Stress and burnout in health care workers during COVID-19 pandemic: validation of a questionnaire

Prevalence of personal, work-related and patient-related burnout during the COVID-19 pandemic and its associated factors among healthcare workers in health clinics in the district of Manjung, Perak: A cross-sectional study

Introduction

Burnout is a syndrome characterised by physical, emotional and mental exhaustion that results from a long period of involvement in an overwhelming work condition. It is prevalent among frontline workers. This study aimed to identify the prevalence of burnout among primary healthcare workers in the district of Manjung, Perak and determine the factors associated with burnout.

Methods

This cross-sectional study was conducted among healthcare workers in seven health clinics located in the district from August to September 2022. The self-administered validated Malay version of the Copenhagen Burnout Inventory and the Malay version of the Multidimensional Scale of Perceived Social Support were used. These instruments consisted of 31 questions rated on a 5-point Likert scale. The scores were then summed up to determine the burnout level. Data were analysed using SPSS version 20. Simple logistic regression analysis was performed. Thereafter, multiple logistic regression analysis was conducted to determine the factors associated with burnout.

Results

A total of 224 participants were included. Among them, 61.6% were nurses; 21.4%, doctors; and 17.0%, assistant medical officers. The prevalence of personal burnout was 31.3%; work-related burnout, 16.5%; and patient-related burnout, 5.4%. The factors associated with burnout were the highest educational level, financial difficulties and low perceived social support from friends and significant others.

Conclusion

Healthcare workers in Manjung health clinics have a higher prevalence of personal burnout than work- and patient-related burnout. The findings of this study provide early insights and guidance for possible interventions.

Impact of Effort-Reward Imbalance and Burnout on the Compliance with Standard Precautions among Nurses and Midwives in Lebanese Hospitals

BACKGROUND

Effort-reward imbalance (ERI) refers to the situation where there is a mismatch between the effort that healthcare workers (HCWs) put into their work and the rewards they receive in return. Burnout, on the other hand, is a psychological syndrome characterized by emotional exhaustion, depersonalization, and reduced personal accomplishment. This study aimed to assess the impact of ERI and burnout on the compliance with standard precautions (SPs) among nurses and midwives in Lebanese hospitals under the economic crisis and after the COVID-19 pandemic.

METHODS

Cross-sectional correlational study, based on self-administered questionnaire data, measuring the compliance with SPs, ERI, and burnout, in addition to the relationship between these factors, was performed among 409 nurses and midwives, working in Lebanese hospitals.

RESULTS

ERI was significantly associated with exposure to burnout among nurses and midwives, and burnout was found to be a significant predictor of nurses and midwives' self-reported adherence with SPs.

CONCLUSIONS

This study highlights the contribution of ERI and burnout to the chain of infection by decreased adherence to infection control SPs of nurses and midwives.

A comparative analysis of stress, anxiety, and social well-being of working mothers and stay-at-home mothers during the covid pandemic

BACKGROUND

The role of mental health is crucial in maintaining the dynamism and productivity of any given society. In contemporary times, a significant proportion of the workforce is comprised of women and mothers. Working in healthcare facilities, where exposure to pathogenic agents is an everyday nuisance, can have detrimental effects on mothers' stress and anxiety levels. Furthermore, such exposure can also endanger the health of both the family and society. Conversely, the employment of mothers could positively impact their social well-being. The primary objective of this study is to assess and compare the stress, anxiety, and social well-being scores of mothers employed in healthcare facilities and stay-at-home mothers during the COVID pandemic.

MATERIALS AND METHODS

This study is a cross-sectional analysis of 246 mothers, equally divided into two groups: Mothers who work in health centers and stay-at-home mothers (123 individuals in each group). The study was conducted from 2021 to 2022, a multistage sampling method was utilized and two questionnaires were administered: The DASS 21 (21 questions) and the social well-being questionnaire (48 questions). The data were analyzed using SPSS 18, and descriptive and analytical tests (Independent Samples T-Test, Mann-Whitney) were employed.

RESULTS

The mean age was 35.7 ± 7.1 for working mothers and 34.3 ± 6.3 for stay-at-home mothers. The average stress score for employed mothers was 5.72 ± 4.7, and for stay-at-home mothers, it was 7.16 ± 4.3, which indicates a statistically significant difference in stress levels between the two groups (P = 0.04). However, the two groups had no significant difference in the mean anxiety score (P = 0.08). The mean score for social well-being was 165.5 ± 18.4 for working mothers and 162.17 ± 21.2 for stay-at-home mothers. This difference was not statistically significant (P = 0.18). Except for the social acceptance dimension (P = 0.003), no statistically significant differences were observed in the social well-being dimension between the two groups.

CONCLUSION

The social acceptance of working mothers appears to be greater than that of stay-at-home mothers. Higher social acceptance suggests that they hold a more positive outlook on people and are at ease in social situations, which may have helped to alleviate their stress and anxiety.

Occupational Stress and Burnout Among Healthcare Workers in Saudi Arabia During the COVID-19 Pandemic

The COVID-19 pandemic has caused a lot of stress for healthcare personnel. They are subjected to arduous and stressful working hours and may contract infection. The objectives of this study were to (i) assess the level of occupational stress and the prevalence of burnout among healthcare workers (HCWs) in the Kingdom of Saudi Arabia during the COVID-19 pandemic and (ii) to identify some sociodemographic characteristics and work-related factors that may influence the level of stress and burnout among such HCWs. An online survey was distributed on social media websites and groups of HCWs in KSA. The survey depended on the stress domain of Depression, Anxiety, and Stress Scale-21 (DASS-21) and the work-related burnout domain of Copenhagen Burnout Inventory (CBI). Data were collected using a Google form and then analyzed. Among 478 respondents, 37.7% of studied HCWs reported mild to extremely severe stress, and 47.9% of them reported work-related burnout. Occupational stress and burnout were more prevalent among front-line HCWs (43.9% and 55%) than among second-line HCWs (31.2% and 40.8%). The mean scores of occupational stress and burnout were significantly much higher among frontline physicians and nurses particularly those who are females, of younger age (≤40 years), with few years of work experience (≤15 years), being married, having chronic disease, and those previously infected by COVID-19. HCWs reported a high prevalence of occupational stress and burnout during the COVID-19 pandemic. Establishing policies and guidelines, enhancing working conditions, and providing continuous psychological support and assurance to HCWs are recommended to improve their resilience and increase their coping capacities toward pandemics.

Feasibility of a 3-Minute Mindful Breathing Intervention for Enhancing Psychiatric Mental Health Nurses' Resilience During COVID: Findings From a 4-Week Pilot Study

COVID created a perfect storm of conditions leading to excessive and prolonged stress on already vulnerable nurses. This study examines the feasibility of enhancing psychiatric mental health nurses' (PMHNs') resilience by practicing a 3-minute mindfulness-based intervention. In this pilot study, we explored if PMHNs could be recruited and retained for intervention implementation, intervention acceptability, and measurement of any notable changes over the prescribed period. Study feasibility is reflected in high participant retention and increased postintervention resilience scores. Given the positive outcomes, a larger-scale study is warranted. Additional areas of opportunity include strategies for increasing participant uptake, and, due to limited acceptability feedback, the introduction of a usefulness scale.

Suicidal ideation, burnout, and their correlation among health care workers at the end of the fourth wave of the COVID-19 pandemic in Alborz Province, Iran

Background

During the COVID-19 pandemic, Health Care Workers (HCWs) were more vulnerable than ever to Burnout and Suicidal thoughts due to stressful work conditions. This study, investigated the level of Burnout and Suicidal thoughts among HCWs during the fourth wave of the pandemic in Alborz Province in Iran and compared it with the conditions at the beginning of the pandemic.

Methods

A total of 305 HCWs from 3 referral hospitals for COVID-19, including 155 men and 150 women, participated in the study. A cross-sectional study was carried out with a sample of HCWs dealing with COVID-19 patients using the available sampling method. The results of this online survey, which was conducted from June 7 to July 5, 2021 (at the end of the Fourth Wave of the COVID-19 Pandemic in Iran), have been compared with the conditions of the First Wave of the Pandemic (from February 24 to April 27, 2020). The participants were evaluated by the Beck Scale for Suicidal Ideations (BSSI) and Maslach Burnout Inventory (MBI).

Results

The mean age of the participants was 36.34 ± 7.37. The means of Suicide Index (SI), Emotional Exhaustion (EE), Depersonalization (DP), and Personal Accomplishment (PA) scores were 0.76 ± 1.74, 19.94 ± 4.69, 4.92 ± 1.51, and 31.30 ± 5.88, respectively. SI and PA were significantly higher in workers other than nurses and physicians and EE was higher among workers with night shifts (p value<0.05 in all indices). Age had a significant and negative correlation with EE (p value<0.01) and DP (p value<0.05) and a significant and positive correlation with PA (p value<0.01).

Conclusion

This study showed a high level of SI and Burnout indices among HCWs in the fourth wave of the pandemic in Iran. Paying attention to the factors affecting the development of social capital and creating health policy changes may be effective in reducing Burnout indices and high Suicide index among HCWs.

Interventions to improve the sleep of nurses: A systematic review

Nurses are at a high risk for short sleep duration and poor sleep quality due to irregular work schedules and high occupational stress. Considering the effect of nurses' sleep on the safety and health of themselves and their patients, it is important to promote healthy sleep for nurses. We sought to synthesize the published experimental and quasi-experimental studies that address interventions to improve sleep in nurses. A systematic search was conducted for studies published in English up until May 15, 2023, using the databases PubMed, CINAHL, Academic Search Ultimate, and PsycINFO. In total, 38 articles were included, covering 22 experimental and 16 quasi-experimental studies with sample sizes ranging from 9 to 207. Studies were assessed using the Cochrane Risk of Bias tool and considered as low to medium quality. Thirty-six of the 38 studies reported positive findings for at least one sleep outcome. Intervention types included aroma therapy, dietary supplements, cognitive behavioral therapy, light therapy, mind-body therapy, sleep education, exercise, napping, shift schedule modification, and multicomponent intervention, all of which showed moderate effectiveness in promoting sleep outcomes of nurses. Comparing and contrasting studies on specific interventions for improving sleep in nurses is sparse and often equivocal. With the variations of research methodology and outcome measures, it is difficult to make a conclusion about each intervention's effectiveness on specific sleep outcomes. Additional high-quality research, including randomized controlled trials, is needed to evaluate strategies for improving sleep in this unique, safety-sensitive occupational group.

Factors Associated with Burnout in Medical Staff: A Look Back at the Role of the COVID-19 Pandemic

Despite the significant consequences for medical practice and public health, burnout in healthcare workers remains underestimated. Pandemic periods have increased the reactivity to stress by favoring some changes whose influence are still felt.

PURPOSE

This study aims to identify opportune factors during pandemic periods that predispose medical personnel to burnout and the differences between medical staff which worked with COVID-19 patients and those who did not work with COVID-19 patients.

MATERIAL AND METHODS

This is a prospective study on 199 subjects, medical staff and auxiliary staff from national health units, COVID-19 and non-COVID-19, who answered questions using the Google Forms platform about the level of stress related to the workplace and the changes produced there. All statistical analyses were conducted using IBM SPSS Statistics (Version 28).

RESULTS

The limited equipment and disinfectant solutions from the lack of medical resources category, the fear of contracting or transmitting the infection from the fears in relation to the COVID-19 pandemic category and the lack of personal and system-level experience in combating the infection due to the lack of information on and experience with COVID-19 were the most predisposing factors for burnout. No significant differences were recorded between those on the front line and the other healthcare representatives.

CONCLUSIONS

The results of this study identify the stressors generated in the pandemic context with prognostic value in the development of burnout among medical personnel. At the same time, our data draw attention to the cynicism or false-optimism stage of burnout, which can mask a real decline.

A pilot study of the depression, anxiety and stress in Greek military personnel during the first year of the COVID-19 pandemic

INTRODUCTION

The ongoing SARS-CoV-2 pandemic is a global health crisis which poses many psychological research challenges. The objective of this study was to evaluate the responsiveness and validity of depression, anxiety and stress in a representative cohort of Hellenic military personnel using the short version of the Greek military version of the Depression-Anxiety-Stress Scales-21 (DASS-21) questionnaire.

METHODS

A total of 158 participants were voluntarily surveyed using an electronically developed structured questionnaire. The anonymous e-questionnaire included a social demographic section and the DASS-21 scale section. It was distributed in September 2020 to the military personnel of the Hellenic Tactical Air Force Units using an intranet network during government restrictive measures due to the COVID-19 crisis.

RESULTS

Our DASS-21 survey indicated a positive outcome at the psychometric level of our military sample population. Age, sex and systemic medications were statistically correlated with anxiety. Inter-correlations between the DASS-21 statements showed that individuals with low-level depression also experienced some degree of stress. Factor analysis indicated the reliability and validity of the questionnaire.

CONCLUSIONS

The low levels of depression and stress among our military sample population demonstrate the importance of periodic monitoring of the psychometric items of the DASS-21 subscales to design and implement psychological prevention strategies, especially during the ongoing and future healthcare crises.

Physician stress in the era of COVID-19 vaccine disparity: a multi-institutional survey

CONTEXT

Healthcare workers are at a high risk of infection during infectious disease outbreaks, such as the COVID-19 pandemic. Despite the availability of several vaccines against COVID-19, the absence of vaccination in patients and colleagues remains a continuous source of stress in healthcare workers. We conducted a survey of physician preceptors, both MDs and DOs, to explore the impact of differences in the patients' and colleagues' vaccination status on their well-being, stress, and burnout.

OBJECTIVES

The objective of this study is to determine whether exposure to unvaccinated patients and/or colleagues increases stress and burnout in physician preceptors by utilizing a self-reported survey.

METHODS

This multi-institutional study was carried out in the United States in 2022. An online survey questionnaire was utilized to collect data from physicians working as preceptors for multiple academic institutions. The anonymous Qualtrics^® survey utilized a modified version of the questionnaire from the expanded Physician Well-being Index (ePWBI) designed by MedEd Web Solutions (MEWS). Statistical analysis on both descriptive and qualitative data were performed. Utilizing a threshold of p≤0.05, data analysis revealed many statistically significant relationships between the variables.

RESULTS

A total of 218 physician preceptors completed the survey. The survey results showed that physicians overwhelmingly (p < 0.001) felt that all patients (and healthcare workers) should be vaccinated. The results also indicated that physicians experienced more stress when working with unvaccinated patients (p<0.001), and these stressors were often associated with the physician's gender and age. Furthermore, physicians stated that both their assessment and treatment plans were significantly different for vaccinated vs unvaccinated patients (p=0.039 and p=0.0167, respectively). Most importantly, stress levels (p<0.001) and burnout characteristics (p=0.024) were noted by physicians, both in themselves and in their colleagues.

CONCLUSIONS

Findings suggest that physician stress and burnout is a common theme due to the differences in vaccination status of patients admitted to COVID-19 clinics. Due to a more rapid progression of COVID-19 in unvaccinated patients, treatment plans for vaccinated vs unvaccinated patients were also considerably different.

Mental health experiences and coping strategies of BAME care workers who worked in nursing and residential care homes during the COVID-19 pandemic in Luton, England

BACKGROUND

The COVID-19 pandemic intensified the risk factors for poor mental health among care workers in the UK. However, there is inadequate evidence on the mental health impact of COVID-19 on Black, Asian, and minority ethnic (BAME) care workers in particular. This study seeks to explore mental health experiences and coping strategies of BAME care workers who worked in nursing and residential care homes during the COVID-19 pandemic.

METHOD

This is a qualitative study conducted between February and May, 2021 in Luton, England. A sample of n = 15 care workers from BAME background working in nursing and residential care homes were recruited purposively using the snowball sampling technique. In-depth interviews were conducted around topics such as views on COVID-19, the impact of the COVID-19 pandemic on mental health and coping during the COVID-19 pandemic. Data from the interviews was analysed using the Framework Analysis Approach.

RESULTS

The COVID-19 pandemic had a negative impact on the participants' mental health as they experienced stress, depression, anxiety, trauma and paranoia. The majority of the participants explained that they managed their mental health by belief in God and religious practices, by keeping themselves busy doing activities they were passionate about, following government guidelines on the prevention of COVID-19, seeing the service users happy and some participants managed through support that was offered by the government. However, some participants did not have any support for their mental health.

CONCLUSION

Issues such as increased workload associated with COVID-19 restrictions engendered mental health problems among BAME care workers, however, the workload only further increased during the pandemic, but the health and social care sector was already affected by heavy workload due to staff shortages and this needs to be addressed through increasing their wages to encourage more people to work in the health and social care sector. In addition, some BAME care workers never received any support for their mental health during the pandemic. Hence, integrating mental health services such as counselling, supportive psychotherapy and recreational therapies in care homes could help to support the mental health of care workers in the COVID-19 era.

Assessment of the risk of burnout and its associated factors in healthcare professionals during the COVID-19 pandemic: A prospective cohort study

Introduction

The COVID-19 pandemic resulted in tremendous physical and psychological pressure on healthcare professionals, especially on those working in intensive care units (ICUs) and Emergency Departments (EDs). The present study intended to characterize the profile of these professionals which is associated with burnout and determine the potential predictors of such condition.

Methods

A Prospective cohort study was carried out in a tertiary hospital between March 2020 and March 2021, in Salvador, Brazil. A standardized and validated version of the Oldenburg Burnout inventory (OLBI) was applied to assess risk of burnout together with data forms designed to collect information on sociodemographic characteristics and religious beliefs. ICU and ED healthcare professionals were evaluated during off-hours at two distinct periods of the COVID-19 pandemic, in 2020 and in 2021. Differences in the results obtained from each study participant between the timepoints were compared. A binary logistic regression analysis was performed to identify the predictors of burnout development independent of other confounding factors.

Results

Seventy-seven healthcare professionals with a median age of 33 (interquartile range [IQR]: 31-37.5) years and predominantly female (72.7%; n = 56) were enrolled. There were 62 professionals at risk of developing burnout through the OLBI. Those had a median age of 33 (IQR: 31-37) and female predominance (71%, n = 44). Disengagement and burnout were the only features which frequencies significantly changed over time, with increasing detection at the latest timepoint. Alcohol consumption was found to be an important risk factor for burnout development [adjusted odds ratio (aOR): 10.8 (95% CI: 1.8-64.2)]. Importantly, working in the ICU [aOR: 0.04 (95%CI: 0.01-0.32)] and the habit of praying daily [aOR: 0.07 (95%CI: 0.01-0.41)] were characteristics linked to reduced odds of burnout.

Discussion

Disengagement substantially increased during the COVID-19 pandemic in healthcare professionals. Alcohol consumption favors the onset of burnout whereas habit of praying daily and working in the ICU are protective against such outcome. Institutional policies aimed at minimizing etilism may positively impact mental health of these professionals.

Lessons Learned From Contact Tracing During the COVID-19 Pandemic: Public Health Students' Experiences in the Field

Contact tracing is a cornerstone in public health practice, providing an effective response to infectious disease outbreaks. Beginning in April 2020, as the COVID-19 pandemic spread quickly in the United States, public health departments increasingly relied on contact tracers to control disease spread and reduce the impact on the community. The Florida Department of Health (DOH) employed hundreds of public health students to pursue transmission control statewide as contact tracers. This study employed a qualitative thematic approach to capture 11 graduate-level public health students' experiences, motivations, challenges, and recommendations on contact tracing procedures as DOH contract tracers. In-depth interview questions focused on students' interest in public health, experiences as a contact tracer, patient/case interactions, and personal outlook on the COVID-19 pandemic. The COVID-19 pandemic brought new experiences and challenges for public health students employed by local health departments as contact tracers. Three categories and subthemes emerged from interviews: (1) motivations to work as a contact tracer, (2) challenges faced throughout employment, and (3) overall assessment of the contact tracing process. Identifying and understanding the work of contact tracers from the system-level perspective is vital as they contribute to improving training and working relationships with management and ultimately extend to the community. Lessons learned during the early months of the COVID-19 pandemic should help inform public health practice, especially when considering recruitment, curricula, training, and retention of the public health workforce in the face of current and emerging public health emergencies.

Access to non-prescription medicines via vending machines: key considerations to help transfer the self-care concept to the next generation while managing safety risks

Objectives

Non-prescription vending machines are automated self-service systems that are increasingly used to dispense these medicines. Whilst regulatory health academics have devoted considerable attention to non-pharmacy medication outlets in Gulf Cooperation Council countries and others, the public health literature on these vending machines remains lacking. Whilst non-prescription vending machines undoubtedly provide a number of benefits, they are not without their risks, which include polypharmacy and medication interactions.

Methods

The purpose of this article is to provide a framework for further investigation of the function, advantages, and practical constraints of non-prescription vending machines.

Key findings

Overall, more research is required to determine the optimal balance between achieving the benefits of non-prescription vending machines whilst avoiding unnecessary constraints on regulatory bodies and vending machine providers but minimizing patient harm.

Conclusions

Further studies are also required to assess the consequences of these policy experiments. Specifically, there is a need to better understand the extent to which vending machines can provide beneficial and reasonable access to non-prescription medicines to enhance the quality of life of the population especially during pandemics.

Assessing COVID-19-related health literacy and associated factors among school teachers in Hong Kong, China

Objectives

The coronavirus disease 2019 (COVID-19) pandemic developed rapidly, with changing guidelines, misinformation, inaccurate health information and rumors. This situation has highlighted the importance of health literacy, especially among educators. The aims of this study were (i) to assess COVID-19-specific health literacy among school teachers in Hong Kong and (ii) to examine its association with demographic factors, self-endangering work behaviors (i.e., work intensification, work extensification and work quality reduction), secondary burnout symptoms (i.e., exhaustion related to work and psychosomatic complaints), the level of knowledge of COVID-19- or pandemic-related information and the level of confusion about COVID-19-related information.

Methods

A self-report survey was administered to 366 Hong Kong school teachers from April 2021 to February 2022. COVID-19-specific health literacy was measured using the HLS-COVID-Q22 instrument. Other instruments, including self-endangering work behavior scales (i.e., extensification of work, intensification of work and work quality reduction) and two dimensions of the Burnout Assessment Tool (i.e., psychosomatic complaints and exhaustion) were also used for assessment. Data were analyzed using an independent samples Student's t-test, analysis of variance, correlation analysis and adjusted multilinear regression models.

Results

The results showed that 50.8% of school teachers had sufficient health literacy, 38.3% had problematic health literacy and 10.9% had inadequate health literacy. The HLS-COVID score did not vary by sex, but varied according to the type of school, the number of working hours per week and the number of students attending the school. Teachers with sufficient health literacy scored significantly lower for two types of self-endangering work behavior-intensification of work (p = 0.003) and work quality reduction (p = 0.007)-than those with insufficient health literacy. After excluding those who had already been vaccinated, respondents with sufficient health literacy felt more positive about COVID-19 vaccination than those with insufficient health literacy (t[180] = 4.168, p < 0.001). In addition, teachers with sufficient health literacy felt more informed (p < 0.001) and less confused (p < 0.001) about COVID-19-related information than those with insufficient health literacy. Multiple linear regression analysis revealed that age (β = 0.14, p = 0.011) and the number of teaching hours per week (β = -0.206, p < 0.001) were significant predictors of the HLS-COVID score.

Conclusions

The findings of this study may serve as a guide for addressing health literacy gaps among school teachers.

Burnout syndrome among frontline doctors of secondary and tertiary care hospitals of Bangladesh during COVID-19 pandemic

INTRODUCTION

During the COVID-19 pandemic, healthcare workers had a high workload and were exposed to multiple psychosocial stressors. However, a knowledge gap exists about the levels of burnout among Bangladeshi frontline doctors during this COVID-19 pandemic. The study investigated burnout syndrome (BOS) among frontline doctors in two public secondary and tertiary care hospitals in Chattogram, Bangladesh.

MATERIALS & METHODS

This cross-sectional study involved frontline doctors working at two hospitals treating COVID-19 and non-COVID patients from June to August 2020. A self-administered questionnaire that included Maslach Burnout Inventory for Human Services Survey (MBI-HSS) was used to capture demographic and workplace environment information. ANOVA and t-test were used to determine the statistical differences in the mean values of the three dimensions of MBI-HSS. Scores for three domains of burnout: emotional exhaustion (EE), depersonalization (DP), and personal accomplishment (PA) were calculated. Post-hoc analysis was done to identify the significant pair-wise differences when the ANOVA test result was significant. Multiple logistic regression was performed to determine the influence of factors associated with BOS.

RESULTS

A total of 185 frontline doctors were invited to participate by convenience sampling, and 168 responded. The response rate was 90.81%. The overall prevalence of BOS was 55.4% (93/168) (95% CI: 47.5% to 63.0%). Moderate to high levels of EE was found in 95.8% of the participants. High DP and reduced PA were observed in 98.2% and 97% of participants. Younger age (25-29 years), being female, and working as a medical officer were independently associated with high levels of burnout in all three domains. EE was significantly higher in females (P = 0.011). DP was significantly higher in medical officers, those at earlier job periods, and those working more than 8 hours per day.

CONCLUSION

During the COVID-19 outbreak, BOS was common among Bangladeshi frontline doctors. Females, medical officers, and younger doctors tended to be more susceptible to BOS. Less BOS was experienced when working in the non-COVID ward than in the mixed ward.

Experiences of intensive care unit nurses working with COVID-19 patients: A systematic review and meta-synthesis of qualitative studies

Objectives

Intensive Care Unit (ICU) nurses are at the forefront of fighting and treating the Coronavirus 2019 (COVID-19) pandemic and are often directly exposed to this virus and at risk of disease, due to their direct care for infected patients. This study aims to synthesize the experiences of ICU nurses working with COVID-19 patients.

Methods

A systematic review and meta-synthesis of qualitative studies were undertaken. A systematic literature search in four databases, including Web of Sciences, Scopus, Embase, and PubMed (including Medline), was performed. Original qualitative studies and the qualitative section of mixed method studies, written in English, which focused on the experiences of only ICU nurses working with COVID-19 patients, were included.

Results

Seventeen qualitative studies and two mixed-method studies were included in the review. As a result of the inductive content analysis, six main categories were identified, as follows: "distance from holistic nursing," "psychosocial experiences," "efforts for self-protection and wellbeing," "organizational inefficiency," "job burnout," and "emerging new experiences in the workplace."

Conclusions

The findings from this study suggest that healthcare authorities and policymakers can facilitate the provision of high-quality patient care during the COVID-19 pandemic through appropriate planning to provide adequate support and training, prevent shortages of nursing staff and equipment, and provide adequate attention to the psychological needs and job satisfaction of ICU nurses.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=256070, identifier: CRD42021256070.

Salivary mental stress biomarkers in COVID-19 patients

BACKGROUND

During the COVID-19 pandemic, mental health disorders and level of stress show a major increase compared to before the pandemic. Coronavirus-related stress is recently the leading cause of negative impacts on global mental health. Thus, maintaining positive mental health is as important as maintaining physical health during COVID-19. The aim of this study was to analyze salivary mental stress biomarkers as cortisol, alpha-amylase, and chromogranin A in hospitalized patients with COVID-19 to compare their potential relationship with stress symptoms.

MATERIAL AND METHODS

A total of 80 adult hospitalized patients with moderate COVID-19 disease and a control group (n = 80) randomly selected were conducted as participants. Saliva cortisol (sCort), saliva alpha-amylase (sAA), and saliva and chromogranin A (sCgA) were determined by the ELISA method (Bio Vendor, USA). Symptoms of stress were measured with a stress symptom checklist (SSCL).

RESULTS

The patients group presented significantly higher levels of sCort, sAA, and sCgA compared with the control group. The correlation analysis showed a positive correlation with strong strength between sCort and sAA (r = 0.934, p < 0.01), as well as sAA with sCgA (r = 0.714, p < 0.01). A moderate positive correlation was found between sCort with sCgA (r = 0.618, p < 0.05). Based on their stress scores from the SSCL the patients were associated with high stress level (30.00%) and very high stress levels (67.5%). In terms of the controls, all the participants showed a low to moderate stress level. We found significant positive correlation between levels of stress and salivary biomarkers.

CONCLUSION

Data from our study demonstrated that salivary biomarkers are promising tools of exploring COVID-19 related stress.

Positive Affect Moderates the Influence of Perceived Stress on the Mental Health of Healthcare Workers during the COVID-19 Pandemic

The coronavirus disease 2019 (COVID-19) pandemic has posed a profound psychological impact on healthcare workers. However, the role of positive affect in moderating the effect of perceived stress on the psychological states of healthcare workers remains unknown. This study aimed to analyze the moderating effect of positive affect on the association between stress and the mental health of healthcare workers during the COVID-19 pandemic. This cross-sectional study evaluated the relationships between perceived stress (the Perceived Stress Scale), positive affect (the Positive and Negative Affect Schedule), depression (the Patient Health Questionnaire-9), and anxiety (the Generalized Anxiety Disorder 7-item Scale) during the COVID-19 pandemic in 644 Chinese healthcare workers who completed online self-reports. The results revealed a significant negative association between positive affect and psychological problems, including stress, depression, and anxiety. At the total group level, multiple regression analysis showed that positive affect alleviated the influence of perceived stress on depression, but no significant moderating effect was found for anxiety. In the subgroups divided by perceived stress, the moderating effect of positive affect on depression was only significant in healthcare workers with a high level of perceived stress. These results suggested that positive affect played a moderative role in alleviating the effect of stress on depression among healthcare workers, particularly those with a high level of stress, thus emphasizing the importance of positive affect as an intervention strategy for promoting the mental health of healthcare workers in the context of the ongoing COVID-19 pandemic.

Prevalence of burnout among health care workers in the Federation of Bosnia and Herzegovina during the coronavirus disease-2019 pandemic: a cross-sectional study

AIM

To investigate the prevalence of burnout syndrome among health care workers in the Federation of Bosnia and Herzegovina (FBiH) during the coronavirus disease 2019 (COVID-19) pandemic.

METHODS

This cross-sectional study was conducted in May and June 2021 using an online survey based on Copenhagen Burnout Inventory. The questionnaire underwent forward and backward translation, preliminary pilot testing, and was assessed for reliability and validity. Personal burnout, work-related burnout, and patient-related burnout were assessed. The survey was sent to the members of the Union of Physicians and Dentists in FBIH, who were asked to forward the link to their medical technicians and nurses.

RESULTS

A total of 77% of participants experienced some form of burnout. As many as 32% experienced all three forms of burnout. Those actively involved in tackling the COVID-19 pandemic more often experienced burnout. In personal and work-related burnout domains, higher level of burnout was reported among female respondents. Higher work-related and patient-related burnout was reported by physicians compared with medical technicians/nurses. Higher level of patient-related burnout was reported in health care workers aged 30-39 and 50-59 years, among respondents working in primary care, and among physicians.

CONCLUSION

The majority of health care workers showed moderate or high levels of personal and work-related burnout, with a lower level of patient-related burnout. There is a need for further research into the causes of burnout, as well as for the implementation of organizational interventions aimed to minimize workplace burnout.

The Impact of COVID-19 on Physician-Scientist Trainees and Faculty in the United States: A National Survey

PURPOSE

Physician-scientists have long been considered an endangered species, and their extended training pathway is vulnerable to disruptions. This study investigated the effects of COVID-19-related challenges on the personal lives, career activities, stress levels, and research productivity of physician-scientist trainees and faculty.

METHOD

The authors surveyed medical students (MS), graduate students (GS), residents/fellows (R/F), and faculty (F) using a tool distributed to 120 U.S. institutions with MD-PhD programs in April-June 2020. Chi-square and Fisher's exact tests were used to compare differences between groups. Machine learning was employed to select variables for multivariate logistic regression analyses aimed at identifying factors associated with stress and impaired productivity.

RESULTS

The analyses included 1,929 respondents (MS: n = 679, 35%; GS: n = 676, 35%; R/F: n = 274, 14%; F: n = 300, 16%). All cohorts reported high levels of social isolation, stress from effects of the pandemic, and negative impacts on productivity. R/F and F respondents were more likely than MS and GS respondents to report financial difficulties due to COVID-19. R/F and F respondents with a dual degree expressed more impaired productivity compared with those without a dual degree. Multivariate regression analyses identified impacted research/scholarly activities, financial difficulties, and social isolation as predictors of stress and impaired productivity for both MS and GS cohorts. For both R/F and F cohorts, impacted personal life and research productivity were associated with stress, while dual-degree status, impacted research/scholarly activities, and impacted personal life were predictors of impaired productivity. More female than male respondents reported increased demands at home.

CONCLUSIONS

This national survey of physician-scientist trainees and faculty found a high incidence of stress and impaired productivity related to the COVID-19 pandemic. Understanding the challenges faced and their consequences may improve efforts to support the physician-scientist workforce in the postpandemic period.

Burnout status of healthcare workers in the world during the peak period of the COVID-19 pandemic

During the COVID-19 pandemic, healthcare workers have a high workload and have been exposed to various psychosocial stressors. This study aimed to evaluate health workers during the COVID-19 pandemic in the world. The method used in this research is qualitative with a literature review approach. The data sources in this study were taken from the Scopus database using the keywords "health workers," "burnout," AND "coronavirus" from the time range of 2020 to April 25, 2022. From the determination of the time range, 150 documents emerged. This study revealed that the Pearson correlation between total burnout scale scores on healthcare workers, professionals, exhaustion, mental, stress, personal, depression, symptoms, emergency, system, job, and impact indicated that overall burnout scores were associated with depression and anxiety. Stress symptoms had correlation values ranging from 0.84 to 0.73. Job burnout had a significant relationship with exhaustion at 0.89; depression r = 0.73), impacting a score of 0.66. At the same time, the fulfillment of professional and interpersonal disengagement showed a Pearson correlation between the total burnout scale scores on health workers, professionals, exhaustion, mental, stress, personal, depression, symptoms, emergency, system, job, and impact. Overall, the participants in health care workers worldwide experienced high levels of psychological distress. We also found that health workers dealing with COVID-19 pandemic patients were more likely to experience depression, stress, and burnout than health staff who were not personally involved in medical work. Furthermore, this study will be a follow-up study using the Work Ability Index (WAI) to measure work ability and work satisfaction.

Impact of less social connectedness and fear of COVID-19 test on employees task performance: A multi-mediation model

The core objective of this study is to examine the impact of less social connectedness and testing fear on employee health. This study also investigates the mediating role of psychological strain between the relationship of less social connectedness, testing fear and employee health. Furthermore, this study also assesses the impact of employee health on employee performance. The study's target audience consisted of employees in the electronics industry in China. The convenience sample method was used in this study to collect data from respondents. Data analysis of this study was performed by using the structural equation modeling technique. The statistical software used for data analysis is Smart PLS 3. The results of this study show that less COVID-19 testing fear has a negatively significant impact on employee health, but less social connectedness has not significant direct impact on employee health. Furthermore, psychological strain was discovered to mediate the relationship between less social connectedness and employee health and testing fear and employee health. In addition, this impact of employee health on employee performance was found significant. This study provides theoretical and practical implications. In the context of practical implications, this study provides valuable insights for the organizational management to develop a healthy and positive working environment and adopt healthy behavior among their employees which ultimately foster their job performance.

Occupational Stress and Quality of Life among Health Professionals during the COVID-19 Pandemic

Introduction

Healthcare professionals, due to the nature of their work, have always experienced occupational stress, depression and low quality of life, which have been aggravated during the COVID-19 pandemic.

Aim

A large-scale cross-sectional descriptive correlational study aimed to investigate the impact of the COVID-19 pandemic on Greek healthcare professionals’ psychological status and quality of life.

Material and Methods

The study was conducted at “Attikon” General University Hospital and the 2nd Health Region in Athens, Greece. An assessment of anxiety and depression was carried out using the Zung’s Self-Rating Anxiety and Depression Scale (SAS/SDS). To assess the participants’ Quality of Life (QoL) the Short Form Survey-36 (SF-36) was used.

Results

147 healthcare professionals were enrolled in the study. 70.7% experienced normal stress levels, 23.8% mild, 4.8% moderate and 0.7% severe. Mild depression was experienced by 34.7%, moderate by 10.2% and severe by 1.4%, with a 53.7% showing no depressive symptoms. Women experienced higher levels of anxiety and depression (p=0.001 & 0.001 respectively), and were 5.4 times more at risk to develop anxiety [Odds Ratio (OR) 5.357, 95% Confidence Interval (CI), 1.95-14.72: p=0.001] and 3.4 depression (OR, 3.365, 95% CI, 1.59- 7.12: p=0.002). Nurses and other professionals experienced higher stress and depression levels (p=0.004 & 0.040 respectively) than doctors. Participants reporting more exhaustion exhibited higher anxiety and depression levels (p=0.001). Compared to the pre-COVID-19 era, women (p=0.001), other health professionals (p=0.001) and those experiencing more physical burnout during COVID-19 (p=0.005) reported worse physical health. Anxiety and depression were negatively correlated with most sub scales of SF-36 except social functioning and bodily pain (p=0.001).

Conclusions

Healthcare professionals’ QoL has been affected by the COVID-19 pandemic and they experience higher levels of anxiety and depression. There is a need to develop strategies to address the negative psychological impact of this pandemic on healthcare professionals.

Mediating effect of sleep disturbance and rumination on work-related burnout of nurses treating patients with coronavirus disease

Background

COVID-19 has created significant and unprecedented psychological distress on nurses working with COVID-19 patients. Nurses dealing with such psychological distress are prone to burnout. This study examined the mediating role of sleep disturbance and rumination in the association between psychological distress and work-related burnout of nurses treating COVID-19 patients.

Methods

A cross-sectional study was conducted from 26th February to 16th March 2021, on a sample of 250 nurses who were actively working during the COVID-19 pandemic in five referral hospitals in Tehran, Iran. The Oldenburg Burnout Inventory, Kessler Psychological Distress Scale (K10), Pittsburgh Sleep Quality Index, and Ruminative Responses Scale were used to collect data. Data analysis was based on pearson’ correlation analysis and path analysis.

Results

Psychological distress has a significant effect on job burnout. When sleep disturbances were modeled as a mediator, path coefficients of psychological distress showed a significant effect on job burnout. Also, according to the findings, rumination poses a significant mediating effect on the association between psychological distress and job burnout.

Conclusion

This study demonstrated the importance of designing psychological interventions intended to reduce sleep disturbances and rumination when experiencing stressful events to avoid job burnout among nurses.

COVID-19 Burnout Subject to the Dynamic Zero-COVID Policy in Hong Kong: Development and Psychometric Evaluation of the COVID-19 Burnout Frequency Scale

We sought to develop and validate a self-assessment burnout scale of the Chinese general population during the COVID-19 pandemic in the context of a dynamic zero-COVID policy. Factors relevant to individuals’ burnout during the prolonged COVID-19 pandemic were identified in the literature and through the reviews of an expert panel. A convenience sample of 1087 was randomly divided into two subsamples and the scale’s psychometric properties were assessed. Findings suggested that the COVID-19 BFS has adequate reliability (α = 0.90) along with factorial, concurrent, and convergent validity. Results of confirmatory factor analysis (CFA) supported the one-factor structure of the scale. Concurrent validity results indicate a significant positive correlation between COVID-19 BFS and the Fear of COVID-19 Scale (r = 0.131, p < 0.001), suggesting that individuals with higher levels of burnout may also have higher levels of fear of COVID, or vice versa. The scale was also correlated positively with being against the dynamic zero-COVID strategy (r = 0.340, p < 0.001), indicating that a higher level of burnout may be associated with individuals who are against the dynamic zero-COVID strategy. The results suggest the five-item COVID-19 BFS is a valid and reliable scale for the measurement of burnout frequency of the Chinese general population in relation to the prolonged COVID-19 pandemic in a dynamic zero-COVID policy context.

Behavior, Social and Economic Impact of COVID-19 Responses among Healthcare Professionals: Development and Validation of COVID-19 Responses Impact Questionnaire (COVRiQ)

As the world goes through the fourth wave and the continued emergence of new COVID-19 variants, the general and work-related risks of the healthcare professionals are expected to rise. This has the capacity to adversely affect productivity and efficiency in healthcare delivery system, particularly in this era of global shortage of trained healthcare professionals. We aimed to develop and validate a new instrument known as the COVID-19 responses impact questionnaire (COVRiQ) to evaluate the impact of the pandemic on the healthcare professionals managing COVID-19 pandemic. This methodological study involved 3 steps; the formulation of COVRiQ draft, content and face validation and construct validity. A total of 61questions were drafted with 3-point Likert scale answers. From the list, 39 were rated valid by panel of experts and subsequently tested on 301 participants. The results were analysed and validated using exploratory factor analysis on SPSS. Components were extracted and questions with low factor loading were removed. The internal consistency was measured with Cronbach's alpha. Following analysis, 3 components were extracted and named as behavioural, social and economic impacts. In general, 29 items were deleted leaving 32 out of 61questions were retained as the final validated COVRiQ. Internal consistency showed high reliability with Cronbach's alpha of 0.91. Participants scored a total cumulative mean of 118.74 marks. A sub analysis by occupation showed that medical assistants scored the lowest in the group with a score of 22.3% whilst medical specialists scored the highest at 77.7%. Higher score indicates higher impact of COVID-19 responses among healthcare professionals. The new COVRiQ consisting of 32 demonstrated to be users-friendly with good psychometric properties, and valid for assessing the impacts of COVID-19 responses among healthcare professionals. This article is protected by copyright. All rights reserved.

Occupational burnout in Iranian health care workers during the COVID-19 pandemic

BACKGROUND AND AIM

Health care workers (HCWs), mostly frontliners, are encountering numerous physical and psychosocial stressors, and even managing some conflicts over the course of the novel coronavirus disease 2019 (COVID-19). In this respect, the present study was to investigate the prevalence rate of occupational burnout (OB) in such workers during this pandemic.

MATERIALS AND METHODS

This cross-sectional study was conducted between April 6 and May 30, 2020, via an online survey in 31 provinces of Iran, on HCWs selected based on convenience sampling method. For data collection, a socio-demographic information form and the Maslach Burnout Inventory (MBI) was utilized. Descriptive statistics, Chi-square test, and multivariate regression analysis were also applied to test the research hypotheses.

RESULTS

In total, 7626 HCWs participated in the present study. Accordingly, 73.2 and 26.8% of the workers were female and male, respectively. As well, 57.8% of the respondents were nurses and 14.4% of the cases were clinicians. Moreover, 44.8% of the participants had thus far worked in isolation wards and 40.3% of these individuals reported working for 4-8 hours with COVID-19 patients. The prevalence rate of OB was 18.3%. Besides, 34.2, 48.7, and 56.1% of the respondents had severe levels of emotional exhaustion (EE), higher depersonalization (DP), and decreased sense of personal accomplishment (PA), respectively. Besides, the HCWs at the age range of 20 to 30, having female gender, no children, and a bachelor's degree, and working in isolation wards showed the higher levels of OB with reference to the Chi-square test results (p < 0.001). Accordingly, the statistical test outcomes demonstrated that a history of physical illnesses (p = 0.001) and psychiatric disorders (p = 0.044) could be the best predictor of OB throughout the first peak of the COVID-19 pandemic.

CONCLUSION

Regarding the high prevalence rate of OB among the HCWs and the remaining COVID-19 journey in Iran, health care managers are recommended to orient the required management and coping strategies toward improving mental health in these individuals.

Investigating Frontline Nurse Stress: Perceptions of Job Demands, Organizational Support, and Social Support During the Current COVID-19 Pandemic

Background

While frontline nurses employ coping alternatives to help deal with occupational stress resulting from unprecedented challenges during the COVID-19 pandemic, their access to necessary resources is unclear.

Objective

This study aims to explore nurses' mental health in Alabama hospitals during the COVID-19 outbreak and investigate the impact of organizational and community support on nurse stressor levels, physio-psychosocial responses, and coping strategies employed.

Methods

A cross-sectional survey was developed to bridge our understanding of stress, support, and coping mechanisms and distributed to nurses working with COVID-19-infected patients in hospital settings in Alabama. A total of 232 frontline nurses responded to 79 items in four domains (stressors, physio-psychosocial symptoms, coping, and support) between May 6, 2020, and June 30, 2020. A two-way ANOVA, regression analysis, and mediation of effects were used to analyze the data.

Results

This study found that both social support and use of coping strategies contributed to the reduction of physio-psychosocial symptoms. Differences were found in how older frontline nurses perceived the efficacy of social support and certain coping strategies. This study provides further evidence of the importance of organizational support in addressing the harmful physio-psychosocial symptoms experienced by nurses.

South Korean validation of the COVID-related-PTSD scale in a non-clinical sample exposed to the COVID-19 pandemic

The threat of COVID-19 outbreak in South Korea and around the globe challenged not only physical health but also mental health, increasing the chances of disorders such as posttraumatic stress disorder (PTSD). Such pandemic situation can be referred to a traumatic event for citizens. The present study aims to examine the psychometric properties of the PTSD Checklist (PCL-5), which is named the K-COVID-related-PTSD. The scale measures PTSD symptomology in the context of the COVID-19 pandemic in South Korea. A total of 1434 South Korean citizens were included in this study. The data were statistically analyzed using SPSS 21.0 and Mplus 8.0. The results of confirmatory factor analysis demonstrated a superior fit for the seven-factor hybrid model (x² = 1425.445 (df = 149), CFI = 0.950, TLI = 0.937, SRMR = 0.033, RMSEA = 0.077) consisting of re-experiencing, negative affect, anxious arousal, dysphoric arousal, avoidance, anhedonia, and externalizing behaviors. Furthermore, the K-COVID-related-PTSD showed a satisfactory level of internal consistency (α = 0.793 to α = 0.939) with good convergent and discriminant validity. Finally, concurrent validity was confirmed by the significant correlations with all the negative mental health outcomes, such as PTSD symptoms, somatization, depression, anxiety, anger, negative affect, job burnout, and suicidal ideation. Overall, the current results demonstrate the K-COVID-related-PTSD is a valid scale and therefore has important implications for future pandemic-related studies.

General Labor Well-Being in Latin American Dentists during the COVID-19 Pandemic

This study aimed to determine the general labor well-being of Latin American dentists according to sociodemographic characteristics during the COVID-19 pandemic. A cross-sectional study was conducted in a final sample of 2214 participants from 11 countries. A validated online questionnaire on general work well-being was used (data collection period from 1 June to 10 July 2021), containing two dimensions: psychosocial well-being and collateral effects. The sociodemographic characteristics of the dentists and their perception of the economic impact of the pandemic were also recorded. A multivariate linear regression analysis was performed (hierarchical regression model) to evaluate the joint effect of the explanatory variables on labor well-being and the changes in the variance between each model. A score of psychosocial well-being of 233.6 + 40.2 and collateral effects of 45 + 20.1 was found. Psychosocial well-being was associated with sex, country of origin, academic training achieved, type of dental activity, and perceived impact during the pandemic (p < 0.05). Somatization was frequently manifested through back pain (88.2%) and muscular tensions (87.2%). Women, those who worked 41 or more hours and had between 1 to 15 years of professional experience presented a greater collateral effect (p < 0.001). The impact of the COVID-19 pandemic a year and a half after it began on the labor well-being of Latin American dentists was evidenced with important interactions with social characteristics.

Depression, Anxiety and Stress in Health Professionals in the COVID-19 Context

To assess the prevalence of depression, anxiety and stress symptoms in health professionals in the COVID-19 pandemic context.

METHOD

Cross-sectional study with non-probabilistic (snow-ball) sampling method. The assessment was performed using the Depression, Anxiety, and Stress Scale (DASS-21) and the prevalence of symptoms severity was calculated by point and 95% confidence interval. The analysis of the psychometric properties of DASS-21 was performed using confirmatory factor analysis (CFA) and the following goodness of fit indices: χ2/df (chi-square ratio by degrees of freedom), Tucker-Lewis index (TLI), comparative fit index (CFI) and root mean square error of approximation (RMSEA) with a 90% confidence interval.

RESULTS

The study participants were 529 health professionals (82.4% women and 66.7% nursing professionals). CFA of the DASS-21 structural model presented adequate fit for the sample (χ2/df = 3.530; CFI = 0.979; TLI = 0.976; RMSEA = 0.069). Regarding prevalence, moderate to extremely severe symptoms of depression, anxiety and stress were found in 48.6%, 55.0% and 47.9% of the participants, respectively.

CONCLUSION

The use of DASS-21 confirmed the validity and reliability of the data. The prevalence of depression, anxiety and stress symptoms in the participants indicated a high risk of mental illness in health professionals in the COVID-19 pandemic.

Ecological momentary intervention to enhance emotion regulation in healthcare workers via smartphone: a randomized controlled trial protocol

BACKGROUND

CUIDA-TE is an APP that offers transdiagnostic cognitive behavioral therapy focused on enhancing emotion regulation. As a novelty, it incorporates ecological momentary interventions (EMI), which can provide psychological support in real time, when suffering arises. The main goal of the study is to evaluate the efficacy of CUIDA-TE to improve emotion regulation in healthcare workers, a population that has been particularly emotionally impacted by the COVID-19 pandemic.

METHODS

In this three-arm, randomized controlled trial (RCT) the study sample will be composed of a minimum of 174 healthcare workers. They will be randomly assigned to a 2-month EMI group (CUIDA-TE APP, n ≥ 58), a 2-month ecological momentary assessment (EMA) only group (MONITOR EMOCIONAL APP, n ≥ 58), or a wait-list control group (no daily monitoring nor intervention, n ≥ 58). CUIDA-TE will provide EMI if EMA reveals emotional problems, poor sleep quality/quantity, burnout, stress, or low perceived self-efficacy when regulating emotions. Depression will be the primary outcome. Secondary outcomes will include emotion regulation, quality of life, and resilience. Treatment acceptance and usability will also be measured. Primary and secondary outcomes will be obtained at pre- and post-intervention measurements, and at the 3-month follow-up for all groups.

DISCUSSION

To our knowledge, this is the first RCT that evaluates the efficacy of an APP-based EMI to improve emotion regulation skills in healthcare workers. This type of intervention might ultimately help disseminate treatments and reach a larger number of individuals than traditional face-to-face individual therapies.

TRIAL REGISTRATION

ClinicalTrial.gov : NCT04958941 Registered 7 Jun 2021.

STUDY STATUS

Participant recruitment has not started.

Prevalence of psychological outcomes and its associated factors in healthcare personnel working during COVID-19 outbreak in India

BACKGROUND

Care of COVID-19 patients has been shown to affect the mental health of healthcare personnel (HCP), however, there is little data reflecting psychological health of HCP in India.

AIMS

The present study was undertaken to assess the prevalence of psychological outcomes and its association with various sociodemographic and occupational factors among the HCP in India.

METHODOLOGY

A cross-sectional, online survey, using snowball sampling method was conducted between June 1, 2020, and June 22, 2020. The HCP working in COVID-19 designated hospitals across India were invited to participate. Patient Health Questionnaire-4 and 19-item stress-related questionnaire were used to evaluate symptoms of overall anxiety, depression, COVID-19 infection specific anxiety, exhaustion, and workload.

RESULTS

In this cross-sectional study with 2334 HCP from 27 states and 7 union territories of India; 17.9% of participants had depression, 18.7% had overall anxiety, 26.5% had exhaustion, 30.3% reported heavy workload, and 25.4% had COVID-19 infection-specific anxiety, respectively. The HCP working in states with higher caseload was a common risk factor for overall anxiety (odds ratio [OR], 1.7; P < 0.001), depression (OR, 1.6; P < 0.001), COVID-19 infection-specific anxiety (OR, 2.5; P < 0.001), exhaustion (OR, 3.1; P < 0.001), and heavy workload (OR, 2.6; P < 0.001). Nurses were more at risk for depression (OR, 2.2; P < 0.001), anxiety specific to COVID-19 infection (OR, 1.3; P = 0.034), and heavy workload (OR, 2.9; P < 0.001); while doctors were more at risk for overall anxiety (OR, 2.0; P = 0.001) and exhaustion (OR, 3.1; P < 0.001).

CONCLUSIONS

Frontline workers, specifically nurses and doctors, and those working in states with high COVID-19 caseload are more at risk for adverse psychological outcomes. The relatively less prevalence compared with other countries, is perhaps a reflection of measures undertaken, including early lockdown, ensuring better all-round preparedness and social norms.

Relationship between stress and alexithymia, emotional processing and negative/positive affect in medical staff working amid the COVID-19 pandemic

The psychological burden of the COVID-19 pandemic may have a lasting effect on emotional well-being of healthcare workers. Medical personnel working at the time of the pandemic may experience elevated occupational stress due to the uncontrollability of the virus, high perceived risk of infection, poor understanding of the novel virus transmission routes and unavailability of effective antiviral agents. This study used path analysis to analyze the relationship between stress and alexithymia, emotional processing and negative/positive affect in healthcare workers. The sample included 167 nurses, 65 physicians and 53 paramedics. Sixty-two (21.75 %) respondents worked in COVID-19-designated hospitals. Respondents were administered the Toronto Alexithymia Scale-20, Cohen's Perceived Stress Scale, Emotional Processing Scale, and the Positive and Negative Affect Schedule. The model showed excellent fit indices (χ2 (2)=2.642, p=0.267; CFI=0.999, RMSEA=0.034, SRMR=0.015). Multiple group path analysis demonstrated physicians differed from nurses and paramedics at the model level (X2diff (7)=14.155, p<0.05 and X2diff (7)=18.642, p<0.01, respectively). The relationship between alexithymia and emotional processing was stronger in nurses than in physicians (difference in beta=0.27; p<0.05). Individual path χ2 tests also revealed significantly different paths across these groups. The results of the study may be used to develop evidence-based intervention programs promoting healthcare workers' mental health and well-being.

Identifying COVID-19 by using spectral analysis of cough recordings: a distinctive classification study

Sound signals from the respiratory system are largely taken as tokens of human health. Early diagnosis of respiratory tract diseases is of great importance because, if delayed, it exerts irreversible effects on human health. The Coronavirus pandemic, which is deeply shaking the world, has revealed the importance of this diagnosis even more. During the pandemic, it has become the focus of researchers to differentiate symptoms from similar diseases such as influenza. Among these symptoms, the difference in cough sound played a distinctive role in research. Clinical data collected under the supervision of doctors in a reliable environment were used as the dataset consisting of 16 subjects suspected of COVID-19 with a specific patient demographic. Using the polymerase chain reaction test, the suspected subjects were divided into two groups as negative and positive. The negative and positive labels represent the patients with non-COVID and with a COVID-19 cough, respectively. Using the 3D plot or waterfall representation of the signal frequency spectrum, the salient features of the cough data are revealed. In this way, COVID-19 can be differentiated from other coughs by applying effective feature extraction and classification techniques. Power spectral density based on short-time Fourier transform and mel-frequency cepstral coefficients (MFCC) were chosen as the efficient feature extraction method. From among the classification techniques, the support vector machine (SVM) algorithm was applied to the processed signals in order to identify and classify COVID-19 cough. In terms of results evaluation, the cough of subjects with COVID-19 was detected with 95.86% classification accuracy thanks to the radial basis function (RBF) kernel function of SVM and the MFCC method. The diagnosis of COVID-19 coughs was performed with 98.6% and 91.7% sensitivity and specificity, respectively.

Influence of Resilience on Burnout Syndrome of Faculty Professors

This research aims to describe the relationship between resilience and burnout facing COVID-19 pandemics. The sample was n = 831 lecturers and professors of a Mexican public university. This study is a quantitative, non-experimental, cross-sectional, explanatory, and ex post facto research using Structural Equations Modeling with latent variables under the partial least square's method technique. We used the CD-RISC-25 and SBI questionnaires to measure resilience and burnout, respectively. Structural Equations Modeling (SEM-PLS) allowed the visualization of the exogenous variable (resilience) in endogenous variables (dimensions of SBI burnout: E9 guilt, E7 emotional exhaustion, E8 indolence, and E6 work illusion). To this day, there are very few previous studies that jointly analyze in Mexico the characteristics of resilience and burnout in the face of the COVID-19 pandemic. Findings show that resources availability has the strongest correlation with accomplishment in teaching, followed by cynicism and emotional exhaustion. These results have important professional implications.

The relationship between coronavirus 19 fear and occupational fatigue, burnout and recovery levels in healthcare professionals in Turkey

Studies conducted after the SARS outbreak (2003) reported that healthcare professionals experienced high levels of psychological distress. These psychological problems need to be addressed during and after the epidemic. This study was planned to be carried out in healthcare professionals to determine the relationship between the fear of COVID-19 and burnout. Data were collected online from 538 healthcare professionals working in different cities and units using the Personal Information Form consisting of questions about demographic characteristics, the COVID-19 Phobia Scale and the Occupational Fatigue Exhaustion Recovery Scale. It was determined that the fear of COVID-19 high and burnout levels of the participants were above the scale. There was a significant difference between the burnout level of individuals, the level of fear of COVID-19, the individual's profession and the unit they work in. It is important to implement psychosocial interventions in order to take the necessary precautions to ensure that healthcare workers are less affected by the negative effects of fear and burnout during the epidemic process. The role of professional teams, including psychiatric nurses, is of great importance in determining and resolving the negative effects of the pandemic on healthcare professionals.

The mediating role of compassion in the relationship between COVID-19 anxiety syndrome and COVID-19 burnout

BACKGROUND

The coronavirus has caused fundamental changes in our way of life, leading to a wave of psychological distress associated with the COVID-19 epidemic, including stress, anxiety, perceived threats, and fear. Considering the psychological consequences of COVID-19, the present study was conducted with the aim of mediating the role of compassion in the relationship between COVID-19 anxiety syndrome and COVID-19 burnout.

MATERIALS AND METHODS

The design of the present study was descriptive correlation. The present study population included all students of Ahvaz Jundishapur University of Medical Sciences in the academic year 2020. Two hundred and fifty-one students were selected and completed the COVID-19 Anxiety Syndrome Questionnaire, Compassion Scale, and COVID-19 Burnout Scale. Pearson correlation coefficient test and structural equation model were performed using SPSS version 18 and LISREL 8.8.

RESULTS

The results showed that COVID-19 burnout had a positive and significant relationship with the overall score of anxiety syndrome (r = 0.42, P = 0.01), while it has a negative and significant relationship with compassion (r = -0.37, P = 0.01). Compassion also has a significant negative relationship with anxiety syndrome (r = -0.35, P = 0.01). In addition, the results of path analysis showed that compassion plays a mediating role in the relationship between COVID-19 anxiety syndrome and COVID-19 burnout.

CONCLUSION

Based on the findings of the present study, it can be said that compassion acts as a protective factor against the negative effects of anxiety syndrome. Therefore, this factor can be considered in the development of prevention and treatment programs for burnout caused by COVID-19.

Exhausted due to the pandemic: Validation of Coronavirus Stress Measure and COVID-19 Burnout Scale in a Polish sample

This study validated Polish versions of the Coronavirus Stress Measure (CSM) and the COVID-19 Burnout Scale (COVID-19-BS) to measure stress and burnout associated with COVID-19. Participants were 431 Polish young adults (72.6% female; Meanage = 26.61 ± 12.63). Confirmatory factor analysis verified a one-factor solution for both the CSM and the COVID-19-BS. Both scales had high internal consistency reliability. Coronavirus stress and COVID-19 burnout were positively related to depression, anxiety, and stress and negatively related to resilience. The coronavirus stress and COVID-19 burnout were correlated with elevated levels of depression, anxiety, and stress over and beyond resilience, age, and gender. Findings suggest that the Polish versions of the CSM and the COVID-19-BS are valid scales to measure stress and burnout related to COVID-19. Findings also demonstrated that the coronavirus stress and COVID-19 burnout experienced during the later stages of the pandemic might be a permanent risk factor for mental health problems.

The Antecedents of Psychological Empowerment and Its Impact towards General Physician Job Performance

BACKGROUND: The emergence of new infectious diseases such as SARS-CoV-2 (Coronavirus Disease 19) creates a burden to the healthcare system especially to the front liners such as medical doctors. The job performance of the general practitioners related to quality of care to SARS-CoV2 patients. AIM: ​​The purpose of this study is to analyze the antecedents of psychological empowerment towards job performance, mediated by service orientation. These antecedents could be seen in hospital perspectives and professional life.   METHODS: This is a quantitative survey study using a cross-sectional approach. 185 samples purposively obtained from the general practitioners who work at SARS-CoV-2 Reference Private Hospital in Jakarta and surrounding area. Data collection using online questionnaires and analyzed by SmartPLS 3.3.3™ . RESULTS: There are nine hypotheses that are supported in this research. The strongest predictor of psychological empowerment is the training opportunities, followed by relationships with fellow doctors and autonomy at work. Psychological empowerment has been proven to have a direct impact on job performance, while service orientation has been found as a mediation in this relationship. CONCLUSION: Psychological empowerment has been proven as an important construct to predict job performance, therefore hospital management has to pay more attention to psychological empowerment for GPs during the pandemic. Training opportunities should be prioritized by the board of directors of the hospitals, they should allocate time and the resources to facilitate the training opportunity. KEYWORDS: Psychological empowerment, service orientation, job performance, general practitioner, SARS-CoV-2 referral private hospital.

Comparative Study of Occupational Burnout and Job Stress of Frontline and Non-Frontline Healthcare Workers in Hospital Wards during COVID-19 Pandemic

Background:

Paying attention to the issue of mental health in the workplace, especially with current pandemic conditions of COVID-19 is of significant importance. Therefore, this study aimed to determine the factors affecting occupational burnout among health care center staff during the pandemic of coronavirus infection.

Methods:

The present study was a case-control study carried out in the first half of the year 2020 on medical staff working in hospitals in Tehran. The sample size was 324 individuals, including 175 employees working in general (non-COVID) wards and 149 people working in COVID-19 wards. Demographic characteristics questionnaire and two standard questionnaires of Maslach Burnout Inventory and Parker and DeCotiis Job Stress Scale were distributed.

Results:

Total score of job stress and its two dimensions (time and pressure) had a significant relationship with different levels of occupational burnout. Logistic regression analyses showed significant relations between job stress with emotional exhaustion (95% CI, 1.11–1.19, OR=1.15) and depersonalization. Participants in both wards experienced statistically significant increasing trends given the different components of occupational burnout concurrently by increasing their total stress score.

Conclusion:

Hospital staff’s levels of stress and occupational burnout regardless of where they worked (COVID-19 wards or general wards) were not significantly different and existed among the members of both groups. On the other hand, job stress and its dimensions (time pressure and anxiety) had a significant relationship with the main dimensions of occupational burnout.

A narrative review of research on healthcare staff’s burnout during the COVID-19 pandemic

Background

During the 2019 coronavirus disease (COVID-19) pandemic, burnout emerges as a critical health problem that might involve workers in many occupations, particularly healthcare personnel. Although burnout syndrome is not necessarily proved to be nosologic, it yields serious physical, mental, and social outcomes. However, it is essential to provide practical strategies and effective instruments for people so that they can adapt to such highly stressful conditions.

Objectives

The present review was conducted to explore preliminary evidence for nature, treatment, and prevention of burnout among healthcare workers during the COVID-19 pandemic.

Methods

Related English literatures published from the beginning of January 2020 to the end of September 2020 were searched in PubMed, Web of Science, Scopus, and Google scholar databases. “Burnout,” “COVID-19,” “healthcare workers,” “medical staff,” and “pandemic” constituted the search terms. A narrative technique was implemented for material synthesis and creating a compelling and cohesive story.

Results

Final results provided the burnout history and its major effects, causes, and prevalence among healthcare workers. Also, some strategies were listed to be employed by hospital medical staff and organizations to deal with the COVID-19 pandemic.

Conclusions

Recent evidence demonstrated that healthcare staff could gain significant benefits from interventions to modify burnout syndrome, especially from organization-directed interventions. So, health policymakers and practitioners should adopt such interventions and develop context-specific approaches promoting a healthy workplace and averting burnout during the COVID-19 crisis.

Work Stress Hampering Employee Performance During COVID-19: Is Safety Culture Needed?

During uncertain situations, such as the COVID-19 partial lockdown, maintaining satisfactory levels of employee performance (EP) is an important area of concern for many organizations. The current study examines the relationship of work stress due to COVID-19 (COVID-19 STR) and EP. Using social exchange theory (SET), safety culture (SC) is presented as a moderator for stress and performance relationships. A sample of 213 bank employees was collected using a convenient sampling method. Data were analyzed using stepwise linear regression and PROCESS Macro by Hayes (2013). Results revealed that COVID-19 STR has a negative impact on task and contextual performance (CP) and a positive impact on adaptive performance (AP). Similarly, the prevalence of SC significantly moderates the stress and performance relationships.

Physician Satisfaction With Telemedicine During the COVID-19 Pandemic: The Mayo Clinic Florida Experience

OBJECTIVE

To evaluate physician perceptions and attitudes toward telemedicine use at a tertiary care academic institution in northeast Florida during the coronavirus disease 2019 pandemic.

PATIENTS AND METHODS

An anonymous 38-question cross-sectional survey was developed using Qualtrics survey software (Qualtrics) and e-mailed to all staff physicians from all specialty disciplines at Mayo Clinic in Florida. The survey was open from August 17, 2020, through September 1, 2020. Collected data included general demographic characteristics and employment information, attitude and experience with telemedicine use before and during the coronavirus disease 2019 pandemic, perception of patients' experience, and the effect of telemedicine on burnout.

RESULTS

The survey was distributed to 529 eligible physicians at our institution, with 103 physicians responding (20%). The distribution of specialties was 22% primary care specialties, 41% other internal medicine subspecialties, and 18% surgical specialties. Collectively, 63% found comparable quality of care when provided virtually (vs in-person) whereas 80% perceived telemedicine as cost-effective. A total of 76% of physicians felt that telemedicine increased flexibility and control over patient care activities, with 36% reporting improved work-life balance and 30% reporting improved burnout symptoms. Overall, 42% preferred using telemedicine over in-person visits when possible.

CONCLUSION

Physicians generally had positive attitudes regarding the adoption of telemedicine and perceived that the quality of health care delivery as generally comparable to in-person care. Future studies are needed to explore attitudes regarding telemedicine after the pandemic and how this virtual technology may be further used to improve physicians' professional and personal well-being.

Impact of COVID-19 on the Applied Behavior Analysis Workforce: Comparison across Remote and Nonremote Workers

With the abrupt transition to observing physical distancing as a result of COVID-19, applied behavior analysts were faced with the sudden need to modify their service delivery model, while at the same time managing personal difficulties brought about by the pandemic. The present article provides a description of the impact of COVID-19 on the behavior analyst workforce currently providing clinical services in the United States. We conducted a survey to assess work conditions, burnout, and productivity of behavior analysts at various certification levels. These data provide a snapshot of the impact of COVID-19 on the workforce. Overall, one third of the participants reported experiencing job insecurity, and almost half of participants reported decreased productivity and increased burnout, with remote workers more severely affected. Taken together, these factors could compromise the ability of behavior analysts to adequately provide services to their clients. We provide recommendations for behavioral health agencies for supporting staff during extreme situations such as a pandemic.

Stress and Associated Factors among Frontline Healthcare Workers in the COVID-19 Epicenter of Da Nang City, Vietnam

Frontline healthcare workers (HCWs) involved in the COVID-19 response have a higher risk of experiencing psychosocial distress amidst the pandemic. Between July and September 2020, a second wave of the COVID-19 pandemic appeared in Vietnam with Da Nang city being the epicenter. During the outbreak, HCWs were quarantined within the health facilities in a bid to limit the spread of COVID-19 to their respective communities. Using the stress component of the 21-item Depression, Anxiety and Stress Scale (DASS-21), we assessed the level of stress among HCWs in Da Nang city. Between 30 August and 15 September 2020, 746 frontline HCWs were recruited to fill in an online structured questionnaire. Overall, 44.6% of participants experienced increased stress and 18.9% severe or extremely severe stress. In multivariable analysis, increased stress was associated with longer working hours (OR = 1.012; 95% CI: 1.004–1.019), working in health facilities providing COVID-19 treatment (OR = 1.58, 95% CI: 1.04–2.39), having direct contact with patients or their bio-samples (physicians, nurses and laboratory workers; OR = 1.42, 95% CI: 1.02–1.99), low confidence in the available personal protective equipment (OR = 0.846; 95% CI: 0.744–0.962) and low knowledge on COVID-19 prevention and treatment (OR = 0.853; 95% CI: 0.739–0.986). In conclusion, many frontline HCWs experienced increased stress during the COVID-19 outbreak in Da Nang city. Reducing working time, providing essential personal protective equipment and enhancing the knowledge on COVID-19 will help to reduce this stress. Moreover, extra support is needed for HCWs who are directly exposed to COVID-19 patients.

The Mental Health Impact of the Coronavirus Disease-19 Pandemic on Resident Doctors at M. Jamil Hospital Padang, Indonesia

BACKGROUND: The first case of the coronavirus disease 2019 (COVID-19) was reported in Wuhan, China at the end of December 2019 and soon spread to all corners of the world in early 2020. As the number of case increases, healthcare workers who come into contact with COVID-19 patients are to provide care under unprecedented physical and psychological pressure. Several studies have shown that such gravity lead healthcare workers to experience depression, anxiety and stress disorders. METHODS: Data collection was carried out on July 13–July 31, 2020, when participants – resident doctors at the Faculty of Medicine, Andalas University, Indonesia – could download and complete the online questionnaire uploaded on the Google form application. It reveals demographic characteristics and assessing the level of depression, anxiety and stress using the “Depression, Anxiety and Stress Scale-42.” RESULTS: Out of 494 residents in total who are in training and based in Dr. M. Djamil Hospital Padang, Indonesia, 448 residents (90.7%) agreed to participate in this research. In the course of the COVID-19 pandemic, majority of the residents – 355 people (79.2%) from 12 branches of specialization – were assigned to man the emergency unit. The analysis of the collected data shows that 57 residents suffer from mild-moderate depression (12.7%) and 19 residents (4.2%) struggle with severe-very severe depression. The other 58 residents (12.9%) experience mild-moderate anxiety while 12 residents (2.7%) labor under severe-very severe anxiety. Mild-moderate stress affects 89 residents (19.9%) and severe-very severe stress impact 20 residents (4.5%). CONCLUSION: This study finds that residents experience mild-moderate depression, anxiety and stress as well as severe-very severe due to working in a pandemic situation.

Low Anti-Mullerian Hormone Levels Are Associated with the Severity of Anxiety Experienced by Healthcare Professionals During the COVID-19 Pandemic

The objective of this study is to investigate a possible correlation between anxiety status and anti-Mullerian hormone (AMH) levels among healthcare professionals who provide medical care directly to COVID-19-positive patients during the recent pandemic. Fifty-two healthcare professionals (nurses, midwives, and residents) who provide medical care directly to COVID-19-positive patients in inpatient clinics or intensive care units were enrolled in this study. Serum AMH levels were analyzed to reflect ovarian reserve. The Beck Anxiety Inventory (BAI) and the State-Trait Anxiety Inventory (STAI-S and STAI-T, respectively) were completed by participants to assess their anxiety status. A linear regression model with participant age as the constant variable was applied to analyze the relationship between inventory scale scores and AMH levels. P-values less than 0.05 were considered statistically significant. The mean AMH value was significantly lower for the participants in the moderate/severe anxiety group compared to the minimal/mild anxiety group (p = 0.007). A linear regression analysis revealed a significant negative correlation between AMH levels and both BAI (B = -0.030, standard error = 0.010, p = 0.004) and STAI-S and STAI-T scores when age was controlled (both p = 0.003). The severity of anxiety experienced during the recent COVID-19 pandemic among healthcare professionals, who provide medical care directly to COVID-19-positive patients, is found to be related to low AMH levels.