxiety (95% CI:34.2%; 57.7%) and PTSD symptoms (95% CI,21.4%; 65.4%) (moderate risk of bias). Age, level of exposure and type of care professional were identified as important moderating factors.

CONCLUSION

Mental disorders affect healthcare workers during and after infectious disease pandemics, with higher proportions experiencing symptoms.

IMPACT

This review provides prevalence estimates of mental health conditions during and after a pandemic which could be used to inform service staffing impact and formulation of preventative strategies, by identifying clinical populations who may be at high risk of developing mental health symptoms and conditions.

Influencing factors of high PTSD among medical staff during COVID-19: evidences from both meta-analysis and subgroup analysis

Background

PTSD (Post-traumatic stress disorder, PTSD) had a great impact on health care workers during the COVID-19 (Corona Virus Disease 2019, COVID-19). Better knowledge of the prevalence of PTSD and its risk factors is a major public health problem. This study was conducted to assess the prevalence and important risk factors of PTSD among medical staff during the COVID-19.

Methods

The databases were searched for studies published during the COVID-19, and a PRISMA (preferred reporting items for systematic review and meta-analysis) compliant systematic review (PROSPERO-CRD 42021278970) was carried out to identify articles from multiple databases reporting the prevalence of PTSD outcomes among medical staff. Proportion random effect analysis, I² statistic, quality assessment, subgroup analysis, and sensitivity analysis were carried out.

Results

A total of 28 cross-sectional studies and the PTSD results of doctors and nurses were summarized from 14 and 27 studies: the prevalences were 31% (95% CI [confidence interval, CI]: 21%–40%) and 38% (95% CI: 30%–45%) in doctors and nurses, respectively. The results also showed seven risks (p < 0.05): long working hours, isolation wards, COVID-19 symptoms, nurses, women, fear of infection, and pre-existing mental illness. Two factors were of borderline significance: higher professional titles and married.

Conclusion

Health care workers have a higher prevalence of PTSD during COVID-19. Health departments should provide targeted preventive measures for medical staff away from PTSD.

Mental health symptoms during the COVID-19 pandemic in developing countries: A systematic review and meta-analysis

Background

This systematic review aims to 1) summarize the prevalence of anxiety, depression, distress, insomnia, and PTSD in the adult population during the first year of the COVID pandemic in developing countries and 2) uncover and highlight the uneven distribution of research on mental health in all developing countries across regions.

Methods

Several literature databases were systemically searched for meta-analyses published by September 22, 2021, on the prevalence rates of mental health symptoms in developing countries worldwide. We meta-analysed the raw data of the individual empirical results from the previous meta-analysis papers in developing countries in different regions.

Results

The prevalence rates of mental health symptoms were summarized based on 341 empirical studies with a total of 1 704 072 participants from 40 out of 167 developing countries in Africa, Asia (East, Southeast, South, and West), Europe, and Latin America. Comparatively, Africa (39%) and West Asia (35%) had the worse overall mental health symptoms, followed by Latin America (32%). The prevalence rates of overall mental health symptoms of medical students (38%), general adult students (30%), and frontline health care workers (HCWs) (27%) were higher than those of general HCWs (25%) and general populations (23%). Among five mental health symptoms, distress (29%) and depression (27%) were the most prevalent. Interestingly, people in the least developing countries suffered less than those in emergent and other developing countries. The various instruments employed lead to result heterogeneity, demonstrating the importance of using the well-established instruments with the standard cut-off points (eg, GAD-7, GAD-2, and DASS-21 for anxiety, PHQ-9 and DASS-21 for depression, and ISI for insomnia).

Conclusions

The research effort on mental health in developing countries during COVID-19 has been highly uneven in the scope of countries and mental health outcomes. This meta-analysis, the largest on this topic to date, shows that the mental health symptoms are highly prevalent yet differ across regions. The accumulated systematic evidence from this study can help enable the prioritization of mental health assistance efforts to allocate attention and resources across countries and regions.

Tiny Habits® for Gratitude-Implications for Healthcare Education Stakeholders

The COVID-19 pandemic has led to diminished sleep and increased stress, anxiety, and burnout for many health professionals and health professions students. One simple approach that may be effective for bolstering personal well-being is consciously cultivating gratitude. Gratitude is positively associated with physical health, psychological health, hope, sleep, and health behavior engagement; and randomized studies indicate that gratitude interventions can improve psychological well-being and sleep. The primary aim of this study was to assess the impact of practicing Tiny Habits^® on self-reported gratitude, as measured by the 6-Item Gratitude Questionnaire (GQ-6). In January 2021, 154 adult participants with GQ-6 <35/42 were randomized to one of 3 groups: Tiny Habits for Gratitude (n = 50), Tiny Habits Control (n = 52), and Inactive Control (n = 52). Both Tiny Habits groups chose 3 Tiny Habits Recipes to practice daily and participated in the free, email-based 5-Day Program with automated daily check-in emails and personalized feedback from a Certified Tiny Habits Coach. The Recipes for the Tiny Habits for Gratitude group focused on cultivating gratitude, while those for the Tiny Habits Control group did not. Post-intervention, the mean change in GQ-6 scores in the Tiny Habits for Gratitude (Δ = ↑6.9 ± 5.6; n = 37/50, 74%; p< 0.001, Cohen's d = 0.85) and Tiny Habits Control (Δ = ↑5.6 ± 4.1; n = 31/52, 60%; p = 0.009, Cohen's d = 0.71) groups were greater than that of the Inactive Control group (Δ = ↑2.5 ± 4.4; N = 42/52, 81%). At 1 month, the mean change in GQ-6 scores in the Tiny Habits for Gratitude group (Δ = ↑7.0 ± 5.3; N = 28/50, 56%) was greater than that of the Inactive Control group (Δ = ↑2.9 ± 5.4; N = 39/52, 72%; p = 0.002, Cohen's d = 0.78). These findings suggest that practicing Tiny Habits Recipes and participating in the 5-Day Program can significantly increase gratitude in the short term and focusing specifically on gratitude during this process can sustain the increase in gratitude for up to 1 month. Implementation is quick, simple, and free. This has significant implications for healthcare education stakeholders.

Collective Occupational Trauma, Health Care Quality, and Trauma-Informed Leadership: Intersections and Implications

Managing stress, burnout, and vicarious trauma is a long-standing issue for the health and behavioral health workforce, including those in case management. Yet, the recent novel coronavirus pandemic has amplified routine burnout to record levels. Practitioners and patients are amid a new dynamic of collective occupational trauma (COT). In this realm, health and behavioral health workers (HBWs) experience the same reality as their patients, families, and support systems; professional boundaries become blurred, leading to heightened levels of emotional vulnerability that can prompt the development of more pervasive psychopathology. This reality has put the Quadruple Aim in peril, with increased workforce turnover, staff shortages, costs, and quality challenges. This article: Applicable to all health and behavioral health settings where case management is practiced. Organizational cultures must shift from a "process and roll" mindset to one that is trauma-informed. Implementation of TIC has yielded successful outcomes for the workforce via enhanced patient engagement, treatment adherence, and successful outcomes. In tandem, TIC leadership and supervision models have had promising results and should be more readily utilized; they acknowledge and address workforce trauma while prioritizing staff health, mental health, and wellness. Failure to shift the culture will result in an ongoing exodus of practitioners, leaving insufficient numbers to render safe, cost-effective, efficient, and patient-centered care. The case management workforce comprises professional disciplines across health and behavioral health, employed in every setting. The expanding workforce presence has put them at risk of COT. Leadership strategies must shift to acknowledge workforce exposure to occupational trauma, address mental health and wellness, and address professional self-care. This shift is key to mitigating retention, sustainability, and quality challenges.

COVID-19 pandemic: study on simple, easy, and practical relaxation techniques while wearing medical protective equipment

BACKGROUND

No studies have reported on how to relieve distress or relax in medical health workers while wearing medical protective equipment in coronavirus disease 2019 (COVID-19) pandemic. The study aimed to establish which relaxation technique, among six, is the most feasible in first-line medical health workers wearing medical protective equipment.

METHODS

This was a two-step study collecting data with online surveys. Step 1: 15 first-line medical health workers were trained to use six different relaxation techniques and reported the two most feasible techniques while wearing medical protective equipment. Step 2: the most two feasible relaxation techniques revealed by step 1 were quantitatively tested in a sample of 65 medical health workers in terms of efficacy, no space limitation, no time limitation, no body position requirement, no environment limitation to be done, easiness to learn, simplicity, convenience, practicality, and acceptance.

RESULTS

Kegel exercise and autogenic relaxation were the most feasible techniques according to step 1. In step 2, Kegel exercise outperformed autogenic relaxation on all the 10 dimensions among the 65 participants while wearing medical protective equipment (efficacy: 24 v. 15, no space limitation: 30 v. 4, no time limitation: 31 v. 4, no body position requirement: 26 v. 4, no environment limitation: 30 v. 11, easiness to learn: 28 v. 5, simplicity: 29 v. 7, convenience: 29 v. 4, practicality: 30 v. 14, acceptance: 32 v. 6).

CONCLUSION

Kegel exercise seems a promising self-relaxation technique for first-line medical health workers while wearing medical protective equipment among COVID-19 pandemic.

Predictors of Learning Engagement in the Context of Online Learning During the COVID-19 Pandemic

The main aim of the present research is to analyze the predictive value of individual characteristics such as online self-efficacy, adaptability to uncertainty, and sources of stress during online learning on learning engagement. We also aimed to highlight if these relationships could be mediated by the online self-regulated learning strategies, during the COVID-19 pandemic. The participants were 529 university students and the design was cross-sectional. The results showed significant associations of the sources of stress in online learning with self-efficacy, leaning engagement and self-regulated learning strategies. Self-regulated strategies—task strategies and goal setting represent mediators of stressors perceived by the students under the conditions of the sudden shift to online activity and online learning engagement. The most relevant self-regulation strategies seemed to be goal setting and task strategies, which confirm the need for a clear structure of learning in the context of online activities. The implications of this study reside in the increased awareness regarding how learning engagement in online learning can be predicted by individual characteristics.

The pooled prevalence of the mental problems of Chinese medical staff during the COVID-19 outbreak: A meta-analysis

BACKGROUND

The COVID-19 pandemic has had a great impact on the mental health of the medical staff in China, especially those on the first-line (frontline) of the pandemic. But the profile of the mental problem of nationwide Chinese medical staff is still unclear, especially about the sleep problems.

METHODS

There are five databases (PubMed, Embase, CNKI, Wanfang Database and Web of Science) searched to identify the published studies on the mental health of the medical staff in China during the COVID-19 outbreak. The pooled prevalence of mental problems of Chinese medical staff during the pandemic were calculated, especially for the first-line medical staff. Subgroup analysis and meta-regression analysis were performed to identify the potential impact factors.

RESULTS

A total of 71 articles including 98,533 participants are included in this meta-analysis. The results showed that the pooled prevalence of the mental problems was as follows: anxiety problem 27%, depression problem 29%, sleep problem 40%. Subgroup analysis showed that there were significant differences in the prevalence of anxiety and depression problems between first-line and non-first-line medical staff (p < 0.01). Sex had a significant impact on the sleep of first-line medical staff (p < 0.01).

LIMITATIONS

There may be heterogeneity among the included studies. The analysis of potential influencing factors remains limited.

CONCLUSIONS

The prevalence of adverse mental problems among medical staff is high during the COVID-19 outbreak. We need to pay special attention to the mental health of first-line medical staff, especially the sleep problems of female first-line workers.

COVID-19 epidemic effects on sleep quality among health sector workers: A follow up study

Health care workers (HCWs) were vulnerable to sleep disturbances in normal circumstances. Poor sleep quality (PSQ) is common during the coronavirus disease 2019 (COVID-19) epidemic. The aim of this study is evaluation of sleep quality among healthcare workers during COVID-19 epidemic in a cohort study. In a follow-up study, we assessed sleep quality in 453 Iranian HCW participants in late-April 2021, after approximately 8 weeks of the epidemic of COVID-19. In order to compare the sleep quality in the two time intervals, during and before COVID-19, we used the recorded data of the same group of participants who were enrolled in a study named SHAHWAR (SHAhroud Health care Workers Associated Research) cohort that is focused on the health of HCWs who work at the Shahroud university of medical sciences. Data collection process in the SHAHWAR study started on October 2, 2019 and continued until February 19, 2020. Our results showed sleep quality worsened among shift-workers during COVID-19 outbreak; however, it was improved among non-shift staff. Sleep quality was more likely to be worsening if HCWs had shift-working roles [OR: 1.84(1.11-3.06), and if they experienced death in their families [OR: 5.06(1.60-12.80)]; however, having a paramedical role was a protective effect [OR: 0.52(0.27-092)], for poor quality sleep. Sleep quality worsened during the epidemic among HCWs. A greater impact, in terms of higher PSQI index, in this group of workers was seen in shift working staff.

Cancer staff in an NHS cancer center: infections, vaccination, stress and well-being support during the COVID-19 pandemic

Aim: To evaluate the impact of the pandemic on the well-being of cancer staff and determine the uptake of opt-in mitigation strategies. Materials & methods: Staff at Guy's Cancer Centre (London, UK) participated in an anonymized survey between May and August 2021. Results: Of 1182 staff, 257 (21.7%) participated. Ethnicity (p = 0.020) and comorbidity burden (p = 0.022) were associated with SARS-CoV-2 infection status. Of 199 respondents, seven (3.6%) were vaccine-hesitant, which was associated with low flu vaccine uptake (p < 0.001). Greater stress was associated with younger age (p = 0.030) and redeployment (p = 0.012). Lack of time and skepticism were barriers to using mental well-being resources. Conclusion: Albeit cautious, numerous trends the authors observed echo those in the published literature. Improved accessibility, awareness and utility of mental well-being resources are required.

Perceived Concerns and Psychological Distress of Healthcare Workers Facing Three Early Stages of COVID-19 Pandemic

Background

This study analyzed the difference in psychological distress of the healthcare workers in three different periods of the coronavirus disease 2019 (COVID-19) pandemic in Argentina. Specifically, from the third week of the mandatory quarantine through the two following weeks.

Methods

Analysis of the responses of 1,458 members of the health personnel was done on a questionnaire on healthcare workers concerns regarding the care of patients with coronavirus, indicators of depression, anxiety, intolerance of uncertainty, and coping.

Results

The psychological indicators that were considered presented differences between the evaluated periods. Perceived concerns about the possibility of infecting loved ones and infecting themselves were greatest in the periods after the onset of the pandemic. In addition, the perception of how the work environment worsened and how lack of sleep interfered with their work was also higher in periods 2 and 3. The same results were found in the indicators of depression, anxiety, and intolerance of uncertainty. Finally, the indicators of high tension and concurrent lack of emotional control, which was greater in the last periods evaluated, were also expressed in the coping strategies (showing emotional lability, only contained by hypercontrol).

Conclusion

The differences found in the psychological indicators between the evaluated periods support the need for early psychological care of health personnel which should be a priority of public health and a fundamental fact to increase its immediate effectiveness in the care of infected patients.

[Personal factors influencing daytime sleepiness]

Hintergrund und Zielsetzung

Während der ersten Coronawelle kam das öffentliche Leben weitgehend zum Erliegen. Viele Beschäftigte haben zum Schutz vor Ansteckung im Homeoffice gearbeitet. Mit der vorliegenden Befragung wurden Veränderungen im Schlafverhalten und der Tagesmüdigkeit bei Personen untersucht, die coronabedingt ins Homeoffice gewechselt hatten.

Methode

Büroangestellte wurden online zu ihrem Chronotyp, ihren üblichen Schlafenszeiten und dem Auftreten von Tagesmüdigkeit befragt. Die Datenerhebung fand zwischen dem 15.07. und 07.08.2020 statt. Zur Chronotypermittlung wurde die Composite Scale of Morningness (CSM) in der deutschsprachigen Version verwendet. Der Zusammenhang von Alter, Geschlecht, Chronotyp, Schlafqualität und Schlafdauer mit der selbst eingeschätzten Tagesmüdigkeit wurde mittels multivariabler logistischer Regression untersucht.

Ergebnisse

Die Daten von n = 228 Personen konnten ausgewertet werden. Unter Homeoffice-Bedingungen verlängerte sich die Schlafdauer. Der Anteil an Personen mit einer „Zeit-im-Bett“ von weniger als 7,5 h verringerte sich von 57 % auf 33 %, und der Anteil mit mehr als 8 h „Zeit-im-Bett“ erhöhte sich von 43 % vor Pandemiebeginn auf 67 % beim Arbeiten im Homeoffice. Der Anteil an Personen, die sich bei der Arbeit immer oder häufig müde fühlten, verringerte sich von 47 % vor Pandemiebeginn mit Präsenzpflicht im Büro auf 15 % unter Lockdown-Bedingungen beim Arbeiten im Homeoffice. Der Chronotyp zeigte einen signifikanten Einfluss auf die Tagesmüdigkeit an Büroarbeitstagen, nicht aber beim Arbeiten im Homeoffice unter Lockdownbedingungen.

Diskussion

Die längere Schlafdauer und die höhere Zufriedenheit mit der eigenen Schlafqualität könnten die Verringerung im Auftreten von Tagesmüdigkeit erklären. Späte Chronotypen scheinen besonders vom Arbeiten im Homeoffice zu profitieren. Ein flexibler Arbeitsbeginn unter Einbeziehung des Chronotyps sowie Maßnahmen für gesundheitsförderlichen Schlaf könnten die Tagesmüdigkeit verringern und dadurch die Gesundheit und Arbeitssicherheit verbessern.

Sleep disturbances during the COVID-19 pandemic: A systematic review, meta-analysis, and meta-regression

This systematic review and meta-analysis evaluated the extent of sleep disturbances during the COVID-19 pandemic. Eleven databases and six preprint repositories were searched for the period from November 1, 2019, to July 15, 2021. The DerSimonian and Laird method was used to develop random-effect meta-analyses. Two hundred and fifty studies comprising 493,475 participants from 49 countries were included. During COVID-19, the estimated global prevalence of sleep disturbances was 40.49% [37.56; 43.48%]. Bayesian meta-analysis revealed an odds of 0.68 [0.59; 0.77] which translates to a rate of approximately 41%. This provides reassurance that the estimated rate using classical meta-analysis is robust. Six major populations were identified; the estimated prevalence of sleep problem was 52.39% [41.69; 62.88%] among patients infected with COVID-19, 45.96% [36.90; 55.30%] among children and adolescents, 42.47% [37.95; 47.12%] among healthcare workers, 41.50% [32.98; 50.56%] among special populations with healthcare needs, 41.16% [28.76; 54.79%] among university students, and 36.73% [32.32; 41.38%] among the general population. Sleep disturbances were higher during lockdown compared to no lockdown, 42.49% versus 37.97%. Four in every ten individuals reported a sleep problem during the COVID-19 pandemic. Patients infected with the disease, children, and adolescents appeared to be the most affected groups.

Sleep disorders and mental health in hospital workers during the COVID-19 pandemic: a cross-sectional multicenter study in Northern Italy

INTRODUCTION

From the beginning of the COVID-19 pandemic, healthcare workers had to face unprecedented emergency needs associated with an extraordinary amount of psychological distress. In this cross-sectional multicenter study, we investigated sleep disturbances, and the level of anxiety and depression among the healthcare and non-healthcare staff of three hospitals in Milan (Italy) during the COVID-19 outbreak. Moreover, we explored potential predisposing factors for affective symptoms and poor sleep.

METHODS

Between June and July 2020, we administered an online questionnaire to evaluate the presence of sleep disorders (Pittsburgh Sleep Quality Index), insomnia (Sleep Condition Indicator), anxiety (State Trait Anxiety Inventory), and depression (Beck Depression Inventory-II). We used univariate and multivariate analysis to evaluate the association between the personal conditions and sleep and affective disorders.

RESULTS

The 964 participants reported high rates of sleep disorders (80.3%)-mainly insomnia (30.5%)-anxiety (69.7%), and depression (32.8%). The multivariate analysis showed a strong association of sleep disorders, especially insomnia, with female gender (p = 0.004), divorced marital status (p = 0.015), self-isolation (p = 0.037), and chronic diseases (p = 0.003). Anxiety was significantly associated with teleworking (p = 0.001), while depressive symptoms were associated with self-isolation (p = 0.028), modified work schedules (p = 0.03), and chronic diseases (p = 0.027).

CONCLUSION

In hospital workers, the high prevalence of sleep and psychiatric symptoms during the COVID-19 outbreak appears to be determined mainly by modifications of personal or work habits. Teleworking was associated with increased anxiety. An accurate planning of hospital activities and a psychological support are needed to prevent and manage sleep and mental disorders.

"This Isn't Just Busy, This is Scary": Stress, Social Support, and Coping Experiences of Frontline Nurses During the COVID-19 Pandemic

Despite having previous experience and extensive trauma training, the COVID-19 pandemic presented unprecedented challenges for nurses working in hospital settings. During the pandemic, nurses struggle to care for patients and protect themselves from infection, while navigating ongoing organizational changes. Guided by prior literature on social support and coping, this study explores nurses' experiences of coping with stress while treating COVID-19 patients during the pandemic. In-depth semi-structured interviews were conducted with 14 active staff nurses working in hospitals and one licensed practical nurse (LPN) at a rehabilitation center who treated COVID-19 patients during the pandemic. An inductive thematic analysis was employed to analyze those data, and three overarching themes emerged: (1) nurses' unique experiences in the [COVID-19] trenches, (2) nobody else understands, and (3) coping with stress together. Practically, this study is heuristic and generates an increased understanding of professional communication during times of healthcare crises, illuminating the need to enhance communication skills for both staff nurses and management. This study also extends our understanding of communal coping in the context of healthcare organizations.

Mental health of nursing professionals during the COVID-19 pandemic: a cross-sectional study

OBJECTIVE

To identify the prevalence of and factors associated with: (1) major depressive episodes; (2) minor psychiatric disorders (MPDs); and (3) suicidal ideation among nursing professionals from a municipality in southern Brazil.

METHODS

Using a cross-sectional design, we recruited 890 nursing professionals linked to 50 Primary Care units, 2 walk-in clinics, 2 hospital services, 1 emergency room service, 1 mobile emergency care service, and 1 teleconsultation service, in addition to the municipal epidemiological surveillance service and the vacancy regulation center between June and July 2020. We used the Patient Health Questionnaire-9 and the Self-Reporting Questionnaire to evaluate the studied outcomes. Associations between the outcomes and variables related to sociodemographic profile, work, health conditions, and daily life were explored using Poisson regression models with robust variance estimators.

RESULTS

The observed prevalence of depression, MPDs, and suicidal ideation were 36.6%, 44%, and 7.4%, respectively. MPDs were associated with the assessment of support received by the service as 'regular' (PR: 1.48; 95% CI: 1.19-1.85) or 'poor' (PR: 1.54; 95% CI: 1.23-1.94), with a reported moderate (PR: 1.63; 95% CI: 1.29-2.07), or heavy (PR: 2.54; 95% CI: 2.05-3.15) workload, and with suspected COVID-19 infection (PR: 1.44; 95% CI: 1.25-1.66). Major depressive episodes were associated with a reported lack of personal protective equipment (PR: 1.20; 95% CI: 1.01-1.42), whereas suicidal ideation was inversely related to per capita income > 3 minimum monthly wages (PR: 0.28; 95% CI: 0.11-0.68), and positively related to the use of psychotropic drugs (PR: 3.14; 95% CI: 1.87-5.26).

CONCLUSION

Our results suggest that nursing professionals' working conditions are associated with their mental health status. The need to improve working conditions through adequate dimensioning, support and proper biosafety measures is only heightened in the context of the COVID-19 pandemic.

Analysis of the Calls Received during the COVID-19 Lockdown by the Mental Health Crisis Helpline Operated by the Professional College of Psychology of Aragon

COVID-19 has had a direct impact on the physical and mental health of millions of people worldwide. Therefore, a Mental Health Crisis Helpline (MHCH) was set up and offered free of charge by the Professional College of Psychology of Aragon (COPPA) during the lockdown period. This research aims to study the reasons for the calls, to describe the population segments that used it, and to analyse the possible relationships between the variables studied. A total of 1411 calls were answered and 598 were registered. The main reasons for the calls were: anxiety symptoms, concern for a relative, previous mental health problems, conflicts, and depressive symptoms. Significantly more men called for anxiety symptoms (60.8% vs. 49.5%) versus more women calling regarding a chronic physical illness (3.5% vs. 0.7%), concern about a relative (22.7% vs. 12.4%), care guidelines (6% vs. 1.3%), and bereavement (6.2% vs. 2%). Calls regarding conflict increased slightly as the lockdown period progressed (p < 0.001; r = 0.15), in contrast with calls regarding previous psychological conditions and anxiety symptoms (p = 0.035; r = −0.09; p = 0.005; r = −0.12). These results highlight the intensive use of the MHCH, confirming the need for the implementation of specific psychological care resources in times of crisis.

Sleep Disturbances and Their Association With Quality of Life in Older Psychiatric Patients During the COVID-19 Pandemic

AIMS

The negative effect of the COVID-19 pandemic on sleep quality of clinically stable psychiatric patients is unknown. This study examined the prevalence of sleep disturbances and their association with quality of life (QOL) in clinically stable older psychiatric patients during the COVID-19 pandemic.

METHODS

This multicenter, cross-sectional study involved older patients attending maintenance treatment at outpatient departments of four major psychiatric hospitals in China. Patients' socio-demographic and clinical characteristics were collected. Sleep disturbances, depressive symptoms, and QOL were assessed with the Insomnia Severity Index, the 9-item Patient Health Questionnaire, and 2 items of the World Health Organization Quality of Life-Brief version, respectively. Binary logistic regression analysis was conducted to examine the independent associations of socio-demographic and clinical variables with sleep disturbances, while the association between sleep disturbances and QOL was explored with analysis of covariance.

RESULTS

A total of 941 patients were recruited. The prevalence of sleep disturbances was 57.1% (95% CI: 53.9-60.2%). Analysis of covariance revealed that QOL was significantly lower in patients with sleep disturbances compared to those without. Multivariate logistic regression analysis showed that sleep disturbances were positively and independently associated with more severe depressive symptoms (OR = 1.32, 95% CI: 1.26-1.37). Compared to patients with major depressive disorder, those with other psychiatric diagnoses had a significantly higher prevalence of sleep disturbances (OR = 1.44, 95% CI: 1.00-2.08).

CONCLUSION

Sleep disturbances were common among clinically stable older psychiatric patients during the COVID-19 pandemic. Considering the negative association with QOL, this subpopulation needs regular assessment and timely treatment to reduce their sleep disturbances and improve their QOL.

Impact on Sleep Quality, Mood, Anxiety, and Personal Satisfaction of Doctors Assigned to COVID-19 Units

The SARS-CoV-2 health emergency has led to a restructuring of health care systems and the reassignment of medical specialists from their usual duties to attend COVID-19 patients. The aim of this paper is to describe the levels of insomnia, anxiety, depression, and the impact on quality of life of doctors who were on the frontline of COVID-19 during the first two waves of the pandemic. Self-report surveys were conducted on said physicians during both waves, with 83 and 61 responses in the first and second waves, respectively. The reported presence of insomnia was frequent (71.8%), although it decreased in the second survey. Anxiety was moderate, decreasing from 57.1% to 43.1% between measurements. Overall, depression rates decreased between the two surveys. Substance use was found to have an indirect correlation with personal and professional satisfaction. In the light of the unforeseeable evolution of the pandemic and the medium- to long-term repercussions on professionals, we believe the adaptation of health resources is crucial to meet the new unpredictable mental health needs of this group.

The Beneficial Effect of the First COVID-19 Lockdown on Undergraduate Students of Education: Prospective Cohort Study

Background

The COVID-19 pandemic has been spreading consistently since the beginning of 2020. On February 27, 2020, the first patient with coronavirus was diagnosed in Israel. On March 14, 2020, the Israeli government declared a general lockdown that lasted about a month, which altered the lives of the entire population.

Objective

The objective of this paper is to evaluate the change in the well-being, physical activity, and sleep quality of undergraduate students of education at 2 time points: before (November 2019) and during (April 2020) the first COVID-19 lockdown.

Methods

In total, 533 undergraduate students of education submitted an online questionnaire before the lockdown and at its end. The questionnaire comprised 4 parts: a (1) sociodemographic and (2) weekly exercise questionnaire taken from the International Physical Activity Questionnaire–Short Form; (3) sleep quality, rated using the Mini Sleep Questionnaire; and (4) well-being, rated using the short version of the Mental Health Inventory. This was a pre-post prospective cohort questionnaire study.

Results

It was predicted that there would be a decrease in the aforementioned parameters. Contrary to all expectations, an increase was observed in all 3. Results showed that during the lockdown, there was an increase in the level of exercise students engaged in. Overall, 102 (61.4%) of 166 students engaged in a greater amount of physical activity during the COVID-19 lockdown compared to 150 (40.9%) of 367 students who engaged in a greater amount of physical activity before COVID-19. Levels of sleep quality (mean 5.34 [SD 0.92] vs mean 5.12 [SD 0.46], P=.02) and well-being (mean 3.79 [SD 0.62] vs mean 3.67 [SD 0.59], P=.02) were also higher during the COVID-19 lockdown.

Conclusions

These findings indicate that undergraduate students seem to have taken advantage of the change in lifestyle due to the lockdown, directing the free time toward improving health by engaging in more physical activity, thus improving sleep quality and well-being.

Adapting to a major crisis: Sleep and mental health during two lockdowns

The present study aimed at investigating the impact of the pandemic on sleep and mental health in healthy individuals (n = 78) as well as in psychiatric outpatients (n = 30) during the first and the second lockdown in Germany, in March and November 2020, respectively. Sleep quality and anxiety were worse in patients compared with controls during both lockdowns. Further, patients but not controls exhibited higher levels of depression and overall psychiatric symptomatology during the second lockdown. No differences were found in the perceived threat evoked by the pandemic. The data suggest that healthy individuals adapt flexibly to the difficult situation over the time course of the pandemic, whereas psychiatric patients seem to get worse, indicating difficulties in adapting to stressful circumstances.

How does the COVID-19 fuel insomnia?

One of the leading health consequences of the pandemic is the prevalence of sleep-related issues, such as insomnia. Hence, this study highlights the relationship between COVID-19 and insomnia and how insomnia is increasing due to the pandemic. The study's findings summarise that the COVID-19 pandemic has produced ubiquitous mental challenges, including loneliness, anxiety, fear, stress, extreme tiredness, and health concerns. It is also associated with physical issues such as social isolation, juggling work or study, parenting challenges, and significant behavior changes stemming from mass home confinement. There are also economic hardships, financial insecurity, risk, and infection. These factors lead to undoing routines and broken circadian rhythms amid the pandemic, affecting three sleep regulatory processes of the homeostatic sleep drive, the circadian rhythm, and the arousal system. Furthermore, we suggest future research directions to explore (1) long-term health impacts of the pandemic, (2) therapeutic strategies and the implementation of social policies to support people with sleep difficulties, (3) prevention programs and clinical interventions, and (4) nationwide or cross-regional online and practical psychological and sleep management intervention systems and platforms to address the psychological strain of isolation and traumatic experiences of the pandemic.

Work-based concerns of Australian frontline healthcare workers during the first wave of the COVID-19 pandemic

OBJECTIVE

This research sought to gauge the extent to which doctors, nurses and paramedics in Australia were concerned about contracting SARS-CoV-2 during the country's first wave of the virus in April 2020.

METHODS

Australian registered doctors, nurses and paramedics (n=580) completed an online questionnaire during April 16-30, 2020 (period immediately following the highest four-week period (first wave) of SARS-CoV-2 confirmed cases in Australia).

RESULTS

During April 2020, two-thirds of participants felt it was likely they would contract SARS-CoV-2 at work. Half the participants suggested Personal Protective Equipment (PPE) supplies were inadequate for them to safely perform their job, with two-thirds suggesting management advised them to alter normal PPE use. One-third of participants suggested they were dissatisfied with their employer's communication of COVID-19 related information. Conclusions and implications for public health: After reports of PPE shortages during Australia's first SARS-CoV-2 wave, and suggestions access to PPE was still limited during Australia's second wave five months later, we must forecast for this and future pandemics ensuring adequate access to PPE for frontline healthcare workers. Further, ensuring consistent and standardised pathways for communication to staff (acknowledging the reality that information may rapidly change) will help alleviate frustration and anxiety.

Insomnia episodes, new-onset pharmacological treatments, and other sleep disturbances during the COVID-19 pandemic: a nationwide cross-sectional study in Brazilian health care professionals

STUDY OBJECTIVES

To evaluate the impact of the coronavirus disease 2019 (COVID-19) pandemic on insomnia and other sleep disturbances in health care professionals.

METHODS

A survey was distributed using social media and organizational emails to Brazilian active health care professionals during the COVID-19 outbreak. We explored potential associated factors including age, sex, occupation, workplace, work hours, income, previous infection with COVID-19, recent/current contact with COVID-19 patients, regional number of incident deaths, anxiety, and burnout. We evaluated new-onset/previous insomnia worsening episodes (primary outcome), new pharmacological treatments, sleep quality, duration, nightmares, and snoring (secondary outcomes).

RESULTS

A total of 4,384 health professionals from all regions of the country were included in the analysis (44 ± 12 years, 76% females, 53.8% physicians). Overall, 55.7% were assisting patients with COVID-19, and 9.2% had a previous COVID-19 infection. The primary outcome occurred in 32.9% of respondents in parallel to 13% new pharmacological treatments for insomnia. The sleep quality worsened for 61.4%, while 43.5% and 22.8% reported ≥ 1-hour sleep duration reduction and worsening or new-onset nightmares, respectively. Multivariate analyses showed that age (odds ratio [OR]: 1.008; 95% confidence interval [CI] 1.001-1.015), females (OR: 1.590; 95% CI 1.335-1.900), weight change (decrease: OR: 1.772; 95% CI 1.453-2.161; increase: OR: 1.468; 95% CI 1.249-1.728), prevalent anxiety (OR: 3.414; 95% CI 2.954-3.948), new-onset burnout (OR: 1.761; 95% CI 1.489-2.083), family income reduction > 30% (OR: 1.288; 95% CI 1.069-1.553), and assisting patients with COVID-19 (OR: 1.275; 95% CI 1.081-1.506) were independently associated with new-onset or worsening of previous insomnia episodes.

CONCLUSIONS

We observed a huge burden of insomnia episodes and other sleep disturbances in health care professionals during the COVID-19 pandemic.

CITATION

Drager LF, Pachito DV, Moreno CRC, et al. Insomnia episodes, new-onset pharmacological treatments, and other sleep disturbances during the COVID-19 pandemic: a nationwide cross-sectional study in Brazilian health care professionals. J Clin Sleep Med. 2022;18(2):373-382.

The association between sleep and psychological distress among New York City healthcare workers during the COVID-19 pandemic

BACKGROUND

Healthcare workers (HCWs) treating patients with COVID-19 report psychological distress. We examined whether disturbed sleep was associated with psychological distress in New York City (NYC) HCWs during the initial peak of the COVID-19 pandemic (April-May 2020).

METHODS

HCWs completed a survey screening for acute stress (4-item Primary Care PTSD screen), depressive (Patient Health Questionaire-2), and anxiety (2-item Generalized Anxiety Disorder scale) symptoms. Insomnia symptoms (modified item from the Insomnia Severity Index) and short sleep (SS, sleep duration <6 h/day) were assessed. Poisson regression analyses predicting psychological distress from SS and insomnia symptoms, adjusting for demographics, clinical role/setting, redeployment status, shifts worked, and multiple comparisons were performed.

RESULTS

Among 813 HCWs (80.6% female, 59.0% white) mean sleep duration was 5.8 ± 1.2 h/night. Prevalence of SS, insomnia, acute stress, depressive, and anxiety symptoms were 38.8%, 72.8%, 57.9%, 33.8%, and 48.2%, respectively. Insomnia symptoms was associated with acute stress (adjusted prevalence ratio [PR]: 1.51, 95% CI: 1.35, 1.69), depressive (PR: 2.04, 95% CI: 1.78, 2.33), and anxiety (PR: 1.74, 95% CI: 1.55, 1.94) symptoms. SS was also associated with acute stress (PR: 1.17, 95% CI: 1.07, 1.29), depressive (PR: 1.36, 95% CI: 1.233, 1.51), and anxiety (PR: 1.38, 95% CI: 1.26, 1.50) symptoms.

LIMITATIONS

Our cross-sectional analysis may preclude the identification of temporal associations and limit causal claims.

CONCLUSIONS

In our study, SS and insomnia were associated with psychological distress symptoms in NYC HCWs during the COVID-19 pandemic. Sleep may be a target for interventions to decrease psychological distress among HCWs.

Two-stage mental health survey of first-line medical staff after ending COVID-19 epidemic assistance and isolation

Facing with COVID-19 epidemic such a catastrophic health emergency, the mental health status of medical staff deserves attention. We conducted a two-stage of psychological status monitoring after the end of the assistance and 14 days of isolation, further targeted the vulnerable groups in need of intervention. The study is a cross-sectional survey on 1156 Yunnan medical staff aid to Hubei. Used Cluster sampling method to collect data at 2 time points (at the end of returning from Wuhan and the 14th day of isolation), from March 18, 2020 to April 6, 2020. Female and nurse had higher rates of depressive symptoms than male and doctors and other occupations. The proportion of female with mild and above moderate anxiety levels (22.91%, 2.61%) was higher than male (17.35%, 1.03%) (p < 0.05). Female had a better impaired sleep quality (45.06%, 17.49%) more than male (28.57%, 7.94%). Medical staff supported in Wuhan and with junior professional titles reported a higher proportion of sleep quality impairment. At the 14th isolation day stage, the proportion of nurses changed from depression to health (9.15%) and from health to depression (6.1%) better than doctors. The front-line medical staffs had suffered greater psychological pressure in the treatment process of major public health emergency. Researches on the dynamic monitor for the change of psychological status after aiding epidemic areas were still in relatively blank stage. Targeting the vulnerable characteristics of aiding medical staff is significant for effective psychological intervention and sustainable operation of health system.

Mental Health Outcomes of Perceived Stress, Anxiety, Fear and Insomnia, and the Resilience among Frontline Nurses Caring for Critical COVID-19 Patients in Intensive Care Units

Background

The coronavirus disease-2019 (COVID-19) pandemic has led to a significant disruption in healthcare delivery and poses a unique long-term stressor among frontline nurses. Hence, the investigators planned to explore the adverse mental health outcomes and the resilience of frontline nurses caring for COVID-19 patients admitted in intensive care units (ICUs).

Materials and methods

A cross-sectional online survey using Google form consisted of questionnaires on perceived stress scale (PSS-10), generalized anxiety disorder scale (GAD-7), Fear Scale for Healthcare Professionals regarding the COVID-19 pandemic, insomnia severity index, and the Connor-Davidson Resilience Scale-10 (CD-RISC) were administered among the nurses working in COVID ICUs of a tertiary care center in North India.

Results

A considerable number of subjects in the study reported symptoms of distress (68.5%), anxiety (54.7%), fear (44%), and insomnia (31%). Resilience among the frontline nurses demonstrated a moderate to a high level with a mean percentage score of 77.5 (31.23 ± 4.68). A negative correlation was found between resilience and adverse mental outcomes; hence, resilience is a reliable tool to mitigate the adverse psychological consequences of the COVID-19 pandemic.

Conclusion

Emphasizing the well-being of the nurses caring for critical COVID-19 patients during the pandemic is necessary to enable them to provide high-quality nursing care.

How to cite this article

Jose S, Cyriac MC, Dhandapani M, Mehra A, Sharma N. Mental Health Outcomes of Perceived Stress, Anxiety, Fear and Insomnia, and the Resilience among Frontline Nurses Caring for Critical COVID-19 Patients in Intensive Care Units. Indian J Crit Care Med 2022;26(2):174–178.

Depression, anxiety and insomnia among frontline healthcare workers amid the coronavirus pandemic (COVID-19) in Jordan: a cross-sectional study

OBJECTIVE

This study aimed to explore the prevalence and factors associated with depression, anxiety and insomnia among frontline healthcare workers (HCWs) in Jordan.

METHODS

A cross-sectional design was conducted among 122 frontline HCWs who have dealt with suspected or confirmed cases of COVID-19. The study survey included standardised questionnaires of the 7-item Generalized Anxiety Disorder (GAD-7) Scale, 9-item Patient Health Questionnaire (PHQ-9) and the Insomnia Severity Index (ISI). Data were collected online during the active surge period of cases from 11 May 2020 to 13 June 2020. The statistical analysis included descriptive statistics, analysis of variance, bivariate correlation and multivariate linear regression analyses.

RESULTS

A total of 122 HCWs participated in the study (response rate=64.2%). Among the participants, 44.3% were physicians, 32.8% were nurses and 17.2% were paramedics. The mean age of participants was 32.1 (±5.8) years, and the majority were males (80.3%). The mean scores for GAD-7, PHQ-9 and ISI were 8.5 (±5.2), 9.5 (±5.7) and 11.2 (±6.4), respectively. Results showed that the participants reported severe symptoms of anxiety (29.5%), depression (34.5%) and insomnia (31.9%), with no observed differences based on gender, job title, marital status or educational level. Moreover, in the multivariate linear regression, none of the independent factors were associated with GAD-7, PHQ-9 or ISI scores, and the only exception was increased severity of insomnia among paramedics.

CONCLUSION

The COVID-19 pandemic has exerted strenuous emotional, psychological and physical pressures on the health of frontline HCWs.

Psychological responses of hospital-based nurses working during the COVID-19 pandemic in the United States: A cross-sectional study

Studies show decreased well-being during the COVID-19 pandemic, especially for healthcare providers from Asia. Less is known about the psychological responses of working during the pandemic on hospital-based registered nurses (RNs) in the United States (US). Therefore, the purpose of this paper is to report the well-being of U.S.-based hospital RNs working during the initial acute phase of COVID-19 and compare it with well-being among healthcare workers described in two global meta-analyses. We conducted a cross-sectional survey in May–June 2020 (N = 467). Well-being was measured using the following tools: Generalized Anxiety Disorder-7, Patient Health Questionnaire-2 for depressive symptoms, Impact of Events Scale-Revised for traumatic stress, and the Insomnia Severity Index. Compared with global rates from two meta-analyses, US-based RNs reported significantly more traumatic stress (54.6% vs. 11.4% and 21.5%; p < .001) and depressive symptoms (54.6% vs. 31.8% and 21.7%; p < .001). Rates of insomnia were also higher in U.S.-based RNs than in the meta-analysis that reported insomnia (32.4% vs 27.8%; p < .033). Rates of anxiety symptoms among US-based RNs did not differ from that reported in one meta-analysis (37.3% vs. 34.4%), while it was significantly higher in the other (37.3% vs. 22.1%; p < .001). Hospital-based RNs from the US exhibited over twice the rates of trauma and nearly double the rates of depressive symptoms than shown in reports from hospital workers globally during the acute phase of the COVID-19 pandemic. The lasting effects of this distress are unknown and warrant ongoing evaluation and solutions to better support emotional well-being and prevent burnout in the workplace.

Physicians' Health-Related Quality of Life and Its Associated Factors During COVID-19 Pandemic in Jordan: A Cross-Sectional Study

Healthcare workers worldwide have been exposed to extraordinary stress during COVID-19 pandemic. This study aimed to investigate health-related quality of life (HRQoL) level and its health and occupational associated factors among Jordanian physicians during COVID-19 pandemic. A cross-sectional design using an online survey was adopted targeting physicians at different Jordanian hospitals. The study survey included demographics, HRQoL measured by 12-item Short Form health survey (SF-12) mental and physical components, physicians' evaluation of work conditions during COVID-19, Neck Disability Index (NDI), Depression Anxiety Stress Scale (DASS 21), and International Physical Activity Questionnaire (IPAQ). Descriptive analyses were conducted to summarize primary data. Factors associated with HRQoL were determined using a multiple variable regression analysis. In total, 326 physicians successfully completed the survey, 44.2% were males with mean age of 32.08 (±6.93). SF-12 mental component mean was 52.13 (±20.84) and physical component mean was 69.24 (±18.1). Physicians HRQoL level was significantly associated with levels of stress (β = -0.23, 95% CI -1.05 to -0.27), depression (β = -0.22, 95% CI -1.09 to -0.28), neck disability (β = -0.30, 95% CI -1.08 to -0.57), health self-evaluation (β = 0.14, 95% CI 1.66-7.87), sleep self-evaluation (β = 0.09, 95% CI 0.16-3.58), and physical activity level (β = 0.09, 95% CI 0.00-0.001). Jordanian physicians' level of HRQoL was relatively low during COVID-19. Healthcare facilities administrators should take into consideration factors associated with physicians' HRQoL level when planning for future healthcare emergencies.