The mental health of medical workers in Wuhan, China dealing with the 2019 novel coronavirus

Bibliometric review of 1992–2022 publications on acupuncture for cognitive impairment

Objective

To explore the development context, research hotspots, and frontiers of acupuncture therapy for cognitive impairment (CI) from 1992 to 2022 by visualization analysis.

Methods

Articles about acupuncture therapy for cognitive impairment were retrieved from the Web of Science Core Collection (WoSCC) until 1 March 2022. Basic information was collected by Excel 2007, and VOSviewer 1.6.17 was used to analyze the co-occurrence of countries, institutes, and authors. Co-citation maps of authors and references were analyzed by CiteSpace V.5.8.R3. In addition, CiteSpace was used to analyze keyword clusters and forecast research frontiers.

Results

A total of 279 articles were retrieved, including articles from 19 countries, 334 research institutes, and 101 academic journals. The most published country and institutes were the People's Republic of China (217) and the Fujian University of Traditional Chinese Medicine (40). Ronald C Petersen owned the highest co-citations (56). Keywords and co-cited references cluster showed the main research directions in this area, including “ischemic stroke,” “cerebral ischemia/reperfusion,” “mild cognitive impairment,” “Alzheimer's disease,” “vascular dementia,” “vascular cognitive impairment with no dementia,” “multi-infarct dementia,” “synaptic injury,” “functional MRI,” “glucose metabolism,” “NMDA,” “nuclear factor-kappa b pathway,” “neurotrophic factor,” “matrix metalloproteinase-2 (MMP-2),” “tumor necrosis factor-alpha,” “Bax,” “Caspase-3,” and “Noxa”. Trending keywords may indicate frontier topics, such as “randomized controlled trial,” “rat model,” and “meta-analysis.”

Conclusion

This research provides valuable information for the study of acupuncture. Diseases focus on mild cognitive impairment (MCI), Alzheimer's disease (AD), and vascular dementia (VaD). Tauopathies with hyperphosphorylation of Tau protein as the main lesions also need to be paid attention to. The development of functional magnetic resonance imaging (fMRI) will better explain the therapeutic effect of acupuncture treatment. The effect of acupuncture on a single point is more convincing, and acupuncture on Baihui (GV20) may be needed in the future. Finally, the implementation of high-quality multicenter randomized controlled trials (RCTs) requires increased collaboration among experts from multiple fields and countries.

Rasch Modeling and Multilevel Confirmatory Factor Analysis for the Usability of the Impact of Event Scale-Revised (IES-R) during the COVID-19 Pandemic

BACKGROUND

Several instruments are currently used to assess Coronavirus Disease 2019 (COVID-19) -induced psychological distress, including the 22-item Impact of Event Scale-Revised (IES-R). The IES-R is a self-administered scale used to assess post-traumatic stress disorder (PTSD). The current study aimed to examine the construct validity of the IES-R, based on the Rasch model, with COVID-19-related data, as well as to test the multilevel construct validity of the IES-R within and among countries during the pandemic crisis.

METHODS

A multi-country web-based cross-sectional survey was conducted utilizing the 22-item IES-R. A total of 1020 participants enrolled in our survey, of whom 999 were included in the analyses. Data were analyzed using Rasch modeling and multilevel confirmatory factor analysis (MCFA).

RESULTS

The Rasch modeling results of the IES-R demonstrated that the IES-R is a satisfactory instrument with the five-point Likert scale, asserting that its 22 items are significant contributors to assessing PTSD as a unidimensional construct covered by the items of the IES-R. The MCFA confirmed that the 22-item IES-R, with its three factors, including intrusion, avoidance, and hyperarousal, demonstrates adequate construct validity at the within- and among-country levels. However, the results of the Akaike information criterion (AIC) model determined that the 16-item IES-R is better than the 22-item IES-R.

CONCLUSION

The results suggested that the 22-item IES-R is a reliable screening instrument for measuring PTSD related to the COVID-19 pandemic, and can be utilized to provide timely psychological health support, when needed, based on the screening results.

Study protocol for a randomized controlled trial evaluating the effectiveness of an internet-based self-help intervention to cope with psychological distress due to COVID-19 in the Italian general population: the RinasciMENTE project

BACKGROUND

This study aims to evaluate the feasibility and effectiveness of the RinasciMENTE program, an Internet-based self-help intervention based on cognitive behavioral therapy (CBT) principles and techniques in supporting individuals experiencing psychological impairments during the COVID-19 pandemic. A randomized controlled trial (RCT) design with random allocation at the level of individual will be conducted to compare the impact of the RinasciMENTE program with a waiting list control in improving the psychological functioning of the general population during the COVID-19 pandemic.

METHODS

A minimum sample of 128 participants experiencing mild/subthreshold levels of psychological symptoms during the COVID-19 pandemic will be recruited. After the initial screening, participants will be randomly assigned to either the experimental group or the control condition. The program will last 2 months, during which participants will receive 8 weekly CBT treatment modules. The impact of the RinasciMENTE program on selected primary and secondary psychological outcomes will be tested at the end of the intervention (2 months) and 6- and 12-month follow-ups.

DISCUSSION

We expect people to show an increased level of psychological functioning and to acquire the skills and self-confidence necessary to deal with the psychological consequences of the COVID-19 outbreak and its related social isolation during and following the pandemic.

TRIAL REGISTRATION

ClinicalTrials.gov NCT0497903 Registered on 28 May 2021.

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

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

The influences of corporate policies for COVID-19 on work stress and anxiety among healthcare employees

BACKGROUND: During the coronavirus disease (COVID-19) pandemic, if it is considered that educated manpower is the most valuable resource of countries, it can be thought that various policies should be developed both at the macro- and micro-levels to minimize the loss of healthcare employees. OBJECTIVE: This study aims to determine the effects of the corporate policies for COVID-19 on the work stress and anxiety of healthcare employees. METHOD: The sample of the study consists of 136 of 265 healthcare employees in Sakarya Provincial Health Directorate Emergency Health Services in Turkey. The average age of the participants was 34.43 years old; the average duration of professional experience was 12.12 years. Approximately 61% of the participants are male and 51% have a bachelor’s degree or higher level. A questionnaire form was used in the study as the data collection tool consisting of socio-demographic characteristics, institutional policies on COVID-19, work stress, and the Status Anxiety Scale. Process Macro Model 4, descriptive statistics and correlation analysis were used for the data analysis. RESULTS: According to the results of the study, the corporate policies for COVID-19 perception of participants was above average (3.30±0.82) while work stress (2.99±0.88) and anxiety (2.65±0.56) were below average. The corporate policies for COVID-19 perception of participants reduced their work stress (β= – 0.430) and anxiety (β= – 0.361). Additionally, anxiety played a mediating role in the effect of the corporate policies for COVID-19 perception on work stress, and it further raised the impact of corporate policies for COVID-19 perception on the work stress reduction (β= – 0.169). CONCLUSIONS: During the COVID-19 pandemic, health managers should determine and control the anxiety and stress levels of the health employees on their staff and take a number of steps to reduce their anxiety and stress.

Saúde Mental na Pandemia de Covid-19 em um Município Mineiro: Diálogos diante de uma Realidade Global

Introdução: O estudo buscou rastrear a presença de sintomas de ansiedade, depressão e estresse pós-traumático, além de descrever as principais mudanças comportamentais apresentadas por moradores de Juiz de Fora, MG, diante da covid-19. A coleta de dados foi on-line e, para o recrutamento, utilizou-se a técnica da “bola de neve”. Método: Participaram 897 sujeitos que responderam a um questionário sociodemográfico e comportamental; Escala Hospitalar de Ansiedade e Depressão; e Instrumento de Rastreio para Sintomas de Estresse Pós-Traumático (SPTSS). Resultados: indicaram mudanças comportamentais e de humor expressivas, como: percepção de estar infectado, mesmo estando saudável, maior uso de álcool que o habitual, medo, irritabilidade, ansiedade e tristeza. Os instrumentos de rastreamento evidenciaram também a presença de sintomas de ansiedade (53,4%), depressão (93,4%) e estresse pós-traumático (43,1%). Discussão/Conclusão: Apresenta-se um recorte local, contudo, os dados apresentam consonância com a comunidade científica quanto ao sofrimento psíquico na pandemia da covid-19.

MusicTeamCare (MTC): Theory and practice of clinical intervention for music therapists offering remote support to clients during emergencies

The COVID-19 pandemic meant that people’s lives and work changed significantly across the world. Governments took measures such as social distancing, lockdowns and quarantine protocols to stem the spread of the pandemic. This had a significant impact on music therapy clinical practice, generating reflections and adaptations among the worldwide music therapy community, with several studies still underway. A number of professional music therapy organisations have explored methods for carrying out remote interventions. MusicTeamCare is an approach developed by three Italian Certified Music Therapists that could offer access to support in emergency and crisis situations. This approach is rooted in receptive music therapy theory, with particular reference to Guided Imagery and Music (GIM). MusicTeamCare was used for the first time in March to April 2020, with healthcare workers in Italy who were treating COVID-19 patients. This article outlines theoretical framework, development and evaluation phases of MusicTeamCare. Detailed explanations are given of the theoretical framework, methods of musical analysis, assessment and evaluation strategies, criteria for constructing the playlists and interactive triangulation between the Music Therapists in the research team.

Dispositional Resilience as Mediator in Psychological Stress on Healthcare Workers: A Multi-Group Analysis of Frontline and Non-Frontline Workers

The experiences of healthcare workers (HCWs) during COVID-19 have been characterized by psychological symptoms such as stress, anxiety and depression, compassion fatigue and post-traumatic stress, which are long-lasting. The general picture of HCWs, especially frontline workers, is that of a physically and psychologically exhausted group. The aim of the study was to examine the potential mediating role of dispositional resilience in the impact of depression, anxiety and stress on professional quality of life among HCWs during the pandemic period. We also investigated possible differences between the frontline and non-frontline HCWs. The study enrolled 487 participants from public Italian hospitals. The variables of stress and anxiety predicted all factors related to professional quality of life, against depression which positively predicted only burnout and secondary traumatic Stress. Resilience was an important mediator in all these paths and the multigroup analysis suggested statistically significant differences between frontline and non-frontline HCWs. Results emphasised the importance of caring and concern for frontline HCWs to improve their quality of life, satisfaction and have positive impacts on the quality of service and care provided. There is a need to reflect on the necessity to develop projects and protocols that address health emergencies in advance.

Perceived Challenges Caused by Covid-19 Outbreak in Students of Medical Sciences

BACKGROUND

Students of medical sciences are a highly vulnerable group during COVID-19 pandemic who may experience a wide range of challenges and stresses. The aim of this study was to investigate the perceived challenges caused by COVID-19 outbreak in students of medical sciences.

MATERIALS AND METHODS

A qualitative study was carried out based on conventional qualitative content analysis following Graneheim and Lundman from December 2020 to February 2021. The participants were 17 students of medical sciences and data gathering was done through semistructured interviews.

RESULTS

Data analyses revealed 5 categories and 12 subcategories. The extracted categories were perceived fear of contracting coronavirus, social limitation, changes in education, neglecting health protocols, and worrying news and information overload.

CONCLUSIONS

The findings indicated that students of medical sciences had been facing challenges and the COVID-19 had affected the psychological, social, and academic functioning of the health-care students. It is important to take measures to improve their mental health. These measures can prevent medical complications in these students, especially during clinical internship.

Psychological stress and influencing factors of hospital workers in different periods under the public health background of infectious disease outbreak: A cross-sectional study

Background and Aims

It is well known that public health emergencies can affect the mental health of medical personnel, and many studies have focused on cross-sectional studies with short-term benefits. The present study aimed to investigate the long-term influence of infectious disease outbreak about the mental health of hospital staff.

Methods

The demographic characteristics and mental health status of staff in Fuzhou, China, were analyzed by using the Generalized Anxiety Disorder (GAD-7) Scale and Depression Screening Scale (9-item Patient Health Questionnaire [PHQ-9]) in February and December 2020.

Results

There were no significant differences in anxiety levels during different time periods (p > 0.05), but there were significant differences among anxiety level and total score of GAD-7 scale (p < 0.001). There were significant differences among the number of people with depression, depression level, and total score on the PHQ-9 scale (p < 0.001). As the pandemic progressed, total scores of anxiety in medical staff with different titles decreased (p < 0.05), but depression scores in professionals with intermediate and senior titles increased significantly (p < 0.05). changes in anxiety and depression scores during different time periods also changed according to hospital worker specialty. Total scores of anxiety in doctors, nurses, medical technicians, and other staff members all decreased (p < 0.05), while total scores of depression in doctors, nurses, and other staff members significantly increased (p < 0.05). There were no significant differences in total depression score among medical technicians (p > 0.05).

Conclusions

Since the outbreak of an infectious disease public health emergency, the anxiety of hospital staff has decreased over time, but the depression has increased. The management and psychological support personnel in medical institutions should continue to pay attention to the mental health of medical staff, and it is necessary to take different intervention measures in different periods when implementing the psychological crisis prevention mechanism.

Evaluation of COVID-19 fear and quality of life in patients with haematopoietic stem cell transplantation during the COVID-19 pandemic

OBJECTIVE

We aimed to determine the coronavirus disease 2019 (COVID-19) fear state in haematopoietic stem cell transplant patients and to examine its relationship with quality of life.

METHODS

In this prospective study, 64 patients who underwent HSCT during the pandemic were included. The COVID-19 fear situation was evaluated with the Fear of COVID-19 Scale (FCV-19S). Quality of life was evaluated with the European Organisation for Quality of Life Research and Treatment Core Questionnaire (EORTC QLQ-C30) (Version 3).

RESULTS

The median FCV-19S score was 16.5 (12.0-22.0). The FCV-19S score was significantly higher in urban residents than rural residents. The general health score was 59.64 ± 20.04. The strongest positive correlation between fear level and life quality was found in emotional function. A weak, significant, positive correlation was observed between role function, nausea-vomiting, pain, appetite loss and fear level.

CONCLUSION

FCV-19S is a quick, safe and valid tool that can be used to determine the COVID-19 fear level in vulnerable patient groups such as HSCT patients and to direct them to the necessary psycho-oncological support.

The impact of the COVID-19 pandemic on the career choice of medicine: A cross-sectional study amongst pre-medical students in Pakistan

Background

The COVID-19 pandemic has significantly affected the lives of healthcare workers due to the frontline nature of their work. Their hard work and sacrifice have forged new perceptions of healthcare workers. These changes may potentially influence students' interest in medicine. This study explores how the COVID-19 pandemic has affected premedical students' decisions to pursue medicine as a career.

Methods

A cross-sectional study using a self-designed online questionnaire was carried out amongst pre-medical students across Pakistan.

Results

A total of 1695 students from 93 public and private schools filled in the survey. After the onset of the COVID-19 pandemic, significantly more pre-medical students want to pursue medicine (60.7%-62.9%) and less are unsure (20.2%-17%). Students are significantly more likely to be motivated to pursue medicine due to altruistic benefits to society (57% vs. 62.7%) and be deterred by the risk of contracting infections on duty (10%-14.6%). There is a minor but significant increase in the popularity of internal medicine (17.1%-18.9%), public health (4.1% vs. 5.7%), emergency medicine (3.8% vs. 5.7%), pediatrics (3.8% vs. 4.7%), and radiology (2.1% vs. 2.9%). Most pre-medical students felt that doctors routinely undergo physical and emotional turmoil (84%).

Conclusions

Although awareness of hardships faced by medical professionals has increased, motivation to pursue medicine has grown. Through understanding trends in the motivations of students to pursue medicine, medical schools can accommodate the expectations of incoming students and reach out to potential applicants.

Assessment of COVID-19–Associated Stress and Knowledge Among Iranian Population: A Web-Based Cross-sectional Survey

Background: The first COVID-19 case was reported in December 2019 in China. The number of infected cases increased rapidly, and COVID-19 became a public health issue worldwide. The high transmission rate and global spreading of COVID-19 caused public anxiety and may lead to unfavorable effects on psychological health. Objectives: This study evaluated the COVID-19 impact on the public anxiety, knowledge, and behavior of Iranians. Methods: We used a web-based cross-sectional survey and collected data from 1627 volunteers. Demographic information, anxiety self-reporting, Generalized Anxiety Disorder 7-Item Scale (GAD-7), and COVID-19–related knowledge were evaluated. Results: Among the participants, the dominant GAD-7 score was mild, and the self-reporting level of anxiety was 5.28/10. Women and younger people reported higher anxiety than men and older groups. Further, 69.76% of participants had good knowledge, and among them, the level of education had a positive effect on knowledge, while sex and age did not have any effect. Social media and applications were the most common source of information. Conclusions: Our study showed that Iranians’ anxiety was at the medium level, and their high knowledge level about COVID-19 could affect this reduction; however, we should not ignore that less anxiety makes the matter less essential.

BURNOUT, RESILIENCE AND PSYCHOLOGICAL FLEXIBILITY IN FRONTLINE NURSES DURING THE ACUTE PHASE OF THE COVID-19 PANDEMIC (2020) IN MADRID-SPAIN

Background

In April 2020, Spain was the country with the highest number of patients infected by COVID‐19 in Europe. The pressure on health care providers has had a direct impact on nurses and their mental health.

Aim

The aim of this study is to demonstrate the causal relationship between resilience, acceptance, experiential avoidance, psychological inflexibility and burnout syndrome, all of which are measured with validated questionnaires.

Methods

This was designed as a transversal correlational study with nurses who worked during the acute phase of the pandemic in public hospitals in the Community of Madrid with patients diagnosed with COVID‐19 in COVID‐19 medical hospitalization units, emergency services and intensive care units. Google Forms was used to obtain an informed consent sheet, socio‐demographic variables and the following questionnaires: 10 CD‐Risk, Connor‐Davidson Risk Resilience Scale, Acceptance and Action Questionnaire‐II and the Maslach Burnout Inventory.

Results

The final sample included 375 nurses with a high number of consecutive days of direct exposure to an infected patient and a very high number of consecutive days without rest; almost 18% suffered from COVID‐19. The nurses presented medium levels of resilience, medium levels of experiential avoidance and medium levels as measured for emotional exhaustion, personal accomplishment and depersonalization. We also found a predictive correlation between all the dimensions of the burnout questionnaire in relation to the data obtained from the resilience questionnaire.

Conclusions

There is a direct and predictive relationship between the resilience that nurses had during the acute phase of the pandemic and their capacity for acceptance, experiential avoidance, psychological inflexibility and burnout syndrome.

Implications for Nursing Management

The scores show the necessity to implement preventive measures to avoid fatal psychological consequences for nurses.

Experiencing the COVID-19 pandemic as a healthcare provider in rural Dhanbad, India: An interpretative phenomenological analysis

Background

The COVID-19 pandemic is causing widespread morbidity and mortality. It has led to a myriad of mental health problems, particularly in health care providers (HCPs). To strengthen the fight against COVID-19, it is essential to investigate the mental health challenges being faced by the HCPs, their emotional responses, and coping strategies.

Objectives

We aimed to explore the lived experiences of frontline HCPs in rural India during the peak of the second wave of the COVID-19 pandemic.

Methods

Through purposive heterogenous snowball sampling, five HCPs in rural Dhanbad were recruited and one-on-one double-blind unstructured interviews were conducted. The interviews were transcribed and master themes and subthemes were extracted by interpretative phenomenological analysis.

Results

Six master themes and 23 subthemes were identified. Our findings demonstrate that the participants were under mental duress due to heavy workloads, fear of getting infected and transmitting the infection, urban–rural disparities in access to medical supplies and peer support, and negative social perception of HCPs during the pandemic. Most HCPs have not yet processed the psychological effects of being at the frontlines of the COVID-19 pandemic in a resource-poor setting; however, spirituality seems to be an important coping mechanism that helps them get through the day.

Conclusions

This study is unique in the sense that not many studies have been conducted to evaluate the psychological issues of Indian HCPs during this pandemic. Much less is known about the mental health of HCPs in rural settings. Moreover, novel findings such as negative social perception of HCPs during the pandemic and HCPs resorting to spirituality as a coping strategy against stress, open a plethora of research opportunities wherein the results of this qualitative study, along with the existing literature and findings of future quantitative studies, can establish better understanding of the impact of the pandemic on HCPs.

Emotional Burden among Pharmacists and Pharmacy Technicians during the COVID-19 Lockdown: A Cross Sectional Study

This study aims to investigate the prevalence of depression and anxiety symptoms among Spanish community pharmacists and pharmacy technicians during the coronavirus disease 2019 (COVID-19) lockdown. A descriptive cross-sectional quantitative study was designed. An online survey was administered to participants from 4 to 21 April 2020 using a questionnaire assessing sociodemographic information and the Spanish version of the Hospital Anxiety and Depression Scale (HADS). Informed consent to participate was requested. Participants comprised 1162 pharmacy staff from Spain with an average age of 39.15 ± 9.718, from 20 to 65 years old, of whom 83% were women, and 50.6% were married. More than half of the participants expressed symptoms of depression (62.7%) and anxiety (70.9%). An important prevalence of anxiety and depression symptoms has been detected among Spanish pharmacists and pharmacy technicians during the COVID-19 lockdown. Being a woman, smoking, feeling fear, feeling stress and believing that pharmacists/pharmacy technicians are very exposed to COVID-19 seem to be associated with higher HADS scores.

Clostridioides difficile infection epidemiology and clinical characteristics in COVID-19 pandemic

Information on Clostridioides difficile infection (CDI) in patients with COVID-19 is scarce and points to an overall decrease of episodes during the pandemic. This situation results paradoxical, as COVID-19 patients had long periods of hospital stay and high use of antibiotics. We conducted a retrospective study from January 1st 2019 to December 31st 2020 comparing the incidence of hospital-acquired episodes of CDI (HA-CDI) among patients with and without COVID-19 admitted to our institution. During the study period, there were 47,048 patient admissions in 2019, 35,662 admissions of patients without COVID-19 in 2020 and 6,763 of COVID-19 patients. There were 68 episodes of HA-CDI in COVID-19 patients (14.75/10,000 days), 159 in 2020-non-COVID-19 patients (5.54/10,000 days) and 238 in 2019 (6.80/10,000 days). Comparison of HA-CDI in COVID-19 and non-COVID-19 patients indicates it occurs more frequently, in terms of CDI disease severity, COVID-19 does not seem to have a negative impact.

Does COVID-19 Fear Induce Employee Innovation Performance Deficiency? Examining the Mediating Role of Psychological Stress and Moderating Role of Organizational Career Support

With the immense, short/long-term, and multidirectional effects of the coronavirus disease (COVID-19) pandemic on work performance, industry activities, and the national/global economy, it has adversely affected employees' psychological well-being due to its elevated stress and anxiety that have substantially affected employee innovation performance (deficiency) (EIP(D)). The goal of this empirical paper is to identify how COVID-19 induces EIPD by examining the mediating role of psychological stress (PS) on the relationship between fear of infection with COVID-19 (FIC) and EIPD based on affective events theory (AET) and the moderating effect of organizational career support (OCS) on the relationship between PS and EIPD. Based on 865 survey responses provided by mid-level managers from Chinese manufacturing firms and the covariance-based structural equation modeling (SEM) technique using AMOS 25, we identified that FIC has a positive relationship with EIPD while PS can fully mediate the link between FIC and EIPD and OCS weakens the positive relationship between PS and EIPD (that is, in the presence of OCS, EIPD decreases despite the presence of PS among the employees). The findings of our empirical study will theoretically and practically contribute to the pandemic-related existing literature by providing an in-depth understanding of these variables. Furthermore, policymakers can also benefit by boosting their EIP from the outcomes revealed and suggestions provided.

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.

Relationship between perceived stress and depression in Chinese front-line medical staff during COVID-19: A conditional process model

BACKGROUND

Sustained stress during COVID-19 may be associated with depression in front-line medical staff, which would expose them to severe threats. This study aimed to examine whether the relationship between perceived stress and depression is mediated by insomnia, and whether this mediation is moderated by resilience.

METHODS

For front-line medical staff, this study used online questionnaire to evaluate their perceived stress, depression, insomnia and resilience. A conditional process model was performed to examine the relationship between perceived stress and depression, as well as the mediating effect of insomnia and the moderating effect of resilience.

RESULTS

A total of 606 front-line medical staff completed the survey. Higher level of perceived stress was significantly positively related to severe insomnia and depression. In addition, insomnia was positively related to depression, while resilience could moderate the effect of perceived stress on depression by direct and indirect paths.

LIMITATIONS

The causality among perceived stress, depression, insomnia and resilience is difficult to be verified.

CONCLUSIONS

Perceived stress is positively related to depression, and insomnia can mediate the effect of perceived stress on depression. In addition, the effect of perceived stress on depression, whether direct or indirect, is moderated by resilience, which is a protective factor for mental health.

Lived experiences of recovered COVID-19 persons in Nigeria: A phenomenological study

Background

Numerous publications have documented the mode of transmission and prevention of COVID-19 but little or no evidence exists on the experiences of people who survived the infection.

Objective

This study explored the specific experiences of persons who were infected with COVID-19, but have recovered completely. A secondary objective was to identify essential elements in the lived experiences of such persons, which would be useful in designing appropriate policies and programs for managing the virus in Nigeria.

Method

The data were collected using in-depth interviews with 21 persons who were diagnosed with the virus and recovered. The data were transcribed and analyzed qualitatively using NVivo software. The experiences of the survivors of COVID-19 were examined under six themes: compliance with prevention measures before being infected, perceptions on how they contracted the virus, the symptoms they experienced, the management of the disease, their experiences with the healthcare system, their emotional experiences, and their recommendations on specific strategies to prevent and manage the virus based on their experiences.

Results

The commonly perceived means of contracting the virus were through colleagues, patients, and friends who were infected. The most commonly experienced symptoms were anosmia and fever. The health providers were described as courteous but some of the respondents observed avoidance and fear. Not all the interviewees knew the drugs they were treated with, but some, particularly the medical personnel, identified hydroxychloroquine, azithromycin, vitamin C, Augmentin, among others. Some of the participants used herbal remedies. While some respondents recounted good experiences in the isolation centre, others had unpleasant experiences. Direct and indirect encounters which were perceived as stigmatizing and discriminatory were reported by some respondents.

Conclusion

We conclude that persons who recovered from COVID-19 in Nigeria had varied experiences relating to the mode of infection, the clinical features, methods of treatment, and psychosocial effects of the virus. These experiences would be useful for designing and implementing appropriate interventions, policies, and programs for managing the pandemic in the country.

Healthy lifestyle changes and mental health of healthcare workers during the COVID-19 pandemic in China

This study investigated lifestyle changes in physical activity, sleep, and diet among healthcare workers and their impact on their mental health during the COVID-19 pandemic in China. Healthcare workers (N = 589) completed an online survey about demographic and personal characteristics, working experiences, COVID-19-related stressors, lifestyle changes, and mental health (anxiety and depression) about three months after the lift of the lockdown policy in China. Lifestyle Changes (including changes in physical activity, sleep, and diet), Generalized Anxiety Disorder (GAD-7), and Depression (PHQ-9) were used to measure main outcomes. Of the participants, 39.7% (N = 234) had less physical activity, 36.0% (N = 212) slept less, and 41.8% (N = 246) ate healthier than before pandemic. Lower educational level, working within original hospitals, less physical activity and less sleep time was associated with increased anxiety. Working within original hospitals, less physical activity and an unhealthier diet was associated with increased depression. In summary, healthcare workers who became less healthy in lifestyles experienced a higher level of anxiety and depression symptoms during the COVID-19 pandemic. Strategies to promote healthy living and improve mental health among healthcare workers should be developed and implemented both during the ongoing COVID-19 pandemic and beyond.

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.

Depression and anxiety among children and adolescents pre and post COVID-19: A comparative meta-analysis

BACKGROUND

Published studies in comparing pre and post the COVID-19 pandemic depression and anxiety levels among children and adolescents yielded incongruent results. Therefore, there is a necessity to perform a timely meta-analysis to synthesize existing evidence.

METHODS

A total of 10 digital databases (PubMed, Web of Science, PsycINFO, the Cochrane Library, Embase, Scopus, ScienceDirect, CNKI, WanFang, CQVIP) were fully searched for eligible studies published before November 6, 2021. Based on quality assessment results, relevant data were extracted for eligible studies of higher quality. We combined standardized mean difference (SMD) or prevalence ratio (RR) for anxiety and depression pre and post the COVID-19 pandemic by using random-effects models. Sensitivity analysis was further performed to evaluate heterogeneity of included studies.

RESULTS

14,508 articles were preliminarily identified, and after stepwise screening process, 8 articles were included eventually. The results showed that the SMD for post COVID-19 anxiety score measured by GAD-7 was 0.12 (95% CI: 0.08, 0.17), an significant increase compared with pre COVID-19 period; the SMDs and 95% CIs for post COVID-18 depression scores measured by PHQ-9, PHQ-8, and MFQ were 0.17 (95% CI: 0.10, 0.24), 0.23 (95% CI: 0.08, 0.38), and 0.11 (95% CI: 0.06, 0.17), respectively, also significantly increased compared with pre COVID-19 period. The RR for depression was 2.54 (95% CI: 2.48, 2.60) in post COVID-19 period when compared with pre-pandemic.

CONCLUSIONS

Children and adolescents reported deteriorated anxiety and depression levels after the COVID-19 pandemic. More attention should be paid to this vulnerable group. Effective, expedient, and practical intervention measures which are compatible with COVID-19 prevention and control policies should be developed and implemented to maintain mental health wellbeing of the youths.

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.

Trastorno de estrés postraumático y calidad de vida del paciente post COVID-19 en atención primaria

Objetivo

Determinar la asociación entre los síntomas de trastorno por estrés postraumático (TEPT) con la calidad de vida relacionada con la salud (CVRS) del paciente post-COVID-19 en Atención Primaria.

Diseño

Estudio transversal, multicéntrico, con muestreo probabilístico aleatorizado.

Emplazamiento

Centros de Atención Primaria de Ica-Perú.

Participantes

Seiscientos treinta y seis pacientes con diagnóstico previo de COVID-19.

Mediciones principales

La variable síntomas de TEPT, fue medida con el cuestionario COVID-19-PTSD y la CVRS con la escala EuroQol (EQ-5D). Se analizaron factores sociodemográficos y de salud que incluyó el síndrome post-COVID-19. Se realizó un análisis descriptivo y se calcularon razones de prevalencia (RP) crudas y ajustadas, mediante modelos lineales generalizados de la familia Poisson, para buscar asociación entre las variables.

Resultados

De los participantes, el 21,4% presentó síntomas de TEPT; el 33,6%, síntomas de excitación disfórica y ansiosa; el 22,3%, intrusión, evitación y afecto negativo; 22,6%, anhedonia, y el 23,6%, comportamiento exteriorizante. El 50,3% reveló al menos un componente de la CVRS afectada; el 35,5%, problemas vinculados con ansiedad/depresión; el 34,9%, dolor/malestar; el 11%, actividad cotidiana; el 10,7%, movilidad y el 6,6%, cuidado personal. La presencia de síntomas de TEPT mostró asociación con la CVRS afectada (RP = 2,46: IC del 95%: 2,19-2,78). Asimismo, ciertas variables sociodemográficas y de salud se asociaron con los síntomas de TEPT y la CVRS afectada.

Conclusiones

Los síntomas de TEPT incrementan la probabilidad de afectar la CVRS del paciente post-COVID-19. Existen variables sociodemográficas y de salud potencialmente modificables que podrían mermar los síntomas de TEPT y mejorar la CVRS.

Nurse's experience in giving nursing care to Covid-19 patients

Objective

The objective was to describe Nurse's experience in giving nursing care to covid-19 patients.

Method

Phenomenology design was used in this study. Participants in this study were nurses who provided nursing care for COVID-19 patients. Participant data were obtained from the nursing office and contacted via cell phone to become participants. After data saturation the researcher found six nurses as participants. In-depth interviews were conducted from July to August 2020 to explore the experiences of nurses giving nursing care to Covid-19 patients. Data was analyzed using the Colaizzi method.

Result

We found five themes of nurses giving nursing care to Covid-19 patients. The themes include the Motivation of nurses to provide nursing care during the COVID-19 pandemic, the nurse emotional response, the patient emotional response, the problems faced by COVID-19 nurses, and the expectations of the nurses.

Conclusion

Nurses need support while giving nursing care to Covid-19 patients to break Covid-19 transmission.

Psychological Distress in Healthcare Workers During the Covid-19 Pandemic: Development and Validation of the Italian Version of the Healthcare Workers Emergency Distress Questionnaire (HEDQ)

Objective

The COVID-19 pandemic has presented unprecedented challenges for health systems as it has proven to be an extraordinary emergency. Exposure to such chronic stress can have detrimental effects on the psychophysical well-being of healthcare workers, with possible manifestation of stress-related symptoms. The present study aimed to develop and validate the Healthcare Workers Emergency Distress Questionnaire (HEDQ), a self-report screening questionnaire with the purpose of identifying the healthcare workers at risk for psychological and moral distress, and PTSD-related symptoms during emergencies.

Method

The HEDQ was administered to 250 healthcare workers of the AULSS 3 Serenissima and 47 citizens from the general population in Venice (Italy) during the health emergency period (from April to June 2020). In the second administration (from August to September 2020), data were collected from 101 of the 250 healthcare workers who had participated in the first administration. To test for the convergent validity, the Depression Anxiety Stress Scale (DASS-21) was also administered.

Results

Exploratory and hierarchical confirmatory factor analyses validated the 21-item structure of the questionnaire. Internal consistency, and factorial and convergent validity were good. Moreover, the HEDQ discriminated between those who worked in COVID-19 hospital units and those who did not (including the general population), showing good known-group validity. The two-month temporal stability of the questionnaire was excellent. The HEDQ scale scores significantly decreased from the first to the second administration, thus supporting that the tool is a measure of acute stress in healthcare workers.

Conclusions

Our results provide support for the use of the HEDQ as a brief, multidimensional measure of emergency-related stress reactions in healthcare workers. Consequently, the HEDQ can be considered a useful instrument supporting clinical activity to identify those who may be more easily affected by stress reactions in the event of atypically high levels of risk exposure during crises.

Concern about COVID-19 among the Spanish population: Validation of a scale and associated symptoms

BACKGROUND

The health crisis caused by the COVID-19 pandemic has led to a considerable increase in the psychopathology of COVID-19 patients and among the general population. This study aims to conduct the psychometric analysis of the scale of concern about COVID-19 in the Spanish population and to estimate the level of concern and dysfunctional anxiety present one year after the lockdown measures in Spain aimed at resisting the spread of the viral disease among the population.

METHODS

The factorial structure of the instrument, its reliability for the general population and for COVID patients, and its construct validity have been analyzed, and measurements of dysfunctional concern have been obtained from a sample of 502 adults.

RESULTS

The scale of concern about COVID-19 showed optimal results of reliability and validity for the Spanish population, confirming that it is an ideal instrument for estimating the concern regarding coronavirus contagion.

LIMITATIONS

This study used a cross-sectional design and thus, could not compare the changes in the incidence of anxiety symptoms before and after the COVID-19 outbreak. Furthermore, the use of mental health services prior to the COVID-19 restrictions was not assessed in this study, and therefore, no comparisons between the two time points could be made.

CONCLUSIONS

After a year of the confinement measures that was instilled to avoid further spread of the disease, the Spanish population presented levels of concern and anxiety that may require clinical attention, with a significant percentage of participants meeting the requirements to be diagnosed with generalized anxiety disorders.

Stress appraisal as a mediator between the sense of coherence and the frequency of stress coping strategies in women and men during COVID-19 lockdown

The COVID-19 lockdown experience is a unique and unexpected stressful life situation. In our research project, we explored gender differences in the mean level of stress appraisal (SAQ), the frequency of stress coping strategies (COPE), and the sense of coherence (SOC), as well as gender differences in the strength of the relationships between SAQ, COPE, and SOC during the COVID-19 lockdown. Finally, we tested if stressor appraisal (as a threat, harm/loss, or challenge) mediates the relationship between SOC and COPE in women and men respectively. Data were collected during the first wave of the COVID-19 lockdown in Poland in 2020. An online survey was conducted among 326 adults aged between 18 and 72. We observed gender differences in the level of SAQ, COPE, and SOC and gender differences in the significance and strength of the correlations between these variables. SOC had a twofold effect on COPE in men: direct and indirect through SOC-threat and SOC-harm/loss. In women, SOC did not directly predict COPE frequency but affected COPE in an indirect way through SAQ. SAQ is an important factor that modifies the strength of the SOC effect on COPE in women and men during the lockdown.

How empowering leadership influences medical workers' work–family conflict in the post-pandemic era: A moderated mediation model of leadership “black box”

After experiencing the COVID-19 pandemic, the status and mechanisms of leadership, and the challenges for medical workers in terms of family–work conflicts, have caused widespread concern. In the post-pandemic era, based on role theory and the stressor-detachment model, this paper seeks to break the “black box” of negative effects that can be caused by leadership, research the mechanism and boundary conditions of those negative effects, and explore factors to reduce those negative effects. We recruited 1,010 Chinese medical workers fighting COVID-19 on the frontline. Our study results showed that there was a significant negative correlation between empowering leadership and work–family conflict, and this relationship was completely mediated by role stress, while psychological detachment moderated the relationship between role stress and work–family conflict. Moreover, psychological detachment moderated the mediating effect of empowering leadership on work–family conflict through role stress. Therefore, higher levels of psychological detachment were less conducive to medical workers' family–work conflict. This study has important theoretical significance and practical value for revealing the negative effects and mechanisms of empowering leadership and for medical workers to better deal with work–family relations.

Factors Affecting the Psychological Well-Being of Health Care Workers During the COVID-19 Crisis

Background

Health care workers (HCWs) are a group that especially suffered during the COVID-19 pandemic. In addition to facing the stress of dealing with patients and social isolation, they had to worry about being infected themselves and transmitting the infection to their families. This study evaluated the fear, anxiety, and depression experienced by HCWs during the COVID-19 crisis.

Subjects and Methods

The sample size was 541 HCWs. Data collection was done using an online validated questionnaire through Google Docs, sent to HCWs by email and WhatsApp groups. We assessed depression and anxiety with the 4-item Patient Health Questionnaire-4 (PHQ-4), while evaluating fear with the Fear of COVID-19 Scale (FCV-19S).

Results

A statistically significant difference was found in the perception of fear between married and unmarried people, and between those with colleagues who had died from COVID-19 infection and those without. There was a significant relation between HCWs' anxiety and a history of death from COVID-19 infection, either of friends or of close relatives. The prevalence of depression was 18.48% in the tested sample of HCWs. Participants who had close relatives or friends infected with COVID-19 showed a significantly higher degree of depression. The age group <30 and those working 20 to 30 hours weekly showed higher degrees of anxiety and depression.

Conclusion

Sociodemographic variables such as age, marital status, and working area had a significant impact on the mental and psychological health of HCWs during the COVID-19 crisis. HCWs who lost patients due to COVID-19 had a significantly higher prevalence of fear, depression, and anxiety.

Academic, clinical and personal experiences of undergraduate healthcare students during the COVID-19 pandemic: A prospective cohort study

Background

Coronavirus disease 2019 has impacted upon the role and safety of healthcare workers, with the potential to have a lasting effect on their wellbeing. Limited research has been conducted during previous pandemics exploring how student healthcare workers are impacted as they study and train for their professional careers.

Objective

The aim of the current study was to examine the specific impact of COVID-19 on the academic, clinical and personal experiences of healthcare students.

Method

Undergraduate students across three year groups within the School of Health Sciences at Ulster University completed online Qualtrics surveys at three timepoints during one academic year (2020/2021). Quantitative survey data was downloaded from Qualtrics into SPSS Version 25 for descriptive analysis of each cross-sectional sample. Qualitative survey data was downloaded into text format, which was thematically analysed using content analysis.

Results

412 students completed the survey at Time 1 (October 2020), n = 309 at Time 2 (December 2020) and n = 259 at Time 3 (April 2021). Academically, the pandemic had mostly a negative impact on the learning environment, the development of practical skills, the assessment process and opportunities for peer learning and support. Students reported increased stress and challenges managing their workload and maintaining a sense of motivation and routine. Clinically, they felt unprepared by the university for placement where the pandemic had an increasingly negative impact over time on learning and skill development. In terms of personal experiences, despite the majority of students taking steps to keep physically and mentally well, negative impacts on friendships, mental wellbeing and concerns for family were reported. The pandemic had not impacted upon career choice for most students.

Conclusion

Consideration must be given to the development of practical skills so students feel prepared for their professional careers given the practical nature of their roles. Programme coordinators should adopt a holistic approach to student wellbeing.

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.

Management of the COVID-19 pandemic: challenges, practices, and organizational support

BACKGROUND

Health organizations currently face tremendous challenges in the management of the COVID-19 pandemic. To do this, successful and proven scientific practices and support are needed.

AIM

This study aimed to explore the challenges, practices, and organizational support dealt with by nursing managers in the management of the COVID-19 pandemic.

METHOD

A qualitative content analysis study evaluated 35 nursing managers in five university hospitals through a semi-structured interview. The Consolidated Criteria for Reporting Qualitative Research were used for this qualitative study.

RESULTS

Three main themes emerged: Challenges include the development of a COVID-19 crisis management plan, a shortage in nursing staff, and psychological problems. Practices include; changes in work schedules for nursing staff, the exchange process, hospital preparation, and training and education. And organizational support includes both support at an organizational level and support at an individual level.

CONCLUSION

This study revealed that nursing managers are faced with many challenges in the management of COVID-19, requiring good practices and organizational support. This study offers evidence for nursing managers to expect problems that may arise during the pandemic.

RECOMMENDATIONS

The COVID-19 pandemic requires the development of an integrated plan, and this plan must be disseminated to the hospital's nursing and medical teams to better equip them for the current and future crises.

Awareness, Psychological State, and Coping Skills among the Frontline Doctors during the COVID-19 Pandemic—A Cross-Sectional Study

Background Frontline doctors managing the current novel coronavirus 2019 (COVID-19) pandemic work under stressful conditions due to change in workload, working pattern, and worries about the infection to themselves and families with frequently changing treatment protocols. Their psychological well-being is necessary for the effective management of the health crisis.

Objectives This study aims to assess the psychological state and worries of frontline doctors while dealing with the COVID-19 pandemic, the various coping skills employed by them for maintaining their mental health, and the knowledge about illness and related myths and misinformation among them. A further objective is to compare the above between two groups of frontline doctors: the consultants and the junior residents (JR) working in the hospital.

Materials and Methods A total of 164 participants (76 consultants and 88 JRs) were cross-sectionally evaluated online using a prevalidated questionnaire within a period of 3 months after obtaining institutional ethics approval

Statistical Analysis The study sample and results were described using descriptive analysis. The association between the categorical variables was measured using chi-squared test.

Results Most participants frequently updated themselves through reliable sources (consultants = 92%, JR = 73.9%) predominantly from the hospital task force and university. Overall, 71% of consultants and 58% of JRs were worried about being infected. JRs were significantly more worried about the spread of infection due to faulty sterilization of the protective equipment as compared to the consultants (p = 0.031). Most participants were worried about their families getting infected (consultants = 79%, JR =89.8%). Both consultants (18.4%) and JRs (35.2%) had sleep disturbances. Although most did not have syndromal depressive features and COVID-19-related anxiety, tiredness (45.1%) and worrying too much (47.5%) were the most common psychological symptoms. Almost all participants (consultants = 76.3%, JR = 80.7%) used multiple coping styles, such as avoiding thinking about COVID-19, listening to music, and physical activities.

Conclusion Frontline doctors overall reported higher worries regarding their family being infected and protective equipment-related issues, whereas they had less core depressive and anxiety symptoms. They had adequate COVID-19-related awareness and used multiple coping skills.

Burnout and psychological symptoms in healthcare workers during the COVID-19 pandemic: Comparisons of different medical professions in a regional hospital in Turkey

BACKGROUND: Early studies have revealed the psychological effects of the COVID-19 outbreak on healthcare workers (HCWs). Burnout and psychological outcomes of different medical professions during the pandemic have not yet been addressed. OBJECTIVE: The study aimed to investigate the burnout, depression, anxiety, and psychological distress levels of HCWs, and to determine the predictive factors of burnout in different professions of frontline HCWs during the pandemic. METHODS: This cross-sectional study included 253 HCWs (79 physicians, 95 nurses, and 79 other-HCWs). The Maslach Burnout Inventory, Beck Depression Inventory, Beck Anxiety Inventory, and Impact of Event Scale-Revised, and Sociodemographic Form were used. RESULTS: Emotional exhaustion was significantly higher in physicians and nurses than in other frontline HCWs. While depersonalization was significantly higher in physicians than nurses / other HCWs, levels of avoidance, hyperarousal and intrusion were found to be higher in other HCWs / nurses than physicians. Depression was the most effective predicting variable for burnout, following age, quarantine, supervisor’s/team leader’s attitude, hyperarousal and avoidance. CONCLUSIONS: It has been observed that depending on the uncertainty and life risk of the pandemic in HCWs involved in the treatment of COVID-19, physicians who are the decision-making authorities in the treatment process used more depersonalization than nurses and other HCWs. Nurses and other-HCWs had significantly higher distress symptoms than physicians. Both future research and psychosocial services should address those with high depressive symptoms as a potentially fragile subgroup for burnout among HCWs, and investigate and develop evidence-based interventions that can provide mental well-being, and prevent burnout.

Cross-Cultural Adaptation and Validation of the Fear of COVID-19 Scale for Chinese University Students: A Cross-Sectional Study

BACKGROUND

fear of COVID-19 is widespread among the population, especially among college students because of their increased exposure to the media information overload of the COVID-19 outbreak. The Fear of COVID-19 scale (FCV-19 S) is a relatively short instrument used to evaluate fears surrounding the COVID-19 pandemic. However, the validity and reliability of the Fear of COVID-19 Scale have not been fully investigated in Chinese university student groups.

OBJECTIVES

this study assessed the cross-cultural adaptability and reliability of the FCV-19S for Chinese university students.

METHODS

a Chinese version of Fear of COVID-19 Scale (C-FCV-19S) was generated using the translation-backward translation method. Psychometric properties of the C-FCV-19S, including internal consistency, split-half reliability, construct reliability, convergent validity, and diagnostic accuracy, were evaluated. The Patient Health Questionnaire (PHQ) and Generalized Anxiety Disorder Questionnaire (GAD-7) scales were also used to evaluate participants for depression and anxiety.

RESULTS

the C-FCV-19S has acceptable internal consistency (Cronbach's alpha: 0.872) and satisfactory split-half reliability (correlation coefficient: 0.799). Using the exploratory factor analysis (EFA), we examined the construct reliability (KMO = 0.920). The confirmatory factor analysis (CFA) confirmed that the bifactor model of scale (including general factor, factor1: the awareness of COVID-19 and physiological arousal, factor 2: fear-related thinking) had a good fit index (χ2/df =6.18, RMSEA= 0.067, SRMR = 0.028, GFI = 0.986, TLI = 0.970 and CFI= 0.988). Using depression-positive and anxiety-positive scores as reference criteria, we found that the areas under the curve were 0.70 and 0.68, respectively, and that the optimal cutoff scores of the C-FCV-19S was 17.5 (sensitivity: 66.3% and 58.7%, respectively).

CONCLUSIONS

the validity and reliability of C-FCV-19S are satisfactory, and the optimal cutoff point was 17.5. The C-FCV-19S can be applied adopted in Chinese university students.

The effect of medical staff's professional identity on psychological stress during public health emergencies: The role of intolerance of uncertainty and adversity appraisal

This study aims to explore the relationship between medical staff's professional identity and the psychological stress they feel during a public health emergency. It also examines the possible mediating effects of staff's intolerance of uncertainty (IU) and moderating effects of staff's adversity appraisal on this relationship. This study's 447 participants were surveyed via questionnaire. The results indicate that (1) medical staff's sense of their professional identity can negatively predict the psychological stress they feel during public health emergencies; (2) staff's IU mediates the relationship between professional identity and psychological stress; (3) the direct effects of professional identity and psychological stress were moderated by staff's adoption of positive appraisal strategies (negative appraisal strategies), and the direct effect was significant in medical staff who adopted a less positive appraisal strategy (more negative appraisal strategy). Therefore, professional identity was proven to affect staff's psychological stress through their IU, and staff's adversity appraisal plays a moderating role in the direct path of this effect.

State and trait anxiety among medical staff during the first month of COVID-19 pandemic: A sample from Turkey

OBJECTIVES

During the COVID-19 pandemic, excessive workload, a rapidly changing workplace environment, the danger of carrying the virus and transmitting the disease to their families, relatives and those they live with creates stress for the medical workers. In our study, we aimed to evaluate the state and trait anxiety levels of healthcare professionals who encounter patients with suspected COVID-19 infection and related factors.

METHOD

Data were collected from healthcare professionals working with patients diagnosed or suspected with COVID-19 via online self-report questionnaire between 9-19 April 2020. The state (STAI-S) and trait anxiety (STAI-T) scale was used to measure anxiety.

RESULTS

A total of 291 healthcare professionals, 216 women and 75 men, participated in the study. Women's state and trait anxiety were significantly higher than men's. 11 participants without any lifetime psychiatric illness experienced psychiatric symptoms and consulted to a psychiatrist. The state anxiety of those who have children, nurses and those working in branches directly related to the pandemic (Infectious Diseases, Respiratory Diseases, Emergency Medicine, Internal Medicine, Radiology, Anesthesiology and Reanimation) was higher than others. The state anxiety of those who thought they were not protected with personal protective equipment and those who did not stay in their own home was higher than others.

CONCLUSIONS

At the forefront of the fight against COVID-19, there are medical personnel who pay a serious psychological cost. Especially in terms of anxiety, we should pay attention to women, workers with children, nurses and people working in branches that are directly related to pandemics.

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.

Moral Injury, Nurse Well-being, and Resilience Among Nurses Practicing During the COVID-19 Pandemic

OBJECTIVE

The aim of this study was to determine relationships between moral injury (MI), well-being, and resilience among staff nurses and nurse leaders practicing during the COVID-19 (coronavirus disease 2019) pandemic.

BACKGROUND

Attention to MI among health professionals, including nurses, increased in 2021, particularly related to the pandemic. Few studies examined MI, well-being, and resilience; even fewer provided implications for leadership/management.

METHODS

The sample included 676 RNs practicing in Ohio. The electronic survey included assessments of MI, well-being, and resilience distributed via the Ohio Nurses Association and the schools of nursing alumni Listservs.

RESULTS

There was a significant association between MI and negative well-being and negative association between MI and resilience. Differences were observed between staff nurses and leaders.

CONCLUSIONS

This is the first study relating MI, resilience, and well-bring among nurses and nurse leaders during the pandemic. There is a need for additional research to further our understanding about nurses' health and well-being during the pandemic and beyond.

Scalability of an ACT-Based strategy for improving well-being in health care providers: A mix-method and preliminary evaluation of efficacy

The burden of the COVID-19 pandemic has been mainly carried by health care providers. Technology-Mediated Interventions (TMI) seem to be a feasible alternative to increase access to behavioral health resources in this population. However, scaling-up treatments into TMI requires developing user-friendly, accepted, and accessible formats. A two-stage study was conducted to assess scalability of an Acceptance and Commitment Therapy (ACT) based strategy (named FACE COVID) delivered using technology. First, a mix-method design connected qualitative and quantitative data from health providers and ACT experts by which changes were performed to enhance scalability. Second, a pretest-posttest study was conducted to preliminary evaluate the efficacy of FACE COVID intervention on well-being, psychological distress, and psychological flexibility. Results showed a positive impact on well-being, but not distress and psychological flexibility. While this intervention has promising results, changes in dose intensity, social support, and mental health literacy could improve retention as well as increase opportunities to target distress and psychological flexibility in future studies.

Anxiety in patients treated in a temporary hospital in Belgrade, Serbia, during the first epidemic wave of COVID-19

BACKGROUND

It has been reported that COVID-19 patients in general often experience anxiety, depression and stress, but those problems in patients of temporary COVID-19 hospitals seem to have attracted less attention.

METHODS

The study included 87 SARS-Cov-2 infected subjects accommodated and treated in a temporary hospital in Belgrade, Serbia, during the first epidemic wave of COVID-19. The patients' level of anxiety was assessed on two occasions (at admission to the temporary hospital, and 2 weeks after discharge) using the Hamilton Anxiety Rating Scale (HAM-A). Demographic and clinical data were obtained through questionnairesor retrieved from patients' medical records.

RESULTS

A multiple linear regression model revealed that sex, age, the severity of COVID-19 symptoms (COVID-19_SS) and the family history of psychiatric disorder (FHPD) remain significant predictors of the level of anxiety at hospital admission (F (4, 82) = 14.916, p < 0.0001), wih an R² of 0.421. Participants' predicted level of anxiety at admission to the temporary COVID-19 hospital can be calculated as 0.931-0.708 × SEX +0.029 × AGE +0.674 × COVID-19_SS + 1.491 × FHPD, where SEX is coded as 1 for male and 0 for female, AGE is measured in years, COVID-19_SS is coded as 0 for asymptomatic, 1 for mild, 2 for moderate and 3 for severe, and FHPD as 0 for negative and 1 for positive. Comparison between individual HAM-A score at admission to the temporary hospital (median (IQR): 7.00 (2.00-11.75)) and 2 weeks after discharge (median (IQR): 0.00 (0.00-1.00)) revealed significant reduction in the level of anxiety among study participants (Z = -7.53, p < 0.001).

CONCLUSION

These data indicate that psychological changes exist in those hospitalized in temporary hospitals, but that they regress soon after they leave.

Factors affecting the professional functioning of health care workers during the COVID-19 pandemic: A cross-sectional study

AIM

To examine personal and organisational factors related to professional functioning of nurses and physicians during the COVID-19 pandemic.

BACKGROUND

Exposure to COVID-19-related stressors has been associated with lower self-reported professional functioning among health care workers.

METHODS

A cross-sectional study among 115 hospital workers during the COVID-19 pandemic in Israel was designed to explore (a) personal professional functioning, (b) clarity of guidelines, (c) work organisation by the management, and (d) health care workers' feeling of contribution to a global effort.

RESULTS

A feeling of contribution to a global effort while treating patients with COVID-19 mediated the relationships between work organisation by the management and professional functioning (β = .05, p < .05). The clarity of guidelines for routine procedures (β = .21, p < .05) and a feeling of β contribution to a global effort (β = .34, p < .01) positively predicted professional functioning of nurses and physicians during COVID-19 pandemic (R2  = .19, p < .01).

CONCLUSIONS

In order to achieve optimal functioning of health care workers in an emergency, managers should provide clear guidelines and promote workers' feelings of contribution to a global effort.

IMPLICATIONS FOR NURSING MANAGEMENT

The provision of clear guidelines and protocols is essential for efficient emergency management. Expressing appreciation for health care workers and providing positive feedback may improve professional functioning.

Prelicensure Nursing Students’ Reflections on Institutional Response to the 2020 COVID-19 Crisis

The study aimed to describe how prelicensure student nurses perceive academic support and their institutions’ response during the 2020 COVID-19 crisis. The shift to online learning caused by the COVID-19 pandemic disrupted every aspect of higher education, including pre-licensure nursing students. Prelicensure nursing education is one of the most stressful programs in higher education. In a period of great uncertainty, it becomes essential to explore how prelicensure nursing students perceive academic support from their institutions. A qualitative descriptive design was employed for the study. Thematic analysis was used to analyze data obtained from 16 semi-structured interviews. Six themes resulted from the data: Disorganization leading to chaos; technology and technical challenges; stress and frustration; am I prepared to be a nurse?; not having money; mental health matters. This study validates the experiences of nursing students. Students’ obstacles during the pandemic should be identified and mitigated to promote learning and academic success.

Cross-Sectional Survey of Opinions, Professional Changes, and Personal Hardships of COVID-19 on Chiropractors in the United States

OBJECTIVE

The purpose of this study was to assess self-reported data from a sample of U.S. doctors of chiropractic during the COVID-19 pandemic about levels of psychological stress and beliefs of the association between chiropractic spinal manipulation and the immune system.

METHODS

Chiropractors in the United States were invited via social media and e-mail to complete a survey about chiropractic and COVID-19. The survey collected demographic information, office protocols, changes made during the COVID-19 pandemic, chiropractic profession opinions, information related to stress, and personal beliefs from April 19 to May 3 of 2020. Data were analyzed using descriptive statistics.

RESULTS

Of approximately 77000 U.S.-licensed chiropractors,750 responded. Of this sample, 51.2% reported moderate and 30.4% reported severe levels of psychological stress. The primary stressors were financial and business concerns. There was a mixed response regarding beliefs if there was evidence to support a connection between spinal manipulation and the immune system. A majority (76.1%) responded that there should be no advertising for immune-boosting effects of spinal manipulation during the pandemic. A minority (18.3%) reported adding use of telehealth to deliver their services.

CONCLUSION

A majority of chiropractors included in this survey reported that the COVID-19 pandemic caused them psychological stress. More than half of the respondents reported moderate stress, with the second highest number of respondents reporting severe stress. Subgroup differences were noted in stress levels and causes, as well as pandemic-related practice changes. A dichotomy was noted between beliefs and recommended actions about effects on the immune system, which may represent that providers are aware of current evidence and considering association recommendations.

Modelo explicativo del autocuidado, la regulación emocional y el burnout en psicólogas en condición de aislamiento por COVID-19

Los efectos negativos en la salud mental de la población mundial derivados de la pandemia por coronavirus 2019 (covid-19) han incrementado la demanda de los servicios de atención psicológica. Por ello resulta importante estudiar también el bienestar emocional de este grupo de profesionales. El objetivo de este estudio fue analizar los procesos de autorregulación emocional y autocuidado como factores protectores frente a la presencia del burnout en un grupo de psicólogas mexicanas. Para esto, se utilizó un diseño cuantitativo transversal con alcance explicativo, en una muestra por voluntarios de 226 psicólogas con trabajo clínico. Los datos se recolectaron en formato electrónico, y para su obtención se aplicó la Escala de Conductas de Autocuidado para Psicólogos Clínicos (APC), el Cuestionario de Regulación Emocional (ERQ) y el Inventario Maslach de Burnout (MBI-HS). Para el análisis, se obtuvieron estadísticos descriptivos para cada una de las escalas y subescalas, se estimaron coeficientes de correlación de Pearson, se ajustaron modelos de regresión lineal simple y múltiple para las subescalas del MBI-HS, y se ajustó un modelo de senderos mediante el método GLS. Los resultados indican un bajo nivel de burnout, que se asocia al autocuidado como factor protector frente al agotamiento emocional, a la realización personal, a un mayor uso de la supresión emocional como estrategia de autorregulación, y a la reevaluación cognitiva como factor protector ante la despersonalización. El estudio subraya la importancia fomentar el uso de conductas de autocuidado para disponer del mayor número de psicólogas en las mejores condiciones posibles para hacer frente a los efectos a largo plazo de la pandemia por covid-19.

Survey on Anxiety and Post-Traumatic Stress Disorder in Intensive Care Personnel during the COVID-19 Pandemic in a Medically Under-Resourced Country

The COVID-19 pandemic has increased the need for intensive care personnel. Romania has a low number of physicians per inhabitant. The stress of pandemics upon an already weak medical health system triggered some psychological effects upon burnt-out personnel. The main objective is to provide an insight into the psychological status of Romanian ICU personnel by evaluating their level of anxiety. The secondary objectives aim to identify the level of post-traumatic stress disorder and anxiety in different groups and to identify the personnel most affected psychologically. This study enrolled adult responders from the ICU of Târgu Mureș Emergency Clinical County Hospital, Romania, participating voluntarily. The evaluation tests were the State-Trait Anxiety Inventory and Post-Traumatic Stress Test. Out of the 126 eligible participants, 87 adult employees were enrolled-with a 69% response rate. The study comprised three groups: doctors, nurses, and auxiliary personnel. All three groups scored for moderate anxiety symptoms. COVID-19-related anxiety was strongly correlated with age and number of working years in all groups. Increased PTSD scores were observed in doctors and nurses. All ICU personnel who dealt with COVID-19 patients presented with moderate anxiety and post-traumatic stress disorder symptoms. The years of ICU experience had a positive impact on anxiety symptoms.