Psychological Distress Among HIV Healthcare Providers During the COVID-19 Pandemic in China: Mediating Roles of Institutional Support and Resilience

Evolving Challenges in the Implementation of China's "Four Frees and One Care" Policy for HIV/AIDS

In response to the HIV/AIDS epidemic, China initiated the "Four Frees and One Care" policy in late 2003. This policy provided free counseling, testing, and antiretroviral treatment for people living with HIV, while also offering support to affected families. While instrumental in advancing HIV/AIDS prevention, the policy faces evolving challenges. This study aims to analyze this challenge from multiple dimensions and, based on this analysis, provide effective recommendations for the Chinese government to address it, promoting the sustainable development of the "Four Frees and One Care" policy. The research found that reduced government funding has led to the decline of grassroots organizations, creating a disconnect between administrative and treatment systems. Additionally, advancements in medical technology introduce new antiretroviral drugs, complicating their integration into the healthcare system. In the current healthcare reform, updating the list of free antiretroviral drugs proves challenging. Adapting the policy to contemporary HIV/AIDS prevention should be a priority for the Chinese government. Balancing financial constraints, organizational sustainability, and evolving medical technologies will be pivotal for the ongoing transformation of the "Four Frees and One Care" initiative.

"Shame on Me": Exploring the Role of Self-Stigma in Psychological Outcomes Among Type 2 Diabetes Patients in Hong Kong

BACKGROUND

Studies have suggested that type 2 diabetes mellitus (T2DM) are at risk of self-stigmatization (i.e., internalized sense of shame about having diabetes). Self-stigma has been found to be associated with poorer psychological outcomes among chronic disease patients; relevant studies examining such an association and its psychosocial mechanisms are scarce among Chinese T2DM patients. This study aimed to examine the association between self-stigma and psychological outcomes among T2DM patients in Hong Kong. Self-stigma was hypothesized to be associated with higher psychological distress and lower quality of life (QoL). Such associations were also hypothesized to be mediated by lower perceived social support, lower self-care self-efficacy, plus higher self-perceived burden to significant others.

METHODS

T2DM patients (N = 206) recruited from hospitals and clinics in Hong Kong were invited to complete a cross-sectional survey measuring the aforementioned variables.

RESULTS

After controlling for covariates, multiple mediation analysis results indicated the indirect effects from self-stigma to psychological distress via increased self-perceived burden (β = 0.07; 95% CI = 0.02, 0.15) and decreased self-care self-efficacy (β = 0.05; 95% CI = 0.01, 0.11) were significant. Moreover, the indirect effect from self-stigma to QoL via decreased self-care self-efficacy was also significant (β = -0.07; 95% CI = -0.14, -0.02). After considering the mediators, the direct effects from self-stigma to higher psychological distress and lower QoL remained significant (βs = 0.15 and -0.15 respectively, ps < .05).

CONCLUSIONS

Self-stigma could be linked to poorer psychological outcomes through increased self-perceived burden and decreased self-care self-efficacy among T2DM patients. Targeting those variables when designing interventions might facilitate those patients' psychological adjustments.

Psychometric and Circumplex Properties Evaluation of the International Personality Item Pool-Interpersonal Circumplex (IPIP-IPC) in Chinese People Living with HIV (PLWH)

Background and Purpose

With the improved life expectancy of people living with HIV (PLWH) due to widespread use of antiretroviral therapy (ART), there is a greater emphasis on enhancing long-term well-being and overall quality of life for PLWH. Understanding interpersonal personalities of PLWH can gain further insight into how to improve the overall quality of life in this population. The International Personality Item Pool-Interpersonal Circumplex (IPIP-IPC) scale has been developed to assess interpersonal personalities of individuals, and this scale has been translated into Chinese. However, the Chinese version of IPIP-IPC has not been tested among PLWH in China. In this study, we aimed to test the psychometric properties and circumplex structure of this scale.

Methods

This study was based on cross-sectional, multi-center, large sample data. We employed the Chinese version of IPIP-IPC scale on 3040 PLWH from April 2022 to April 2023 in China to test its psychometric as well as circumplex properties. The structural summary method (SSM) was employed to analyze the circumplex structure of the scale.

Results

The total scale exhibited a Cronbach's alpha of 0.85 and McDonald's omega of 0.91. Out of the 288 possible relationships, 275 relationships satisfy the circular properties hypothesis. The scale demonstrates good reliability and validity, meeting the requirements of psychometrics.

Conclusion

Our findings demonstrate that the Chinese version of the IPIP-IPC scale is a reliable tool for evaluating interpersonal personalities in this population. These results highlight the validity and applicability of the IPIP-IPC scale specifically in the Chinese context, providing valuable insights into the intricacies of interpersonal traits among PLWH.

Perceptions of COVID-19 during and after the Omicron outbreak among healthcare personnel in Indonesia

Introduction

The COVID-19 pandemic occurred in several waves with different levels of seriousness. Healthcare personnel (HCP) constituted a high-risk population for COVID-19, necessitating monitoring of their knowledge, attitudes, and practices (KAP) status and level of psychological distress. This study investigated differences in the impacts of COVID-19 during and after the Omicron outbreak among HCP in Indonesia.

Methods

An online structured questionnaire survey was distributed twice in selected hospitals of Indonesia: the first survey was between December 2021 and February 2022 (Omicron era) and the second between August and October 2022 (post-Omicron era). A multiple logistic regression model was used to determine the differences in KAP and psychological distress among HCP toward COVID-19 with demographic characteristics adjusted for.

Results

This study included 402 (Omicron era) and 584 (post-Omicron era) HCP members. Positive attitudes were more common in the Omicron era than in the post-Omicron era (p = 0.001). The availability of face shields and protective eyewear significantly decreased from 62.7 to 55.6% (p = 0.028). However, psychological distress among HCP significantly increased after the Omicron outbreak (p = 0.024). Multiple logistic regression analyses revealed a decrease of positive attitudes (OR = 0.626; 95% CI = 0.476-0.823) in the post-Omicron era.

Conclusion

Our data indicated a significant increase in psychological distress among HCP in the post-Omicron era. These findings suggest a need for greater focus on psychological distress among HCP in Indonesia.

Providing Trauma-Informed Care During a Pandemic: How Health Care Workers at Ryan White-Funded Clinics in the Southeastern United States Responded to COVID-19 and Its Effects on Their Well-Being

As HIV/AIDS health care workers (HCWs) deliver services during COVID-19 under difficult conditions, practicing trauma-informed care (TIC) may mitigate negative effects on mental health and well-being. This secondary qualitative analysis of a larger mixed methods study sought to understand the pandemic's impact on HCWs at Ryan White-funded clinics (RWCs) across the southeastern US and assess changes in prioritization of TIC. RWC administrators, providers, and staff were asked about impacts on clinic operations/culture, HCW well-being, institutional support for well-being, and prioritization of TIC. HCWs described strenuous work environments and decreased well-being (eg, increased stress, burnout, fear, and social isolation) due to COVID-19. RWCs initiated novel responses to disruptions of clinic operations and culture to encourage continuity in care and promote HCW well-being. Despite increased awareness of the need for TIC, prioritization remained variable. Implementing and institutionalizing trauma-informed practices could strengthen continuity in care and safeguard HCW well-being during public health emergencies.

Exploring the impact of COVID-19 on the psychological well-being of oncology healthcare professionals

AIMS

To explore how psychological well-being is maintained by healthcare professionals (HCPs) employed in a cancer setting during the COVID-19 pandemic.

DESIGN

A qualitative design using diaries and interviews to collect data was used to gain insights into how HCPs managed their well-being during the pandemic.

METHODS

Interpretative Phenomenological Analysis (IPA) was used to analyse diaries and interviews completed by 66 HCPs during the second pandemic lockdown period (December 2020-April 2021). A total of 102 HCPs were recruited, drawn from five groups: nursing staff, radiographers, medical staff, allied health professionals (AHPs) (non-radiographers) and support staff.

RESULTS

The majority of participants adjusted to the challenges of the pandemic using positive coping strategies, although difficult days required the mobilization of additional resources. Emotion management was regulated through peer relationships, professional roles and the workplace, sustained through communities of practice involving knowledge exchange, shared goals and social interactions. Maintaining high-quality patient care was a source of job satisfaction, providing a route through which positive emotions could be channelled; however, it was juxtaposed with threats to well-being from busy workloads and variable organizational responsiveness. Work routines provided a platform for well-being, underpinned by the sharing of problems and solutions within peer networks.

CONCLUSION

This study has highlighted the dynamic nature of well-being amongst HCPs during the pandemic. Well-being interventions should build on the preferred coping strategies of HCPs, focusing on the way individuals coalesce in groups to learn from and support one another.

IMPACT

HCPs may experience different psychological responses when exposed to a pandemic situation. This study identifies the strategies used by HCPs to maintain positive psychological well-being within professional roles, whilst adjusting to emerging well-being threats. Key components of HCP's well-being are addressed, which are relevant to clinical practice and the broader healthcare workforce.

PATIENT OR PUBLIC CONTRIBUTION

Research team members included public representatives who contributed to the development, methods, data collection and analysis of the study. They supported the development of the Research Assistant by providing mock interview skills training.

Facilitators of Organizational Resilience Within South Carolina AIDS Service Organizations: Lessons Learned from the COVID-19 Pandemic

HIV care services have been interrupted by the COVID-19 pandemic in many states in the U.S. including South Carolina (SC). However, many HIV care facilities demonstrated organizational resilience (i.e., the ability to maintain needed health services amid rapidly changing circumstances) by addressing challenges to maintaining care during the pandemic. This study, therefore, aims to identify key facilitators for organizational resilience among AIDS Services Organizations (ASOs) in SC. In-depth interviews were conducted among 11 leaders, from 8 ASOs, across SC during the summer of 2020. The interviews were recorded after receiving proper consent and then transcribed. Utilizing a codebook based upon the interview guide, a thematic analysis approach was utilized to analyze the data. All data management and analysis were conducted in NVivo 11.0. Our findings demonstrate several facilitators of organizational resilience, including (1) accurate and timely crisis information dissemination; (2) clear and preemptive protocols; (3) effective healthcare system policies, management, and leadership; (4) prioritization of staff psychological wellbeing; (5) stable access to personal protective equipment (PPE); (6) adequate and flexible funding; and (7) infrastructure that supports telehealth. Given the facilitators of organizational resilience among ASOs in SC during the COVID-19 pandemic, it is recommended that organizations implement and maintain coordinated and informed responses based upon preemptive protocols and emerging needs. ASO funders are encouraged to allow a flexibility in spending. The lessons learned from the participating leaders enable ASOs to develop and strengthen their organizational resilience and experience fewer disruptions in the future.

Metacognitions About Health in Relation to Coronavirus Anxiety: The Mediating Role of Cognitive Attentional Syndrome and Distress Tolerance

The current study aimed to investigate the mediating role of cognitive attentional syndrome (CAS) and distress tolerance in the relationship between health-related metacognitions and coronavirus anxiety. The sample of this study consisted of 462 participants (381 female). Participants voluntarily completed self-report questionnaires on each of the variables mentioned above. The results of the structural modeling analysis showed that health-related metacognitions have a significant effect on the mediator variable of distress tolerance and CAS. Also, health-related metacognitions had a direct effect on coronavirus anxiety. Also, based on the results of the bootstrap test, it can be argued that health-related metacognitive beliefs, apart from their direct effect, play an important role in coronavirus anxiety, with CAS acting as a mediator. This study provides insights into the relationships among metacognitive beliefs, coronavirus anxiety, CAS, and distress tolerance. In particular, dysfunctional metacognitive beliefs, including an individual's beliefs about the uncontrollability of disease-related thoughts, are risk factors that could negatively affect mental health, leading to coronavirus anxiety. In addition, the association of dysfunctional beliefs with maladaptive behaviors resulting from the cognitive attentional syndrome is also involved in predicting and causing coronavirus anxiety. Given the insignificant role of emotional distress tolerance in the psychopathology of COVID-19 anxiety, the findings emphasize the importance of cognitive factors in this context.

Parents of children with congenital heart defects during the COVID-19 pandemic: An examination of mental health variables, risk factors, and protective factors

BACKGROUND

Little is known about the mental health burden or the factors that contribute to mental health variables in parents of children with congenital heart defects (CHD) during the COVID-19 pandemic.

OBJECTIVE

The purpose of this study was to examine risk and protective factors associated with anxiety symptoms, depression symptoms, and perceived stress in parents of young children with CHD during the COVID-19 pandemic.

METHODS

A nonexperimental design was used in this study of 127 parents of children aged newborn to five years with CHD during the COVID-19 pandemic. Regression analyses were conducted to examine associations between COVID-19 stressors, CHD care-related factors, parental resilience, external support, and mental health variables.

RESULTS

Parental resilience, emotional support, and informational support were key protective factors for anxiety, depression, and stress. However, resilience was remarkably low in CHD parents. Increased levels of anxiety symptoms, depression symptoms, and perceived stress were associated with 1) Exposure to a greater number of COVID-19-related stressors, 2) Distress from family visitation restrictions during healthcare encounters, 3) Worry related to the perceived risk of their CHD child's exposure to COVID-19 during healthcare encounters, and 4) Worry about their CHD child's risk of death or serious illness from COVID-19.

CONCLUSIONS

The additive impact of the COVID-19 pandemic plus CHD care-related worries on this parent population's mental health is significant. Interventions that promote resilience, address the effect of healthcare system changes, and support the needs of parents of young children with CHD during this and future pandemics are needed.

The Association between Resilience and Psychological Distress during the COVID-19 Pandemic: A Systematic Review and Meta-Analysis

This study examined the association between resilience and psychological distress in healthcare workers, the general population, and patients during the COVID-19 pandemic. We searched the PubMed, Web of Science, PsycInfo, Science Direct, and Nursing and Allied Health databases. Included articles examined healthcare workers (e.g., physicians and nurses), the general population, and patients during the COVID-19 pandemic. Studies of exposure to other infectious diseases related to epidemics or pandemics (e.g., SARS and MERS) were excluded. This study was performed following the Cooper matrix review method and PRISMA guidelines, followed by a meta-analysis of study results using R version 4.1.2. A random effect model was used for the pooled analysis. This study was registered with PROSPERO (registration No. CRD42021261429). Based on the meta-analysis, we found a moderate negative relationship between overall resilience and psychological distress (r = -0.42, 95% confidence interval [CI]: -0.45 to -0.38, p < 0.001). For the subgroup analysis, a moderately significant negative relationship between overall resilience and psychological distress was found among healthcare workers (r = -0.39, 95% CI: -0.44 to -0.33, p < 0.001), which was weaker than in the general population (r = -0.45, 95% CI: -0.50 to -0.39, p < 0.001) and in patients (r = -0.43; 95% CI: -0.52 to -0.33; p < 0.001). This association was robust, although the heterogeneity among individual effect sizes was substantial (I2 = 94%, 99%, and 74%, respectively). This study revealed a moderate negative relationship between resilience and psychological distress in healthcare workers, the general population, and patients. For all these populations, interventions and resources are needed to improve individuals' resilience and ability to cope with psychological distress during the COVID-19 pandemic and in future disease outbreaks.

Perceived health literacy and COVID-19 vaccine acceptance among Chinese college students: A mediation analysis

BACKGROUND

Although COVID-19 vaccines hold the potential to dramatically alter the COVID-19 pandemic, vaccine hesitancy remains a serious threat to the management and control of COVID-19 infections. Vaccination of young adults plays a crucial role in achieving herd immunity. However, the determinants of COVID-19 vaccine acceptance among the youth in China have not been fully explored. Our study aims to investigate the direct and indirect effects of perceived health literacy on COVID-19 vaccine acceptance.

METHODS

This survey was conducted among Chinese college students during September and October, 2020. COVID-19 vaccine acceptance was defined as the likelihood that participants would get a COVID-19 vaccine. A mediation analysis was employed to explore the direct and indirect effects of perceived health literacy on COVID-19 vaccine acceptance.

RESULTS

A total of 2,587 college students were included in our study. The results of the survey revealed that the majority (80.40%) of the participants expressed high COVID-19 vaccine acceptance. After controlling for demographic characteristics, the relationship between perceived health literacy and COVID-19 vaccine acceptance was mediated by positive attitudes toward general vaccination (std.β = 0.004, p = 0.037) and self-efficacy of COVID-19 vaccine (std.β = 0.053, p < 0.001).

CONCLUSIONS

The findings suggest that interventions targeting health literacy to promote COVID-19 vaccination coverage might consider placing greater emphasis on enhancing the positive attitude towards and self-efficacy of vaccines among youth.

Individual and organizational resilience-Insights from healthcare providers in Germany during the COVID-19 pandemic

We explored the effects of resilience in the healthcare setting during the COVID-19 pandemic in Germany. Our study sheds light on the cross-level effects of resilience in hospitals and thus responds to calls to research this empirically. In a cross-sectional study design, the perceptions of resilience of employees in hospitals and of transformations at the individual, team, and organizational level were analyzed. An online survey was conducted in summer 2020 in Germany in which 1,710 healthcare workers completed a self-report questionnaire. Results indicate that resilience is both a highly interrelated construct on the individual and organizational level and also positively linked to perceptions of transformation as an indicator for demonstration of resilience. We also found a partial mediation effect of organizational resilience and team efficacy, respectively, on the relationship between individual resilience and perceived transformation on the individual and organizational level as well as a full mediation on the team level. The study highlights the interdependence of individual and organizational resilience (which is mediated by team efficacy) and its impact on perceived transformation in German hospitals during the COVID-19 pandemic. Whereas team efficacy is crucial for performance in regular work operations, during a pandemic the organizational level becomes more relevant. Theoretical and practical implications are discussed.

Stress, and coping strategy of university students during COVID-19 in Korea: The mediating role of ego-resiliency

We aimed to identify the level of stress, ego-resiliency (ER), and coping strategies of university students during the onset of coronavirus disease 2019 (COVID-19) and examine the mediating role of ER in the relationship between stress and coping strategies (e.g., problem-solving, social support seeking, and avoidance). We analyzed responses from 160 university students and found that problem-solving was the most common coping strategy (26.02 ± 4.65), followed by social support-seeking (25.08 ± 5.23), and avoidance (19.21 ± 3.78). ER was negatively associated with stress and showed a mediating effect on the relationship between stress and social support, and stress and problem-solving coping strategies. These findings indicate that ER helps decrease stress caused by the pandemic among university students and should be considered a significant factor for developing adaptive stress coping strategies.

The effect of social support on work stress in health workers during the pandemic: The mediation role of resilience

Stressful experiences commonly increase among health workers during the coronavirus disease 2019 (COVID-19) pandemic. From this perspective, this study primarily aimed to examine the mediating role of resilience in the effect of perceived social support on work stress among health workers. The sample of the study consisted of 402 health workers. In the research, the "General Work Stress Scale," "Brief Resiliency Scale," and "Multidimensional Scale of Perceived Social Support" were used. There was a statistically significant negative correlation between work stress and social support (r = -0.223, p = 0.00) and resilience (r = -0.432, p = 0.00), and a statistically significant positive correlation between social support and resilience (r = 0.226, p = 0.00). Resilience mediates the relationship between perception of social support and work stress. When planning effective intervention strategies, it will be critical to reduce the risk of adverse mental health outcomes in health workers, who are fighting against the COVID-19 pandemic, by increasing social support and resilience and reducing work stress.

Workplace Factors, Burnout Signs, and Clinical Mental Health Symptoms among Mental Health Workers in Lombardy and Quebec during the First Wave of COVID-19

Several research contributions have depicted the impact of the pandemic environment on healthcare and social care personnel. Even though the high prevalence of burnout depression and anxiety in healthcare settings before COVID-19 has been well documented in the research, the recent increase in psychological distress and mental health issues in healthcare and mental health workers should be attributed to the effect of the COVID-19 pandemic. The aim of the present study is to develop, evaluate, and compare a model of COVID-19 workplace stressors between two different territories, the Italian region of Lombardy and the Canadian province of Quebec. Within this model, burnout is depicted as the strongest determinant of mental health symptoms for mental health workers. In turn, the main workplace determinants of burnout are the perception of a lack of support from the organization and the fear of contracting COVID-19 at work. Findings also provide insights for designing interventions to promote and protect mental health workers in the context of the pandemic. In conclusion, it is necessary to monitor burnout and carefully analyze elements of organizational culture, in addition to offering clinical and psychological care for those in need.

The impact of workplace safety and customer misbehavior on supermarket workers' stress and psychological distress during the COVID-19 pandemic

Purpose

Essential frontline workers in the retail sector face increased exposure risks to coronavirus disease 2019 (COVID-19) due to frequent interactions with the general public. Often these interactions are fraught with controversies over public safety protocols. The purpose of this study is to examine the impacts of frontline workers' perceptions of workplace safety and customer misbehaviors on their stress and psychological distress to inform managing workplace health and safety during public health crises.

Design/methodology/approach

The authors conducted an online survey of 3,344 supermarket workers in the state of Arizona (US) during the state's first COVID-19 pandemic wave in July 2020. Measures included mental health distress, and perceptions of workplace safety and customer behaviors. The authors utilized a mixed-methods approach combining multiple regression analyses with qualitative analyses of open-ended comments.

Findings

Workers reported high rates of stress and psychological distress. Increases in mental health morbidity were correlated with perceptions of being unsafe in the workplace and concerns about negative customer encounters. Qualitative analyses reveal frustration with management's efforts to reduce risks intertwined with feelings of being unsafe and vulnerable to threatening customer encounters.

Practical implications

The findings highlight the need to provide and enforce clear safety guidelines, including how to manage potential hostile customer interactions, to promote positive health workplace management during a pandemic.

Originality/value

This study is among the first to assess the COVID-19 pandemic's impact on the mental health of non-health care frontline essential workers and presents novel insights regarding perceived customer misbehavior and need for management support and guidance in a public health crisis.

The Impact of COVID-19-Related Work Stress on the Mental Health of Primary Healthcare Workers: The Mediating Effects of Social Support and Resilience

Objective

The psychological condition of healthcare workers since the COVID-19 pandemic has attracted the attention of many studies. However, few have reported on psychosocial problems of primary healthcare workers in the COVID-19 pandemic. This study aimed to examine the mediating roles of social support and resilience in COVID-19-related work stress and symptoms of anxiety and depression.

Methods

A total of 840 primary healthcare workers in 17 community health centers in Guangzhou, China, were recruited from May to July 2021. Data on demographic characteristics, COVID-19-related work stress, social support, resilience, anxiety and depression were collected. A structural equation model was used for mediation analysis.

Results

More than half of participants reported mild or more severe (at least borderline abnormal) symptoms of anxiety (68.1%) and depression (55.6%). Social support and resilience mediate the association between COVID-19-related work stress and symptoms of anxiety and depression, respectively. Furthermore, the association between work stress and symptoms of anxiety and depression was also mediated by an accumulation of social support and resilience. The indirect effect of COVID-19-related work stress on anxiety and depression through resilience was much greater than other indirect effects.

Conclusion

Anxiety and depression were prevalent among primary healthcare workers. This study highlights the psychological impact of the COVID-19-related psychosocial work environment on primary healthcare workers. There is an urgent need to improve working conditions for primary healthcare workers in the COVID-19 and to implement intervention strategies aimed at increasing individual resilience alongside the establishment of external supportive work environments.

The Moderating Effect of Resilience on Mental Health Deterioration among COVID-19 Survivors in a Mexican Sample

Resilience has been reported to be a protective psychological variable of mental health; however, little is known about its role in COVID-19 survivors. Thus, in this study, we aimed to evaluate the levels of depression, anxiety, stress, traumatic impact, and resilience associated with COVID-19, as well as to investigate the role of resilience as a moderating variable. A sample of 253 participants responded to an online survey; all were previously diagnosed with COVID-19 by a nasopharyngeal swab RT-PCR test, were older than 18 years, and signed an informed consent form. Significant negative correlations were found between resilience and the mental health variables. Higher resilience was significantly related to a lower impact of the event, stress, anxiety, and depression when the number of symptoms was low. Only when the duration of COVID-19 was short and resilience levels were medium or high was psychological distress reduced. Moreover, resilience moderated the effects of COVID-19 on mental health, even if a relapse occurred. The results emphasize the need for interdisciplinary interventions aimed at providing COVID-19 patients with psychological and social resources to cope with the disease, as well as with probable relapses.

Healthcare Workers' Resilience Mediates the Influence of Organizational Commitment and Anxiety Response to Viral Epidemic on Their Quality of Life in the COVID-19 Pandemic

Objective: In the COVID-19 pandemic era, healthcare workers suffer from psychological problems such as anxiety in response to the viral epidemic and it may decrease their quality of life (QoL). The aim of this study was to explore the influence of healthcare workers' stress and anxiety response to the viral epidemic and their organizational commitment on their QoL. We also explored the mediating effect of resilience on any association. Methods: From January 28, 2021, to January 29, 2021, 389 workers responded to an online survey that included the rating scales Stress and Anxiety to Viral Epidemics-9 items (SAVE-9), Perceived Stress Scale (PSS), Brief Resilience Scale (BRS), Organizational Commitment Questionnaire (OCQ), and the WHO-5 well-being index. Results: A better QoL (WHO well-being index top 25%) of healthcare workers during the COVID-19 pandemic era was predicted by low stress and anxiety in response to the viral epidemic [SAVE-9, adjusted odds ratio (aOR) = 0.92, 95% confidence interval (CI) 0.87-0.97], a high level of resilience (BRS, aOR = 1.26, 95%CI 1.15-1.37), and high organizational commitment (OCQ, aOR = 1.04, 95%CI 1.02-1.07). Mediation analysis showed that resilience partially mediated the effects of stress/anxiety in response to the viral epidemic and the organizational commitment on the quality of life. Conclusion: We observed that the stress and anxiety of healthcare workers in response to the viral epidemic and organizational commitment influenced their QOL. Their resilience mediated the relationship between their psychological problems and QOL.

Effects of COVID-19 pandemic on ART Service delivery: perspectives of healthcare workers in a Teaching Hospital in Ghana

BACKGROUND

Ghana has a generalized HIV epidemic and efforts have been made to curb the spread and reverse its effects on the general population. In the wake of COVID-19 pandemic, the health system was unsettled and antiretroviral therapy (ART) care has been impacted in diverse ways. The study sought to explore the effects of COVID-19 on ART service provision in Ghana from the perspectives of the healthcare workers.

METHODS

An exploratory-descriptive qualitative approach was employed in this study. Using maximum variation sampling method, fifteen healthcare workers; nurses, data managers and pharmacists were recruited from an ART clinic in a Teaching Hospital in Ghana. In-depth interviews were conducted and analysed using Braun and Clarke thematic approach.

RESULTS

Three themes emerged from the data; "… And the pandemic struck", "Impact of the pandemic on ART service delivery"; "Effecting the needed change". The healthcare workers' initial reactions to the pandemic and their show of commitment in ensuring continued ART service was evident. COVID-19 impacted service delivery in three main ways; (1) clients' clinic attendance was erratic at various stages of the pandemic, (2) irregular resource availability as shortage was reported due to affected last mile delivery as a result of the lockdown in Accra, and (3) the health worker-patient interaction became less engaging because of established COVID-19 protocols. The healthcare workers however instituted strategies such as adjusting the patient appointment schedule, health professionals' work schedule, establishing several work stations, task-shifting, and ensuring the implementation of all the COVID-19 protocols within the ART unit to ensure consistent service delivery as well as patient and staff safety. The study also found a decline in the implementation of several strategies established in the ART clinic during the initial phases of the pandemic such as a decline in the supply of Personal Protective Equipment (PPEs) by hospital management.

CONCLUSIONS

Although several strategies were implemented to manage the effects of the pandemic on ART care, there is a need to establish pathways of support for healthcare workers within the ART clinic and to consolidate as well as institutionalise the changes that ensured continuous but safe service delivery.

Psychological distress among healthcare providers during COVID-19 in Asia: Systematic review and meta-analysis

INTRODUCTION

COVID-19 pandemic is having a devastating effect on the mental health and wellbeing of healthcare providers (HCPs) globally. This review is aimed at determining the prevalence of depression, anxiety, stress, fear, burnout and resilience and its associated factors among HCPs in Asia during the COVID-19 pandemic.

MATERIAL AND METHODS

We performed literature search using 4 databases from Medline, Cinahl, PubMed and Scopus from inception up to March 15, 2021 and selected relevant cross-sectional studies. Publication bias was assessed using funnel plot. Random effects model was used to estimate the pooled prevalence while risk factors were reported in odds ratio (OR) with 95% CI.

RESULTS

We included 148 studies with 159,194 HCPs and the pooled prevalence for depression was 37.5% (95%CI: 33.8-41.3), anxiety 39.7(95%CI: 34.3-45.1), stress 36.4% (95%CI: 23.2-49.7), fear 71.3% (95%CI: 54.6-88.0), burnout 68.3% (95%CI: 54.0-82.5), and low resilience was 16.1% (95%CI: 12.8-19.4), respectively. The heterogeneity was high (I2>99.4%). Meta-analysis reported that both females (OR = 1.48; 95% CI = 1.30-1.68) and nurses (OR = 1.21; 95%CI = 1.02-1.45) were at increased risk of having depression and anxiety [(Female: OR = 1.66; 95% CI = 1.49-1.85), (Nurse: OR = 1.36; 95%CI = 1.16-1.58)]. Females were at increased risk of getting stress (OR = 1.59; 95%CI = 1.28-1.97).

CONCLUSION

In conclusion, one third of HCPs suffered from depression, anxiety and stress and more than two third of HCPs suffered from fear and burnout during the COVID-19 pandemic in Asia.

Parental psychological distress and attitudes towards COVID-19 vaccination: A cross-sectional survey in Shenzhen, China

BACKGROUND

Parental attitudes towards the vaccines play a key role in the success of the herd immunity for the COVID-19. Psychological health seems to be a controversial determinant of vaccine hesitancy and remains to be investigated. This study attempted to measure parental psychological distress, attitudes towards the COVID-19 vaccine, and to explore the potential associations.

METHODS

An online survey using convenience sampling method was conducted among parents within the school public health network of Shenzhen. Demographic information and attitudes towards COVID-19 vaccination were collected. The Patient Health Questionnaire (PHQ-4) was applied to measure psychological distress.

RESULTS

Overall, 4,748 parents were included (average age: 40.28, standard deviation: 5.08). More than one fifth of them demonstrated psychological distress, in which only 3.3% were moderate to severe symptom. The proportions of COVID-19 vaccine hesitancy for themselves, their spouses, and their children were 25.2%, 26.1%, and 27.3%, respectively. Parents with psychological distress were more likely to suffer vaccine hesitancy for themselves (OR: 1.277, 95%CI: 1.091~1.494), for their spouses (OR:1.276, 95%CI: 1.088~1.496) and children (OR:1.274, 95%CI: 1.092~1.486). These associations tended to be more significant among parents with mild or severe psychological distress.

LIMITATION

Non-random sampling limited the generalization of our findings to all parents.

CONCLUSION

Parents had a low level of psychological distress but relatively high willingness of COVID-19 vaccination when there was no local epidemic but persistent risk of imported cases. Targeted health education and intervention strategies should be provided to people with vaccine hesitancy, especially for those who are susceptible to psychological distress.

Internet-based stress recovery intervention FOREST for healthcare staff amid COVID-19 pandemic: study protocol for a randomized controlled trial

BACKGROUND

The demand for care during the COVID-19 pandemic has affected the mental health of healthcare workers (HCWs), thus increasing the need for psychosocial support services. Internet-based interventions have previously been found to reduce occupational stress. The study aims to test the effects of an Internet-based stress recovery intervention-FOREST-among HCWs.

METHODS

A randomized controlled trial (RCT) parallel group design with three measurement points will be conducted to assess the efficacy of an Internet-based stress recovery intervention FOREST for nurses. The FOREST intervention is a 6-week Internet-based CBT and mindfulness-based program which comprises of six modules: (1) Introduction, (2) Detachment (relaxation and sleep), (3) Distancing, (4) Mastery (challenge), (5) Control, and (6) Keeping the change alive. We will compare the intervention against a waiting list group at pre-test, post-test, and follow-up. Stress recovery, PTSD, complex PTSD, moral injury, the level of stress, depression, anxiety, and psychological well-being will be measured.

DISCUSSION

The study will contribute to the development of mental healthcare programs for the HCWs. Based on the outcomes of the study, the FOREST intervention can be further developed or offered to healthcare staff as a tool to cope with occupational stress.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04817995 . Registered on 30 March 2021.

Psychological resilience, coping behaviours and social support among health care workers during the COVID-19 pandemic: A systematic review of quantitative studies

Aim

To appraise and synthesize studies examining resilience, coping behaviours and social support among health care workers during the coronavirus pandemic.

Background

A wide range of evidence has shown that health care workers, currently on the frontlines in the fight against COVID‐19, are not spared from the psychological and mental health‐related consequences of the pandemic. Studies synthesizing the role of coping behaviours, resilience and social support in safeguarding the mental health of health care workers during the pandemic are largely unknown.

Evaluation

This is a systematic review with a narrative synthesis. A total of 31 articles were included in the review.

Key Issues

Health care workers utilized both problem‐centred and emotion‐centred coping to manage the stress associated with the coronavirus pandemic. Coping behaviours, resilience and social support were associated with positive mental and psychological health outcomes.

Conclusion

Substantial evidence supports the effectiveness of coping behaviours, resilience and social support to preserve psychological and mental health among health care workers during the COVID‐19 pandemic.

Implications for Nursing Management

In order to safeguard the mental health of health care workers during the pandemic, hospital and nursing administrators should implement proactive measures to sustain resilience in HCWs, build coping skills and implement creative ways to foster social support in health care workers through theory‐based interventions, supportive leadership and fostering a resilient work environment.

Mental Health Problems of HIV Healthcare Providers During the COVID-19 Pandemic: The Interactive Effects of Stressors and Coping

HIV healthcare providers might be vulnerable to mental health problems during the COVID-19 pandemic. Guided by the stress and coping paradigm, the current study aimed at examining the interactive effects of COVID-19-related stressors and coping on mental health problems. A cross-sectional online survey was conducted among 1029 HIV healthcare providers in Guangxi, China. The prevalence of depression and anxiety in the current study was 13.31% and 6.61%, respectively. Results from path analyses revealed that the main effects of COVID-19-related stressors and coping were significant on both depression and anxiety. The interaction of coping and COVID-19-related stressors had significant effects on depression and anxiety. Simple slope tests revealed that more coping behaviors buffered against the negative effect of COVID-19-related stressors on mental health problems. Coping acted as a protective factor that alleviated the harm of COVID-19-related stressors on mental health. Intervention targeting coping management might benefit the mental health of HIV healthcare providers.

Challenges to HIV service delivery and the impacts on patient care during COVID-19: perspective of HIV care providers in Guangxi, China

The COVID-19 pandemic has brought immense challenges on the health system including HIV care service. Based on online survey data of 1,029 HIV care providers in Guangxi, China, we assessed their perspectives on the challenges for HIV service delivery and perceived impacts of such challenges on patient care during the COVID-19 outbreak. Multivariate regression analysis was conducted to test the association between specific challenges and patient care outcomes controlling for socio-demographics of HIV care providers. The prominent impacts of COVID-19 on patient care outcomes included "not being able to make follow-up visits on time", "not being able to get ARV refills timely", and "compromised ART adherence". Patient care outcome was significantly associated with "not being able to go to work due to quarantine and traffic restriction", "no overall arrangement", "no guideline for HIV service", "conflicts between HIV care and response to COVID-19", and "clinics were overwhelmed by COVID-19 care". In response to dual epidemics of COVID-19 and HIV, policy makers may consider the potential impact of large-scale preventive strategies (e.g., lockdowns) on HIV care, assist healthcare providers to navigate shifting tasks and resetting priorities effectively, and develop clear guidelines and clinic-level arrangements to best serve both COVID-19 and HIV patients.