Psychological stress among health care professionals during the 2019 novel coronavirus disease Outbreak: Cases from online consulting customers

Association between pretreatment emotional distress and immune checkpoint inhibitor response in non-small-cell lung cancer

Emotional distress (ED), commonly characterized by symptoms of depression and/or anxiety, is prevalent in patients with cancer. Preclinical studies suggest that ED can impair antitumor immune responses, but few clinical studies have explored its relationship with response to immune checkpoint inhibitors (ICIs). Here we report results from cohort 1 of the prospective observational STRESS-LUNG study, which investigated the association between ED and clinical efficacy of first-line treatment of ICIs in patients with advanced non-small-cell lung cancer. ED was assessed by Patient Health Questionnaire-9 and Generalized Anxiety Disorder 7-item scale. The study included 227 patients with 111 (48.9%) exhibiting ED who presented depression (Patient Health Questionnaire-9 score ≥5) and/or anxiety (Generalized Anxiety Disorder 7-item score ≥5) symptoms at baseline. On the primary endpoint analysis, patients with baseline ED exhibited a significantly shorter median progression-free survival compared with those without ED (7.9 months versus 15.5 months, hazard ratio 1.73, 95% confidence interval 1.23 to 2.43, P = 0.002). On the secondary endpoint analysis, ED was associated with lower objective response rate (46.8% versus 62.1%, odds ratio 0.54, P = 0.022), reduced 2-year overall survival rate of 46.5% versus 64.9% (hazard ratio for death 1.82, 95% confidence interval 1.12 to 2.97, P = 0.016) and detriments in quality of life. The exploratory analysis indicated that the ED group showed elevated blood cortisol levels, which was associated with adverse survival outcomes. This study suggests that there is an association between ED and worse clinical outcomes in patients with advanced non-small-cell lung cancer treated with ICIs, highlighting the potential significance of addressing ED in cancer management. ClinicalTrials.gov registration: NCT05477979 .

Perceived Quality of Life in Intensive Care Medicine Physicians: A French National Survey

Purpose: There is a growing interest in the quality of work life (QWL) of healthcare professionals and staff well-being. We decided to measure the perceived QWL of ICU physicians and the factors that could influence their perception. Methods: We performed a survey coordinated and executed by the French Trade Union of Intensive Care Physicians (SMR). QWL was assessed using the French version of the Work-Related Quality of Life (WRQoL) scale, perceived stress using the French version of 10 item-Perceived Stress Scale (PSS-10) and group functioning using the French version of the Reflexivity Scale, the Social Support at Work Questionnaire (QSSP-P). Results: 308 French-speaking ICU physicians participated. 40% perceived low WRQoL, mainly due to low general well-being, low satisfaction with working conditions and low possibility of managing the articulation between their private and professional lives. Decreased QWL was associated with being a woman (p = .002), having children (p = .022) and enduring many monthly shifts (p = .022). Conclusions: This work highlights the fact that ICU physicians feel a significant imbalance between the demands of their profession and the resources at their disposal. Communication and exchanges within a team and quality of social support appear to be positive elements to maintain and/or develop within our structures.

GAD-7 Generalised Anxiety Disorder scale in Colombian medical professionals during the COVID-19 pandemic: Construct validity and reliability

INTRODUCTION

The detection of anxiety symptoms among health workers who care for patients infected with COVID-19 is a current priority. Fast and valid instruments are required for this population group. The objective is to establish the construct validity and reliability of the Generalised Anxiety Disorder (GAD-7) scale in Colombian doctors during the COVID-19 lockdown.

METHODS

E-health study, in which cross-sectional data were collected online (n = 1030) from 610 COVID doctors and 420 non-COVID doctors, during the Colombian lockdown, between 20 April and 10 August 2020. Each subject was contacted, and they confirmed their participation, identity and professional role.

RESULTS

A single factor factorial structure was found, made up of the 7 items of the instrument, which managed to explain 70% of the variance. The goodness of fit indices (RMSEA = 0.080; CFI = 0.995; SRMR = 0.053; p < 0.001) showed an "acceptable" unidimensionality and adequate factor loadings in each item of the GAD-7, >0.070. Finally, the internal consistency of the instrument was good, with a Cronbach's alpha of 0.920 (95%IC, 8.80-9.71).

CONCLUSIONS

The GAD-7 is an instrument that presents adequate indicators of validity and reliability. It is an excellent tool that is reliable and easy and fast to use for the detection of generalised anxiety symptoms in medical personnel caring (or not) for patients infected with COVID-19.

Psychosocial impact of COVID-19 2 years after outbreak on mental health of medical workers in Iran

Background

The COVID-19 pandemic had a substantial influence on the mental health of healthcare workers. This study investigated general health status, the prevalence, and the severity of depressive spectrum and anxiety-related disorders. It evaluated the association between various factors and depression, anxiety, and stress among healthcare workers in the Khatam-Alanbia Hospital in Iran, after 2 years since the corona virus disease 2019 (COVID-19) pandemic.

Results

In this online cross-sectional study, 409 participants were selected and given a questionnaire about demographic, personal, and clinical characteristics as well as stressors related to COVID-19. The participants completed the General Health Questionnaire (GHQ-28) and the 42-item Depression, Anxiety, and Stress Scale (DASS-42) to report depression, anxiety, and stress/tension levels. We found that the overall incidence of depression, anxiety and stress among health care workers during the COVID-19 pandemic was 44.25%, 50.62%, and 43.76%, respectively. Participants with severe to very severe depression, anxiety and stress accounted for 19.2%, 26.6%, and 18.2% of the sample, respectively. Being female was associated with higher odds of depression, anxiety, and stress.

Conclusions

Two years after the COVID-19 outbreak, health workers are still showing a significant level of depression, anxiety, stress, and remarkable signs of psychological distress. The situation of a health care worker is worrying. The long-term psychological implications of infectious diseases should not be ignored. Mental health services could play an essential role in rehabilitation.

Peripheral mRNA Expression and Prognostic Significance of Emotional Stress Biomarkers in Metastatic Breast Cancer Patients

Emotional stress is believed to be associated with increased tumor progression. Stress-induced epigenetic modifications can contribute to the severity of disease and poor prognosis in cancer patients. The current study aimed to investigate the expression profiles along with the prognostic significance of psychological stress-related genes in metastatic breast cancer patients, to rationalize the molecular link between emotional stress and cancer progression. We profiled the expression of selected stress-associated genes (5-HTT, NR3C1, OXTR, and FKBP5) in breast cancer including the stress evaluation of all participants using the Questionnaire on Distress in Cancer Patients-short form (QSC-R10). A survival database, the Kaplan-Meier Plotter, was used to explore the prognostic significance of these genes in breast cancer. Our results showed relatively low expressions of 5-HTT (p = 0.02) and OXTR (p = 0.0387) in metastatic breast cancer patients as compared to the non-metastatic group of patients. The expression of NR3C1 was low in tumor grade III as compared to grade II (p = 0.04). Additionally, the expression of NR3C1 was significantly higher in patients with positive estrogen receptor status. However, no significant difference was found regarding FKBP5 expression in breast cancer. The results suggest a potential implication of these genes in breast cancer pathology and prognosis.

Continued disruptions in health care services and mental health among health care providers during the COVID-19 pandemic in five sub-Saharan African countries

Background

Continuous monitoring of the pandemic's impact on health service provision and mental health, COVID-19 perceptions, and compliance with prevention measures among health care providers (HCPs) can help with mitigating the pandemic's negative effects.

Methods

A computer-assisted telephone interviewing (CATI) survey was conducted among 1499 HCPs in Burkina Faso (Ouagadougou), Ethiopia (Addis Ababa), Nigeria (Lagos and Ibadan), Tanzania (Dar es Salaam), and Ghana (Kintampo). Self-reported mental health, perceptions of the COVID-19 pandemic, and prevention measures available in the workplace were assessed. HCPs' responses to questions regarding the impact of COVID-19 on nine essential health services were summed into a score; high service disruption was defined as a score higher than the total average score across all sites. Modified Poisson regression was used to identify potential factors related to high service disruption.

Results

Overall, 26.9% of HCPs reported high service disruption, with considerable differences across sites (from 1.6% in Dar es Salaam to 45.0% in Addis Ababa). A considerable proportion of HCPs reported experiencing mild psychological distress (9.4%), anxiety (8.0%), and social avoidance or rejection (13.9%) due to their profession. Participants in Addis Ababa (absolute risk ratio (ARR) = 2.10; 95% confidence interval (CI) = 1.59-2.74), Lagos (ARR = 1.65; 95% CI = 1.24-2.17), and Kintampo (ARR = 2.61; 95% CI = 1.94-3.52) had a higher likelihood of reporting high service disruption compared to those in Ouagadougou. Reporting ever-testing for COVID-19 (ARR = 0.82; 95% CI = 0.69-0.97) and the presence of COVID-19 guidelines in the workplace (ARR = 0.63; 95% CI = 0.53-0.77) were both associated with lower reported health service disruption among HCPs.

Conclusion

The COVID-19 pandemic continues to disrupt essential health services and present a challenge to HCPs' mental health, with important differences across countries and settings; interventions are needed to mitigate these negative effects of the pandemic.

Mental health in Austrian psychotherapists during the COVID-19 pandemic

Although the impact of the COVID-19 pandemic on mental health has been reported in different communities, little is known about the mental health of psychotherapists during the COVID-19 pandemic. This study aimed to assess mental health during the COVID-19 pandemic in Austrian psychotherapists and compare it with the general population. A total of n = 513 psychotherapists (80.5% women; mean age: 53.06 ± 9.94 years) took part in an online survey conducted from April to June 2022. At the same time, a representative sample (N = 1,031) of the Austrian general population was surveyed online. Indicators of mental health were mental wellbeing (WHO-5), depression (PHQ-2), anxiety (GAD-2), insomnia (ISI-2), and stress (PSS-10). The general population sample was matched according to age and gender with the psychotherapist's data using propensity scores, yielding a final sample of n = 513 (80.5% women; mean age: 52.33 ± 13.39 years). Psychotherapists showed lower odds for exceeding cut-offs for clinically relevant depressive, anxiety, insomnia and stress symptoms (0.34-0.58) compared to the general population. Further studies should elucidate the protective factors underlying these findings.

Development and Application of Global Health Events-Mental Stress Scale for Assessment of Medical Staff's Acute Mental Stress Responses

Background

Medical workers have been increasingly involved in emergent public health events, which can lead to severe stress. However, no standardized, officially recognized, unified tool exists for mental distress measurement in medical workers who experienced the public health events.

Purpose

In the present study, we propose the Global Health Events-Mental Stress Scale (GHE-MSS), as a revised version of the Impact of Event Scale-Revision (IES-R), for assessment of medical workers’ acute mental stress responses within one month and their chronic mental stress responses within six months after major health events.

Patients and methods

The IES-R was slightly modified, developed, and its reliability and validity were tested using the Delphi survey, primary survey with 115 participants, formal survey with 300 participants, and clinical evaluation with 566 participants.

Results

Exploratory factor analysis and confirmatory factor analysis confirmed a promising validity of the scale. The values of Cronbach’s alpha coefficient, the Spearman-Brown coefficient, and the retested Cronbach’s alpha coefficient of the scale applied for the clinical evaluation were 0.88, 0.87, and 0.98, respectively, which confirmed a good internal consistency and stability. The results of the goodness-of-fit test indicated a good adaptation of the model. A correlation analysis was conducted to assess the correlation between the GHE-MSS and the PCL-C, which had a correlation coefficient of 0.68 (P<0.01).

Conclusion

GHE-MSS can be applied with a promising reliability and validity for the assessment of the acute mental stress response of medical workers experiencing public health events. This method can also be used for the screening of mental stress-associated disorders.

The Psychological Impact of Quarantine During the COVID-19 Pandemic on Quarantined Non-Healthcare Workers, Quarantined Healthcare Workers, and Medical Staff at the Quarantine Facility in Saudi Arabia

Background

COVID-19 is a viral infectious disease that spreads quickly through droplets. It is highly contagious and could overwhelm the health system. Because of that, many governments established health quarantines for suspected infected people to minimize the spread of this disease.

Objective

This study aimed to assess the prevalence of depression, anxiety, and stress symptoms and to address the associated risk factors among quarantined non-healthcare workers, quarantined healthcare workers, and medical staff in the Ministry of Health quarantine facility.

Patients and Methods

We conducted an analytical cross-sectional study at the health quarantine in Jazan, Saudi Arabia. The total number of participants was 301 individuals. Furthermore, the study questionnaire was composed of three sections, the first two were the background and clinical characteristics, and the last one was DASS 21 scale. Also, we used SPSS software to analyze the data. Lastly, we implemented logistic regression to assess the predictors of depression, anxiety, and stress symptoms.

Results

The prevalence of depression, anxiety, and stress symptoms among quarantined non-healthcare workers were 51.9%, 60.2%, and 40.6%, respectively. These prevalences were 25.0%, 29.8%, and 16.9% among quarantined healthcare workers and 20.5%, 20.5%, and 27.3% among the medical staff. The predictors of depression, anxiety, and stress symptoms among the study participants were female gender, perceived COVID-19 stigma, presence of other relatives in quarantine, comorbidities, and abnormal sleep duration.

Conclusion and Recommendations

Health quarantine is an environment that could negatively affect people's mental health. The quarantined non-healthcare workers were the most affected study participants inside this environment. Therefore, the availability of mental health services there could minimize their depression, anxiety, and stress symptoms. Moreover, a home quarantine would be better to reduce these negative symptoms whenever possible.

Early Care and Education Workers' Experience and Stress during the COVID-19 Pandemic

Early care and education (ECE) workers experience many job-related stressors. During the COVID-19 pandemic, ECE programs either closed or remained open while workers faced additional demands. We deployed a survey of the center-based ECE workforce in Washington State (United States) one year into the COVID-19 pandemic to assess impacts and workers' perceived stress levels. We describe the prevalence of reported impacts, including workplace closures; job changes; COVID-19 transmission; risk factors for severe COVID-19; the use of social distancing practices; satisfaction with workplace responses; perceptions of worker roles, respect, and influence; and food and financial insecurity. Themes from open-ended responses illustrate how workers' jobs changed and the stressors that workers experienced as a result. Fifty-seven percent of ECE workers reported moderate or high levels of stress. In a regression model assessing unique contributions to stress, work changes that negatively impacted home life contributed most to stress. Feeling respected for one's work and feeling positive about one's role as an "essential worker" contributed to lower levels of stress. Experiencing financial insecurity, caring for school-aged children or children of multiple ages, being younger, and being born in the United States also contributed to higher stress. Findings can inform policies designed to support the workforce.

Stress and depressive symptoms among Italian mental health nurses during the COVID-19 pandemic, a cross-sectional study

This study used the cross-sectional web survey methodology to assess how the COVID-19 pandemic affected Italian psychiatric nurses in terms of stress levels and depressive symptoms. A total of 266 nurses belonging to the Italian Mental Health Departments were interviewed and they were subjected to two validated scales respectively PSS-10 (for the evaluation of stress) and PHQ-9 (for the evaluation of depressive symptoms). Statistical analysis showed moderate stress levels and a prevalence of sub-threshold (borderline) depressive symptoms among responding nurses. Logistic regression analysis reported that frontline nurses on COVID-19 positive patients are at greater risk of reporting higher levels of stress and major depressive symptoms, as are female nurses and juvenile nurses. age. Monitoring and managing the psychological well-being of nursing staff are to be considered among the priorities of mental health service managers and are part of a process that aims to increase individual and organizational well-being but above all to improve the outcomes resulting from assistance.

Psychological Distress in Men during the COVID-19 Pandemic in Brazil: The Role of the Sociodemographic Variables, Uncertainty, and Social Support

Objective: To analyze the relationships between sociodemographic variables, intolerance to uncertainty (INT), social support, and psychological distress (i.e., indicators of Common Mental Disorders (CMDs) and perceived stress (PS)) in Brazilian men during the COVID-19 pandemic. Methods: A cross-sectional study with national coverage, of the web survey type, and conducted with 1006 Brazilian men during the period of social circulation restriction imposed by the health authorities in Brazil for suppression of the coronavirus and control of the pandemic. Structural equation modeling analysis was performed. Results: Statistically significant direct effects of race/skin color (λ = 0.268; p-value < 0.001), socioeconomic status (SES) (λ = 0.306; p-value < 0.001), household composition (λ = 0.281; p-value < 0.001), PS (λ = 0.513; p-value < 0.001), and INT (λ = 0.421; p-value < 0.001) were evidenced in the occurrence of CMDs. Black-skinned men with higher SES, living alone, and with higher PS and INT levels presented higher prevalence values of CMDs. Conclusions: High levels of PS and INT were the factors that presented the strongest associations with the occurrence of CMDs among the men. It is necessary to implement actions to reduce the stress-generating sources as well as to promote an increase in resilience and the development of intrinsic reinforcements to deal with uncertain threats.

Perceived and sources of occupational stress in intensive care nurses during the COVID-19 pandemic

OBJECTIVE

To determine the level of occupational stress in intensive care nurses during the COVID-19 pandemic and factors of perceived stress.

METHODS

The study had a descriptive design. A total of 262 nurses working in adult intensive care units (ICUs) across Turkey during the COVID-19 pandemic constituted the sample. Data were collected by an online survey and the Perceived Stress Scale-14. Descriptive statistics, independent t-test, one- way analysis of variance, regression analysis and Bonferroni test were used for data analysis.

RESULTS

Percentage of nurses with moderate level of occupational stress was 62%. High working hours and nurse:patient ratios, heavy workload and failure in patient treatment were the main factors of occupational stress. Level of occupational stress was affected by gender, number of children, years of experience in intensive care and the type of work shift.

CONCLUSION

Intensive care nurses in Turkey experienced moderate stress during the COVID-19 pandemic. Interventions to prevent occupational stress among intensive care nurses in the long run might be implemented.

The Role of Health Literacy among Outpatient Caregivers during the COVID-19 Pandemic

Health literacy became an important competence during the COVID-19 pandemic. Despite outpatient caregivers being a particularly vulnerable occupational group, their health literacy has hardly been examined yet, especially during the pandemic. Hence, this study aimed to explore this field and provide first empirical insights. Data were collected based on a cross-sectional online survey among 155 outpatient caregivers. In particular, health literacy (HLS-EU-Q16), diet and physical activity, pandemic-related worries, perceived information sufficiency and stress perception were examined. Descriptive and ordinal logistic regression analyses were run to test explorative assumptions. The majority of outpatient caregivers reported high values of health literacy (69% on a sufficient level). Although no significant associations between health literacy and health behaviours or perceived information sufficiency were found, perceived information sufficiency and perceived stress (OR = 3.194; 95% CI: 1.542-6.614), and pandemic-related worries (OR = 3.073; 95% CI: 1.471-6.421; OR = 4.243; 95% CI: 2.027-8.884) seem to be related. Therefore, dissemination of reliable information and resource-building measures to reduce worries may be important parameters for improving outpatient caregivers' health. Our results provide first explorative insights, representing a starting point for further research. Considering outpatient caregivers' mobile work setting, they need to be provided with adequate equipment and comprehensible information to ensure physically and mentally healthy working conditions.

The Impact of the COVID-19 Pandemic on ICU Healthcare Professionals: A Mixed Methods Study

The large numbers of patients admitted to intensive care units due to COVID-19 has had a major impact on healthcare professionals. The incidence of mental health disorders among these professionals has increased considerably and their professional quality of life has suffered during the pandemic. This study aims to explore the impact of the provision of COVID-19 patient care on ICU healthcare professionals. A mixed methods study with an exploratory concurrent design was conducted between June and November 2020 in the Balearic Islands, Spain. Data were collected using a self-report online survey (n = 122) based on three validated questionnaires, and individual semi-structured in-depth online interviews (n = 11). Respondents scored 2.5 out of 5 on the moral distress scale, moderate/high on the compassion satisfaction scale, and moderate on the burnout and compassion fatigue subscales. Age was significantly and negatively related to professional quality of life but was positively related to workload and unavailability of protective equipment. Three main groups of themes relating to the impact of the pandemic emerged from the in-depth interviews: (a) clinical, (b) professional, and (c) personal and family impacts in the two waves. ICU healthcare professionals should be viewed as second victims of the COVID-19 pandemic as they have suffered significant psychological, professional, and moral harm.

Psychological Problems in a Sample of Jordanian Healthcare Workers Involved in Caring for Patients With COVID-19: A Cross-Sectional Study

Purpose: To explore the psychological problems (stress, depression, and anxiety) and the level of resilience among frontline healthcare workers (HCWs) who provide care for patients with coronavirus disease 2019 (COVID-19). Additionally, the current study identified the correlation among these problems, resilience, and demographics of participants. The study explored the main predictors of stress, depression, anxiety, and resilience. Methods: Both the descriptive cross-sectional correlational design and convenience sample technique were used to collect data from active Jordanian HCWs who directly deal with patients suspected or confirmed to be infected with COVID-19 and work at healthcare facilities in Jordan. Data were collected by using online questionnaires about the demographics, stress, anxiety, depression, and resilience of the participants. Results: Data were collected from 225 HCWs. Their mean age was 31.17 years (SD = 6.8). All the participants perceived different levels of stress, with most perceiving exposure to a high level of stress (distress) (46.2% with low level and 53.8% with high level of stress); approximately half of them (52.9%; n = 119) reported a high level of anxiety, and more than half (66.2%; n = 149) had a high level of depression. Additionally, an increased anxiety and depression level was significantly associated with the decreased resilience and increased stress level. Increased age and experience of HCWs are significantly correlated with increased stress levels. The participants having personal protection equipment (PPE) reduced anxiety and depression and increased resilience (p > 0.05). The predictors of the main variables were varied in the study. Conclusion: Frontline HCWs involved in treating the patients with COVID-19 are liable to have a high level of stress that is associated with increased anxiety and depression levels. These high levels affect their mental well-being and resilience. Healthcare institutions in Jordan must tailor appropriate psychological interventions and support that are congruent with the needs of HCWs during and after caring for patients with COVID-19.

Perceived stress and post-traumatic stress disorder symptoms among intensive care unit staff caring for severely ill coronavirus disease 2019 patients during the pandemic: a national study

BACKGROUND

Intensive care unit (ICU) staff have faced unprecedented challenges during the coronavirus disease 2019 (COVID-19) pandemic, which could significantly affect their mental health and well-being. The present study aimed to investigate perceived stress and post-traumatic stress disorder (PTSD) symptoms reported by ICU staff working directly with COVID-19 patients.

METHODS

The Perceived Stress Scale was used to assess perceived stress, the PTSD Diagnostic Scale for the Diagnostic and Statistical Manual of Mental Disorders (5th edition) was used to determine PTSD symptoms, and a sociodemographic questionnaire was used to record different sociodemographic variables.

RESULTS

Altogether, 124 participants (57.2% of whom were men) were included in the analysis. The majority of participants perceived working in the ICU with COVID-19 patients as moderately to severely stressful. Moreover, 71.4% of doctors and 74.4% of nurses experienced moderate-to-severe perceived stress. The staff with previous ICU experience were less likely to have a probable diagnosis of PTSD than those without previous ICU experience.

CONCLUSIONS

Assessing perceived stress levels and PTSD among ICU staff may enhance our understanding of COVID-19-induced mental health challenges. Specific strategies to enhance ICU staff's mental well-being during the COVID-19 pandemic should be employed and monitored regularly. Interventions aimed at alleviating sources of anxiety in a high-stress environment may reduce the likelihood of developing PTSD.

[GAD-7 Generalised Anxiety Disorder scale in Colombian medical professionals during the COVID-19 pandemic: construct validity and reliability]

Introduction: The detection of anxiety symptoms among health workers who care for patients infected with COVID-19 is a current priority. Fast and valid instruments are required for this population group. The objective is to establish the construct validity and reliability of the Generalised Anxiety Disorder (GAD-7) scale in Colombian doctors during the COVID-19 lockdown.Methods: E-health study, in which cross-sectional data were collected online (n=1,030) from 610 COVID doctors and 420 non-COVID doctors, during the Colombian lockdown, between 20 April and 10 August 2020. Each subject was contacted, and they confirmed their participation, identity and professional role.Results: A single factor factorial structure was found, made up of the 7 items of the instrument, which managed to explain 70% of the variance. The goodness of fit indices (RMSEA = 0.080; CFI = 0.995; SRMR = 0.053; p <0.001) showed an "acceptable" unidimensionality and adequate factor loadings in each item of the GAD-7, >0.070. Finally, the internal consistency of the instrument was good, with a Cronbach's alpha of 0.920 (95%IC, 8.80-9.71).Conclusions: The GAD-7 is an instrument that presents adequate indicators of validity and reliability. It is an excellent tool that is reliable and easy and fast to use for the detection of generalised anxiety symptoms in medical personnel caring (or not) for patients infected with COVID-19.

Problems Experienced by Family Physicians in Sivas during the Pandemic Period and Its Relationship with COVID-19 Fear

Aim: To determine the COVID-19 fear level of family physicians during the pandemic working in Sivas and its relationship to their experienced problems. Methods: This descriptive study was delivered to 225 family physicians in Sivas between December-January 2021 via an online survey containing 24 questions of participants' sociodemographic data, the problems they experienced in family medicine, and the COVID-19 Fear Scale. Descriptive statistics and logistic regression analysis were used to analyze thedata. Results: A total of 138 family physicians whose mean age was 37.6±7.3, with 52.2 % males and 47.8% females, included. Participants’ 16.7% had the COVID-19 infection. COVID-19 Fear Scale mean score of 18.3±6.5, appearing significantly higher in females (19.6±5.8) than in males (17.2±6.9). 28.3% of subjects needed taking professional psychological support, on which increase of working period in family medicine and COVID-19 Fear Scale Score and being single had a positive effect. Also, 86.2% experienced primary health care services problems, most frequently ranked as cancer screening, mobile service, and chronic illness follow-up. Conclusion: Necessary psychosocial support should be provided to all healthcare workers, especially family physicians, during the pandemic. So, we recommend authorities take proper precautions to continue without interruption for primary preventive health services. Keywords: COVID-19, fear, family practice, COVID-19, fear, primary care physicians

Facing COVID-19 Pandemic in a Tertiary Hospital in Milan: Prevalence of Burnout in Nursing Staff Working in Sub-Intensive Care Units

In early March 2020, Italy became the epicenter of the Coronavirus Disease 2019 (COVID-19) pandemic in Europe. A different organization of hospital units was required to take care of patients affected by acute respiratory failure caused by COVID-19. This study aimed to evaluate the prevalence of burnout in two sub-intensive care units (SICUs) of the COVID-19 hub center of the Lombardia region in Milan (Italy). All nurses and healthcare assistants working in the SICUs during June 2020 were included in the study. Burnout was assessed via the Maslach Burnout Inventory questionnaire. One hundred and five (84%) SICU staff participated in the study. The prevalence of high burnout for nurses and healthcare assistants was 61.9% for emotional exhaustion, 47.6% for depersonalization and 34.3% for personal accomplishment. Depersonalization was significantly more frequent in younger nurses (p = 0.009). Nurses were 4.5 times more likely to have burnout than healthcare assistants. Burnout was a common condition among healthcare workers operating in SICUs during the pandemic. Urgent actions are needed, especially for nurses, as well as preventive strategies for future pandemic scenarios.

The influence of COVID-19 on the mental health of final-year nursing students: comparing the situation before and during the pandemic

The COVID-19 pandemic has had an important impact on the academic world. It is known that university studies can influence the mental health of students, and especially those studying health sciences. In this study, we therefore sought to analyse whether the current pandemic has affected the mental well-being of final-year nursing students. This was a multi-centre study, with a descriptive, longitudinal, and prospective design. Mental well-being was evaluated using the General Health Questionnaire. A total of 305 participants were included in the study, of whom 52.1% had experienced the COVID-19 pandemic. Statistically significant differences were found between the two groups analysed in terms of age, access to university, average marks, mental well-being self-esteem, emotional exhaustion, and sense of coherence. In the case of mental well-being, a direct association was found with both the pandemic situation (OR = 2.32, P = 0.010) and emotional exhaustion scores (OR = 1.20, P < 0.001), while an inverse association was found with sense of coherence scores (OR = 0.45, P < 0.001). This study shows that the mental health of students is a significant factor and one that must be taken into consideration when training nursing staff at university. There is a need to promote healthy habits and provide appropriate coping strategies. It is also important to train and prepare students for pandemic situations as these can have an important impact on the mental health of both the members of the public who will be treated by these future nursing professionals and the students themselves.

The Prevalence of Generalized Anxiety Disorder Among Health Care Workers During the COVID-19 Pandemic: A Systematic Review and Meta-Analysis

Introduction: Health care workers, due to be involved in caring for COVID-19 patients may experience various psychological problems including anxiety disorders. This study aimed to investigate the prevalence of Generalized Anxiety Disorder (GAD) among health care workers during the COVID-19 pandemic by systematic review and meta-analysis. Methods: The PRISMA guideline was used for conducting this study. Related keywords were searched in credited resources including ISC, Magiran, PubMed, Scopus, Web of Science, Cochrane, ProQuest, Science Direct, Google Scholar, and Embase to find the articles published on the prevalence of GAD among health care workers during the COVID-19 pandemic from the first of January to the end of June 2020. Meta-analysis was conducted by the random effects model. Results: In this study, 553 articles were initially identified, from which 19 studies were finally included in the meta-analysis. The results showed that the prevalence of GAD in health care workers based on the GAD-7 and GAD-2 instruments were 32.04% (95% CI: 26.89-37.19, I 2 = 98.2%, p < 0.001) and 22.62% (95% CI: 9.01-36.24, I 2 = 97.7%, p < 0.001). The overall prevalence of GAD was obtained 30.5% (95% CI: 25.58-35.42, I 2 = 98.4%, p < 0.001). Conclusion: This study showed a relatively high GAD prevalence, as one of the fundamental psychological problems, among health care workers during the COVID-19 pandemic. Therefore, health system managers should implement preventive strategies to protect health staff from contracting the virus and monitor them for psychological problems and provide them with supportive measures if necessary.

The Moderating Effect of Community-Level Deprivation on the Association between Individual Characteristics and Smoking Behavior among Chinese Adults: A Cross-Level Study

China joined the World Health Organization (WHO) Framework Convention on Tobacco Control in 2006; however, the overall Chinese smoking rate is still high. The aim of this study is to provide new evidence for the direct effects of community-level deprivation, and the effects of interactions between community-level deprivation and individual characteristics, on smoking intensity, by using cross-sectional data from the 2015 China Health and Nutrition Survey (CHNS). The results show that there is a strong association between community-level deprivation and individual smoking intensity, and that community deprivation moderates the relationship between individual perceived stress and smoking intensity. The findings imply that adequate interventions should be conducted in the context of deprived neighborhoods, and should consider differences between levels of individual perceived stress and between sexes, especially focusing on highly stressed women who live in deprived communities.

Associations between demographic characteristics, perceived threat, perceived stress, coping responses and adherence to COVID-19 prevention measures among Chinese healthcare students

Aim

To investigate the associations between demographic characteristics, perceived threat, perceived stress, coping responses and adherence to COVID‐19 prevention measures in Chinese Healthcare students.

Design

A cross‐sectional survey collecting data in Hong Kong and Fujian Province of China in April 2020.

Methods

A convenience and snowball sample of 2706 students aged 18 years or older and studying a healthcare programme were recruited in tertiary education institutions/universities in Hong Kong and Putian. The participants completed the questionnaire with six scales: Social Distancing Scale; Personal Hygiene Scale; Empathic Responding Scale; Wishful Thinking Scale; Perceived Stress Scale and Perceived Threat Scale. Path analysis was performed to identify factors associated with the preventive measures outcomes. p value < .05 was considered as statistical significance.

Results

The participants reported high compliances to both social distancing (SoD) and personal hygiene measures (PHM). Confidence to manage the current situation, wishful thinking and empathetic responding directly predicted compliance with SoD and PHM. The final model constructed demonstrated a very good fit to the data.

Conclusion

The findings suggest that students who are male, habituate in Hong Kong, have more clinical experience and weak confidence to manage the threat tend to have lower compliance with the COVID‐19 preventive measures.

Impact

The predictive model constructed is the first one to explore factors associating with the compliance with infection control measures in healthcare students amid the COVID‐19 outbreak. As the infection control behaviours of healthcare students, whom are still under training and are the high‐risk group of being infected and infecting others in the community, are rarely reported in literature, this study has provided empirical evidence to nurses and other healthcare professionals to identify students susceptible to poor compliance and provide early monitoring and education to suppress the COVID‐19 transmission.

Work-Related Challenges among Primary Health Centers Workers during COVID-19 in Saudi Arabia

This study aimed to identify certain occupational risk factors for stress among healthcare workers (HCWs) during the COVID-19 pandemic. Using a multistage random sampling approach, an online questionnaire was applied to collect data on role conflict and ambiguity, self-esteem and social support from 1378 HCWs working in primary health centers (regular and fever clinics; clinics specialized in managing patients with COVID-19 symptoms) across Saudi Arabia. The results showed that stress correlated positively with role conflict and ambiguity and negatively with social support. HCWs in fever clinics exhibited significantly more stress and role conflict and ambiguity than those who were working in regular primary healthcare centers. In conclusion, role conflict and ambiguity and social support were determinants for stress among HCWs, especially those working in fever clinics.

Factors Associated with Psychological Distress and Brief Resilient Coping Level During the COVID-19 Pandemic Among Health-Care Professionals in Dessie, Ethiopia

Background

The outbreak of Coronavirus Disease 2019 (COVID-19) has caused serious threats to people’s health and lives in the world. The health-care professionals are bravely fighting on the front lines of the pandemic everywhere in the world. Our study is the first to study psychological distress and coping status among health-care professionals of Dessie town, Ethiopia during the unbridled time of the COVID-19 outbreak.

Methods

A cross-sectional internet-based study was conducted between June 20 and July 13, 2020. The questionnaires included the demographic information, COVID-19 related questions, Kasseler-10 to assess psychological distress level and Brief Resilient Coping Scale, and Oslo-3 social support scale questionnaire were employed.

Results

A total of 423 participants were involved in the study with a response rate of 100%. The mean age of respondents was 34.5 years (SD = ±8.45 years). The prevalence of psychological distress among participants was 42%. Of these 18%, 11%, and 13% had mild, moderate, and severe psychological distress levels. Being married, being nurses and pharmacies, current substance users, working in emergency and outpatient departments, history of chronic medical illness, brief resilient coping level, and social support level were particularly associated with high psychological distress.

Conclusion

Health-care professionals are experiencing a substantial level of psychological distress. In addition to other modifying factors coping level and social support was a significant predictor of psychological distress among health-care professionals. These findings should inform the implementation of interventions that increase coping resilience and social support to mitigate the impact of psychological distress among health-care professionals.

Intervention and Improved Well-Being of Basic Science Researchers During the COVID 19 Era: A Case Study

The coronavirus disease-19 (COVID-19) pandemic has affected individuals of all categories, irrespective of their geographical locations, professions, gender, or race. As a result of full or partial lock-down and stay-at-home orders, the well-being and productivity of individuals were severely affected. Since basic science research requires laboratory experiments, the work-from-home strategy hurt their productivity. In addition, the combination of decreased productivity and staying at home is likely to compromise their well-being by causing stress and anxiety. In this case study, a strategy was developed to engage researchers through listening and learning, motivation, and empowerment, using regular virtual sessions. Through these virtual sessions, research work was prioritized and coordinated, from idea conception to writing research papers and grant proposals. Perceived stress scores (PSS) and COVID-19-related stress (COVID-SS) scores were measured to evaluate general and COVID-19-induced stress, respectively, every month from March to July 2020 during the COVID-19 era. The result showed a significant improvement in both the PSS and the COVID-SS scores of the intervention group compared to the control group. In addition, while there was no/minimal change in PSS and COVID-SS scores from March to subsequent months until July for the control group, the intervention groups showed significant and consistent improvement in both scores in the intervention group. Overall, the intervention strategy showed improved well-being for basic science researchers, which was also consistent with their improved productivity during the COVID-19 era.