Global prevalence of mental health problems among healthcare workers during the Covid-19 pandemic: A systematic review and meta-analysis

Evaluating GenAI systems to combat mental health issues in healthcare workers: An integrative literature review

BACKGROUND

Mental health issues among healthcare workers remain a serious problem globally. Recent surveys continue to report high levels of depression, anxiety, burnout and other conditions amongst various occupational groups. Novel approaches are needed to support clinician well-being.

OBJECTIVE

This integrative literature review aims to explore the current state of research examining the use of generative artificial intelligence (GenAI) and machine learning (ML) systems to predict mental health issues and identify associated risk factors amongst healthcare professionals.

METHODS

A literature search of databases was conducted in Medline then adapted as necessary to Scopus, Web of Science, Google Scholar, PubMed and CINAHL with Full Text. Eleven studies met the inclusion criteria for the review.

RESULTS

Nine studies employed various machine learning techniques to predict different mental health outcomes among healthcare workers. Models showed good predictive performance, with AUCs ranging from 0.82 to 0.904 for outcomes such as depression, anxiety and safety perceptions. Key risk factors identified included fatigue, stress, burnout, workload, sleep issues and lack of support. Two studies explored the potential of sensor-based technologies and GenAI analysis of physiological data. None of the included studies focused on the use of GenAI systems specifically for providing mental health support to healthcare workers.

CONCLUSION

Preliminary research demonstrates that AI/ML models can effectively predict mental health issues. However, more work is needed to evaluate the real-world integration and impact of these tools, including GenAI systems, in identifying clinician distress and supporting well-being over time. Further research should aim to explore how GenAI may be developed and applied to provide mental health support for healthcare workers.

Spiritual coping within medical professions: A psychometric analysis of the Numinous Motivations Inventory short form

AIM

To examine the psychometric properties of a short form version of the Numinous Motivation Inventory (NMI) for use with healthcare providers in measuring their existential engagement with life and to assess its relationship with spiritual coping and emotional dysphoria.

DESIGN

Correlational and psychometric study.

METHOD

Data were collected from June to December 2022. Participants included 102 physicians, recruited from across the United States. Qualtrics was utilized to collect data, and they were evaluated with the NMI short form, Spiritual Coping Questionnaire and Depression, Anxiety, and Stress scale (DASS-21).

RESULTS

Obtained fit statistics from structural equation modelling analysis indicated close fit of the NMI short form with the original model. Multiple regression analyses demonstrated the value of the NMI as a predictor of negative affect independent of spiritual coping. The NMI did not interact with Spiritual Coping, which was independent of negative affect.

CONCLUSIONS

The Numinous represents an important aspect of physicians' coping. The constructs can be utilized in training and clinical settings as a valuable and easy-to-use metric for promoting and assessing wellness. The implications of these findings and the value of the NMI were discussed.

IMPACT

An understanding of existential drivers can equip one to cope with the stressors of healthcare. The NMI short form has the capability to explore an individual's existential drivers through the understanding of three domains.

REPORTING METHOD

Adhered to proper EQUATOR guidelines (GRRAS).

PUBLIC CONTRIBUTION

No patient or public contribution.

Identifying Trends in the Most Cited Nursing Articles: Research Topics, Author Gender Representation and Characteristics Correlated With Citation Counts

AIM

To assess the top 1000 cited nursing articles in terms of their impact, conceptual and social characteristics.

DESIGN

Bibliometric literature review design.

METHODS

A bibliometric analysis on the 1000 most cited nursing articles in English, focusing on assessing their impact and prevalent terms, keywords, co-occurrence networks and topic trends. Non-parametric statistical tests were used.

DATA SOURCES

Web of Science Core Collection (accessed 14 February 2024).

RESULTS

The 1000 most cited articles were exported from 201,310 eligible articles. The most cited articles received a total of 319,643 citations. The Journal of Advanced Nursing and the International Journal of Nursing Studies were the most cited journals. Literature reviews accounted for 21% of the most cited articles, compared to only 7% of all eligible articles. Most first authors were female, 63%. The data showed an increase in female first authorship among the most cited articles over time. This may reflect a shift towards greater gender equity in nursing research. Shorter article titles and fewer article pages were associated with more citations.

CONCLUSION

Methodological and conceptual articles received the most citations, likely due to their broad applicability (e.g., across disciplines) and enduring relevance. There was a statistically significant correlation between article brevity and citation count, but the relationship should be viewed with caution given the small effect size.

IMPLICATIONS FOR THE PROFESSION

Bibliometrics is important for evidence-based practice because it helps nurses evaluate journals, articles and research topics. Since citation counts do not always indicate research quality, nurses and nursing students would benefit from training in bibliometrics to enhance their critical thinking in this area.

IMPACT

Top-cited nursing articles indicate influential research topics and methods. They also influence authors' academic career opportunities, allowing assessment of research equity in terms of dominant countries and author gender representation.

REPORTING METHOD

The Preferred Reporting Items for Bibliometric Analysis (PRIBA) guidelines.

PATIENT OR PUBLIC CONTRIBUTION

No Patient or Public Contribution.

Estimation of the prevalence of anxiety during the COVID-19 pandemic: A meta-analysis of meta-analyses

BACKGROUND

Pandemics such as COVID-19, can lead to psychiatric symptoms like anxiety. It seems that meta-analysis of meta-analysis studies can provide more comprehensive information regarding the needs for post-COVID-19 services. Therefore, this umbrella review and meta-analysis of meta-analyses aimed to estimate the precise prevalence of anxiety during the COVID-19 pandemic.

METHODS

PubMed, Scopus, and Web of Science were searched for published meta-analyses using relevant keywords, such as Anxiety, Prevalence, COVID-19, and Meta-analysis up to November 1, 2023. Google Scholar, reference check, citation check, and grey literature were manually searched. A random-effect model was used for the analysis. All analyses were conducted using STATA: 17.

RESULTS

Out of the 4263 records, Finally, 75 meta-analyses were included. The overall prevalence of anxiety was 30.4% [95% CI: 29-31.8] with a high heterogeneity (I2: 86.76%). The highest prevalence of anxiety according to population type was 41.3% in patients and then in students (30.8), pregnant women (30.6%), and health care workers (30.5%). The Result of meta-regression showed that "Time" (based on the time between the start of COVID-19 and the last search date in articles) was not a significant predictor of the prevalence of anxiety (R Coefficient = 0.000149, P = 0.61).

CONCLUSIONS

Considering the prevalence of anxiety among patients, students, pregnant women, and healthcare workers, special attention should be paid to these groups in case of the re-occurrence of COVID-19 or occurrence of other pandemics. As quarantine due to pandemics causes reduced social interactions, reduced income, and increased worry about severe illness and death, there is a need for large-scale mobilization of political measures.

Evaluation of the mental health status of intensive care unit healthcare workers at the beginning of COVID-19 pandemic

Objective

During pandemic periods, mental health issues are highly prevalent, particularly among healthcare workers who are at a higher risk of developing psychiatric disorders. The aim of this study is to evaluate the mental health status of the intensive care unit (ICU) healthcare workers, who play a vital role in managing the COVID-19 pandemic, in terms of the quality of sleep, levels of depressive and anxiety symptoms, stress and to determine the factors that affect their mental health.

Methods

The research was conducted in April 2020 and incorporated a total of 79 participants working in an university hospital ICUs in Turkey. Pittsburgh Sleep Quality Index (PSQI), Depression Anxiety Stress Scale 42 (DASS-42), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI) were applied.

Results

Among the participants, 58 individuals comprising 73.4% of the cohort were working in the ICUs, managing patients infected with COVID-19. Those working in ICUs with COVID-19 patients had significantly higher DASS-S, BAI, and BDI scores. Doctors' BDI scores were significantly lower compared to both nurses and other healthcare workers. Participants exhibiting COVID-19 symptoms manifested significantly higher BAI scores in compared to those without such symptoms.

Conclusion

Healthcare workers involved in ICUs with COVID-19 patients were more significantly affected psychologically, doctors had lower depressive symptoms as compared to other healthcare workers. In addition, individuals with COVID-19 symptoms demonstrated significantly higher levels of anxiety. The findings of our study emphasize the significance of providing psychological support to healthcare workers throughout pandemics.

Revisiting the prevalence of psychological symptoms among health care workers in Saudi Arabia during COVID-19

OBJECTIVES

To analyze the existing literature on the prevalence of psychological symptoms in healthcare workers (HCWs) in Saudi Arabia during the COVID-19 pandemic. The review will evaluate the assessment methods used for measuring the prevalence of psychological symptoms and critically review the literature's findings concerning psychological support for HCWs.

METHODS

All articles were selected from the PubMed database and reviewed for potential inclusion in March 2023. The articles were screened following the preferred reporting items for systematic reviews and meta-analyses protocol. Assessment of the quality and risk of bias in the included studies was guided using the prevalence critical appraisal tool criteria.

RESULTS

We identified 7 articles that investigated the prevalence of psychological symptoms among HCWs in Saudi Arabia during the COVID-19 pandemic. We determined the studies' characteristics and classified and explained various themes. These themes included the prevalence of psychological symptoms found in HCWs, the study designs, the tools used to assess psychological symptoms in HCWs, and the potential impact of the studies on the mental health challenges faced by HCWs due to COVID-19. We also examined the quality and risk of bias in the included studies.

CONCLUSION

This review's findings provide valuable insights into the psychological symptoms experienced by HCWs during the pandemic. To ensure the consistency of the results, it is essential to reevaluate the prevalence of these symptoms and use a culturally sensitive approach to translating the measures. This review lays the groundwork for future research on psychological symptoms and the interpretation of measurement outcomes.PROSPERO No. ID: CRD42024479813.

A Mixed-Methods Study to Evaluate Depression and Anxiety Among Undergraduate Nursing Students

INTRODUCTION

As the backbone of future healthcare delivery, the mental health of undergraduate nursing students can have a direct impact on patients' perceptions of health and the quality of their healthcare learning. However, there has been little qualitative research on the factors influencing the mental health of undergraduate nursing students.

AIM

This study investigated the current status and factors influencing depression and anxiety in undergraduate nursing students.

METHODS

Questionnaires were administered to third-year nursing students at a medical college university using the Self-Assessment Scale for Anxiety (SAS) and the Self-Depression Scale (SDS). The students who suffered from anxiety or depression were selected for qualitative interviews and the results of the interviews were analysed by using the seven-step Koretz analysis.

RESULTS

(1) SAS and SDS scores of undergraduate nursing students were higher than the national average. (2) The qualitative interviews revealed that five themes, including childhood experience, body image, interpersonal relationships, professional identity and career planning, influenced mental health.

DISCUSSION

Undergraduate nursing students exhibited a high prevalence of anxiety and depression. The colleges should establish a proactive educational model centred on teaching quality, professional identity, career planning and mental health.

IMPLICATION FOR PRACTICE

This study found that the mental health of undergraduate nursing students was influenced by a variety of factors, which require diverse and constant interventions. School, family and social resources should collaborate to develop a systematic approach for better mental health education in undergraduate nursing students.

Prevalence and determinants of occupational depression, anxiety, and stress among Ethiopian healthcare workers

Studies on the prevalence and factors of depression, and anxiety symptoms from a work-ascribed or causal perspective are not available and studies on the prevalence of occupational stress in Ethiopia are limited. Therefore, this study aimed to determine the prevalence of occupational depression, job anxiety, and occupational stress, and to identify their determinants in healthcare workers. We conducted a multicenter cross-sectional study in selected public hospitals in the Central and Southern Ethiopia from 16th January to 28th February 2023. We used stratified random sampling to select 9 public hospitals from three strata: primary, general and tertiary hospitals. We collected data using scales of perceived occupational stress, occupational depression inventory, and job anxiety. We performed a confirmatory factor analysis followed by determining the prevalence of those mental symptoms and identifying independent factors using multiple ordinal logistic regression. Among 1426 healthcare workers, the overall prevalence of occupational depressive, job anxiety, and occupational stress symptoms were 39.0%, 57.6%, and 68.0%, respectively. Females, medical specialists, participants with a history of disease or injury, those with low job dissatisfaction, higher sleeping disorder scores, higher life-threatening events (LTEs) scores, and longer working hours were more likely to report occupational depressive symptoms. Participants with poor perceived health significantly increased the odds of reporting job anxiety symptoms. Participants with low job satisfaction, a history of workplace verbal violence, higher scores for sleep disorders, and higher LTEs score had significantly greater odds of reporting both job anxiety and occupational stress symptoms. Younger participants were also more likely to report occupational stress symptoms. Our study highlights the need to prioritize workplace mental health interventions for healthcare workers. The study also suggested the need to address gender, educational level, job satisfaction, and sleep hygiene, develop coping mechanisms for LTEs, prevent workplace violence, and manage of working hours per week to enhance the mental well-being of healthcare workers in Ethiopia.

Work-related stressors and psychological distress predict career change ideation among Lithuanian healthcare workers

OBJECTIVES

The study aimed to assess the mental health and well-being of Lithuanian healthcare workers by gathering demographic information, identifying common stressors affecting the work environment, evaluating mental health, and exploring directions for psychosocial care. Additionally, the research explored the prevalence of considering a career change among respondents.

MATERIAL AND METHODS

The study included 1618 responders who completed an online survey in December 2021 - January 2022. Participants included in this study: physicians, nurses, residents and other healthcare workers. It evaluated their demographics, most common stressors affecting their work environment and mental health on the Depression, Anxiety and Stress Scale - 21 (DASS-21) scale. Lastly, all responders asked if they had considered changing their occupation to a non-medical job. Univariate analysis was performed using χ2 and Student's t test, and binary logistic regression evaluated career change predictors.

RESULTS

Career change was considered by 1081 (66.8%) responders. The main career change predictors were poor working conditions (OR 1.91, p < 0.001), direct contact with patients (OR 1.84, p < 0.001), lack of career perspectives (OR 1.95, p < 0.001), mobbing (OR 1.67, p = 0.001) and exhaustion (OR 1.51, p = 0.005). After evaluating DASS-21 scores, it was found that 23% of respondents had severe and extremely severe depression symptoms, 27.4% severe and extremely severe anxiety, and 21.4% had severe and extremely severe stress levels.

CONCLUSIONS

Lithuanian healthcare workers are in high distress and have poor mental health. They are in need psychosocial assistance to avoid burnout and staff loss. Int J Occup Med Environ Health. 2024;37(3):287-99.

Acceptability of Teleconsultation Services for HIV Care in Nigeria: A Mixed Methods Study

Introduction: Access to HIV care remains challenging, especially for patients living in remote areas, despite advances in antiretroviral treatment. The acceptability of teleconsultations for routine HIV care post-COVID is not well-explored. We explored factors influencing teleconsultation acceptability among people living with HIV (PLWH) and attending a tertiary care center in Kano, Nigeria. Methods: We used a cross-sectional mixed methods study design. Structured questionnaires were administered to 415 PLWH, supplemented by in-depth interviews with a subsample (n = 20). Logistic regression models and thematic analysis were used for data analyses. Results: Of 415 respondents, 55.7% (n = 231) expressed willingness for teleconsultations. Primary motivations included convenience/efficiency (46.7%, n = 194), elimination of travel expenses (31.8%, n = 132), and remote access to specialist care (17.3%, n = 72). Reasons for reluctance included distrust of technology (61.9%, n = 260) and privacy concerns (37.1%, n = 156). Acceptance was higher among males (adjusted odds ratio (aOR)=1.58, 95% confidence interval (CI) = 1.12-3.72), participants with at least secondary education (aOR = 1.47, 95% CI = 1.27-4.97), monthly income ≥30,000 Naira (aOR = 2.16, 95% CI = 1.21-7.31), currently married (aOR = 3.26, 95% CI = 1.16-5.65), and participants without comorbidities (aOR = 2.03, 95% CI = 1.18-4.24). PLWH who self-assessed as being in good health (aOR = 3.77, 95% CI = 1.44-9.94), used the internet regularly (aOR = 3.12, 95% CI = 2.17-5.37), or were aware of telemedicine (aOR = 3.24, 95% CI = 2.45-7.68) were also more accepting of telehealth services. Themes highlighted the need to offer teleconsultation as an optional service. Conclusion: Teleconsultation acceptance among PLWH was influenced by sociodemographic, clinical, and technology-related factors. Successful integration of teleconsultation services for PLWH in similar settings necessitates targeted educational interventions and assessment of organizational readiness.

Acute treatment residual depression symptoms and functional impairment among depressive patients of different age groups and education levels in China: A prospective, multicenter, randomized study

OBJECTIVE

A prospective, multicenter, randomized study evaluated the efficacy of major depressive disorder (MDD) patients after 2-3 months of acute treatment based on the dual factors of education and age.

METHODS

This study classified the included patients into four groups using two classification parameters: age (≤45 years, vs. >45 years) and education years (≤12 vs. >12). We analyzed age, gender, marital status, personal income, depression onset history, medication use, and follow-up across various groups. We evaluated residual somatic symptoms and social functioning in depression patients was conducted using the 16-item Quick Inventory of Depressive Symptomatology Self-report (QIDS-SR16), the Patient Health Questionnaire-15 (PHQ15), and the Sheehan Disability Scale (SDS).

RESULTS

In China, 16 hospitals, 553 depression patients, and 428 fulfilled the inclusion criteria. Baseline patient data revealed significant differences among the different age groups in gender, marital status, income, first onset age, physical illness, combination of antipsychotics, and benzodiazepines use (all p < .05). Statistically significant differences were observed in overall comparisons among the four groups, encompassing the QIDS-SR16 score, PHQ15 score, and various SDS parameters (all p < .05). However, no statistically significant differences (all p > .05) were found in residual somatic symptoms and social functioning parameters between different education levels (≤12 years vs. >12 years) at baseline, 3 months, and 6 months, based on total scores on the scale. Repeated measures mixed model indicates that the QIDS-SR16 assessment indicates statistical differences among various marital statuses, income levels, medical histories, and antipsychotic medication use (p < .05). Furthermore, PHQ-15 and SDS assessments reveal statistical differences between single and married/cohabiting statuses, physical comorbidities, 3 and 6 months follow-ups compared to baseline (p < .05).

CONCLUSION

This study indicates that compared to depressive patients >45 years old, those ≤45 years old often exhibit more residual depression, somatic symptoms, and severe social functional impairment; patients' education levels less influence this trend.

Association between occupational burnout and psychological symptoms among Chinese medical staff: moderating role of social support

This study aimed to examine the association between occupational burnout and psychological symptoms among Chinese medical staff, assuming social support to play a moderating role in the aforementioned relationship. The survey was conducted online from May 1 to June 28, 2022, and the questionnaires were distributed and retrieved through a web-based platform. The final sample was comprised of 1461 Chinese medical staff in this cross-sectional study. Several multiple linear regressions were performed to analyze the data. After controlling for potential confounding factors, all three dimensions of occupational burnout were associated with poorer psychological symptoms. Emotional exhaustion (β = 0.33; 95% confidence interval [CI], 1.018, 1.479) had the strongest association with psychological symptoms, followed by depersonalization and diminished personal accomplishment. Moreover, medical staff with higher levels of friend support (β =  -0.11; 95% CI, -4.063, -0.573) and significant other support (β =  -0.10; 95% CI, -3.965, -0.168) were less likely to suffer from psychological symptoms when faced with occupational burnout. The results suggested that interventions aimed at lessening occupational burnout and boosting social support can be an effective way to promote the psychological health of medical staff.

The relationship between peritraumatic distress, mental health symptoms, and functioning impairment in healthcare workers during the COVID-19 emergency

OBJECTIVE

Healthcare workers (HCWs) were considered a population at risk for developing psychiatric symptoms during the COVID-19 pandemic, such as anxiety, depression, and post-traumatic stress disorder (PTSD). Peritraumatic distress is associated with post-traumatic psychopathological symptoms; however, little is known about how it may affect functioning. The study aimed at evaluating the level of peritraumatic distress in a sample of HCWs during the first wave of the COVID-19 pandemic and at examining the relationship between peritraumatic distress, mental health symptoms, and functioning impairment.

METHODS

A sample of 554 frontline HCWs were consecutively enrolled in major university hospitals and community services in Italy. The PDI, IES-R, PHQ-9, and GAD-7 were used to assess peritraumatic distress, symptoms of PTSD, depression, and anxiety, respectively, and the WSAS to investigate functioning impairment. PDI scores were higher among females, community services, physicians, and nurses. Furthermore, the PDI correlated significantly with the GAD-7, PHQ-9, IES-R, and WSAS.

RESULTS

In a mediation analysis, the direct effect of PDI on WSAS and the indirect effects through the PHQ-9 and IES-R were statistically significant (P < .001).

CONCLUSION

Peritraumatic distress reported by HCWs was associated with symptoms of PTSD, depression, and anxiety, but the association with reduced functioning may be only partially mediated through symptoms of depression and PTSD.

Ancillary hospital workers experience during COVID-19: systematic review and narrative synthesis

BACKGROUND

COVID-19 overwhelmed healthcare systems worldwide. Its impact on clinical staff is well documented, but little is known about the effects on ancillary staff (cleaners, porters and caterers).

AIM

To identify the evidence of the impact of COVID-19 on ancillary staff at National Health Service (NHS) hospitals in England.

DESIGN

Systematic review and narrative synthesis.

DATA SOURCES

Databases (MEDLINE, CINAHL Ultimate, APA PsycINFO, APA PsycArticles and Academic Search Ultimate). Reference lists were searched. Four independent reviewers screened titles and abstracts against inclusion criteria. Data were extracted from included papers and studies were critically assessed using relevant critical appraisal tools.

RESULTS

8/178 studies were included, of which 5 quantitative, 2 qualitative and 1 mixed methods. Ancillary staff had higher rates of past and present COVID-19 infection. Participants felt that the work of ancillary staff had been insufficiently recognised by managers and that they had little voice within the NHS. They also experienced inequity regarding available support and safe working practices due to largely digital modes of communication which they rarely, if ever, used. In an evaluation of a personal protective equipment support 'helper' programme, ancillary workers were more positive about it than nurses, allied health practitioners, and doctors.

CONCLUSION

Few studies included ancillary staff. As reported, ancillary staff at NHS hospitals had a higher prevalence of COVID-19 infection but felt marginalised and poorly supported. They valued training when offered. Additional research is needed to understand better the impact of COVID-19 on ancillary key workers, and how best to support them in future similar circumstances.

Understanding Rewarding and Challenging Nursing Experiences During the Pandemic in Five Countries: Toward Strengthening the Workforce

INTRODUCTION

Nurses are now more likely to leave their current role in direct patient care than they were before the COVID-19 pandemic. Country culture and the organization of health care systems drive nurses' decisions to leave or stay in the profession.

METHODS

In a fall 2020 survey of nurse professional quality of life, a content analysis of responses to the open-ended question, "What has been challenging or rewarding during this pandemic experience?" was performed. Results were organized within Hofstede's Cultural Dimensions Theory.

RESULTS

Six hundred and fifty-six nurses across five countries responded to the question; 526 comments were analyzed. Most (53.6%) respondents were staff bedside nurses. Themes, such as Distress and Fatigue and Building and Experiencing Social Capital were found and understood to reflect cultural values and dimensions such as Uncertainty Avoidance and Power Distance.

DISCUSSION

Recommendations include strengthening culturally tailored leadership knowledge to inform and facilitate countries' nurse retention.

Errors in Radiology: A Standard Review

Radiological interpretations, while essential, are not infallible and are best understood as expert opinions formed through the evaluation of available evidence. Acknowledging the inherent possibility of error is crucial, as it frames the discussion on improving diagnostic accuracy and patient care. A comprehensive review of error classifications highlights the complexity of diagnostic errors, drawing on recent frameworks to categorize them into perceptual and cognitive errors, among others. This classification underpins an analysis of specific error types, their prevalence, and implications for clinical practice. Additionally, we address the psychological impact of radiological practice, including the effects of mental health and burnout on diagnostic accuracy. The potential of artificial intelligence (AI) in mitigating errors is discussed, alongside ethical and regulatory considerations in its application. This research contributes to the body of knowledge on radiological errors, offering insights into preventive strategies and the integration of AI to enhance diagnostic practices. It underscores the importance of a nuanced understanding of errors in radiology, aiming to foster improvements in patient care and radiological accuracy.

Willingness to pay for improved working conditions of nurses: Results from a factorial survey experiment in Germany

BACKGROUND

Many countries face substantial shortages of skilled nurses. With an aging population and global demographic changes, developing a skilled workforce of nurses has become one of the central challenges for public health care. The recent COVID-19 pandemic has exacerbated labor shortages, which pose a threat to the quality of publicly provided health care. Improving nurses' working conditions could be a means by which to address the global shortages of nurses. However, in countries with public health care, such improvements may come with additional costs in the form of higher taxes or social security contributions. Therefore, such improvements partly depend on people's willingness to pay (WTP) for them.

OBJECTIVE

In this paper, we investigate workers' willingness to pay for improvements in the working conditions of nurses.

DESIGN

This study is a factorial survey experiment included as part of an online survey.

SETTING(S)

The factorial survey experiment was implemented within the high-frequency online panel survey "Life and Employment in Times of Corona" (IAB-HOPP) conducted by the Institute for Employment Research (Germany).

PARTICIPANTS

We analyze data from N = 2128 survey participants; our main analysis consists of N = 6384 responses from those participants.

METHODS

Our research is based on a factorial survey experiment (vignette analysis) designed to quantitatively measure the willingness to pay for various improvements in the working conditions of nurses. We use random effect models and mixed models to estimate the individual-level willingness to pay for these improvements.

RESULTS

Our results show that the survey participants are generally willing to pay for particular policies aimed at improving the working conditions of nurses. However, the amount that respondents are willing to pay varies with the type of policy changes. Survey participants exhibit a high willingness to pay for increases in minimum wages for nurses and wage-related improvements in general. We find, however, a lower willingness to pay for the right to participate in training courses aimed at reducing work-related stress.

CONCLUSIONS

The broad support for improvements in the working conditions of nurses provides policymakers with some guidance in implementing policy measures that might address labor shortages in the nursing sector.

REGISTRATION

There was no preregistration.

TWEETABLE ABSTRACT

Many people are willing to pay extra to improve the working conditions of nurses. Wage-related increases for nurses show the highest willingness to pay.

Influence of Nurses' Perceptions of Government Policies and COVID-19 Risks on Their Mental Health Status: A Web-Based Cross-Sectional Study

This study aimed to understand nurses' perceptions of COVID-19-related policies and risks during the outbreak of COVID-19 in Hong Kong and to determine how their perceptions influenced their mental health status. A web-based online survey among Hong Kong nurses was conducted. The questionnaire included a self-designed 5-point Likert scale with 17 items to assess the nurses' perceptions of COVID-19-related policies and risks, as well as the Davidson Trauma Scale (DTS), the Perceived Stress Scale (PSS), the Patient Health Questionnaire-2 (PHQ-2) and the Generalised Anxiety Disorder scale (GAD) for measurement of posttraumatic stress disorder (PTSD), stress, depression and anxiety, respectively. Of 592 nurses enrolled, 30.6% had PTSD (DTS total score ≥40), and 80.4%, 19.9% and 16.4% had moderate-to-high levels of stress (PSS-10 score ≥14), depression (PHQ-2 score ≥3) and anxiety (GAD score ≥3), respectively. The top three concerned aspects were 'worried about themselves and friends to suffer this disease' (84.5%), 'insufficient number of isolation wards' (81.8%) and 'insufficient number of personal protective equipment' (74.3%). Logistic regression analyses showed that more negative perception on 'personal protective equipment in the healthcare institutions', 'the confidence in HK's control of COVID-19', 'worried about themselves and friends to suffer this disease' and 'self-perceived risk of infection' indicated higher severity of the four mental health problems (all p < 0.01). The perception on 'public gathering ban', 'the number of isolation wards' and 'expected time to control COVID-19' were significantly associated with PTSD and stress (all p < 0.05). Nurses' perception on government policies and COVID-19 risks played an important role in predicting their mental health status. Policy makers should be aware of nurses' psychological responses and provide timely and targeted emotional support to nurses amid and after the COVID-19 pandemic.

Influencing factors on the psychosomatic health of medical staff since the normalized stage of COVID-19 in mainland China

BACKGROUND

During the coronavirus disease 2019 (COVID-19) pandemic, there were under-recognized and unaddressed psychosomatic health problems among medical staff. The purpose of this study was to investigate their psychosomatic status.

METHODS

An online questionnaire was performed to the medical staff of major hospitals in Jinan in January 2023. In total, 1244 valid questionnaires were collected, and their psychosomatic status was assessed by the Psychosomatic Symptom Scale (PSSS) and Perceived Stress Scale-10 (PSS-10). Finally, we analyzed the influencing factors for their psychosomatic status.

RESULTS

The psychological health of the medical staff was poor, and the level of stress perception was intense, accompanied by obvious psychosomatic symptoms. Regression analysis indicated that age, gender, frontline involvement, work experience, marriage, presence of disease history and COVID-19 infection history were risk factors for psychosomatic symptoms, while education, frontline involvement and presence of disease history were risk factors for stress feeling.

CONCLUSION

Medical staff often showed obvious psychosomatic symptoms and intense stress. Psychological health education and intervention should be given in order to improve their working quality.

Efficacy of the my health too online cognitive behavioral therapy program for healthcare workers during the COVID-19 pandemic: A randomized controlled trial

Background

Healthcare workers' mental health has been impacted by the COVID-19 pandemic, emphasizing the need for mental health interventions in this population. Online cognitive behavioral therapy (CBT) is efficient to reduce stress and may reach numerous professionals. We developed "MyHealthToo", an online CBT program to help reduce stress among healthcare workers during the COVID-19 pandemic.

Objective

The aim of our study is to investigate the efficacy of an online CBT program on stress and mental health conditions among healthcare workers during a health crisis.

Methods

We performed a multicentric randomized controlled trial among 155 participants allocated either to the experimental or active control group (bibliotherapy). The primary outcome was the decrease of perceived stress scores (PSS-10) post-treatment. Secondary outcomes included depression, insomnia and PTSD symptoms along with self-reported resilience and ruminations. Assessments were scheduled pretreatment, mid-treatment (4 weeks), post-treatment (8 weeks), and at 1-month and 4-months follow-up.

Results

For both interventions, mean changes on the PSS-10 were significant post-therapy (W8), as at 1-month (W12) and 4-months (W24) follow-ups. The between-group comparison showed no difference at any time point (ps > 0.88). Work-related ruminations significantly decreased in the experimental group with a significant between-group difference at W8 (Δ = -1.83 [-3.57; -0.09], p = 0.04). Posttraumatic stress symptoms significantly decreased in the experimental group with a significant between-group difference at W12 (Δ = -1.41 [-2.68; -0.14], p = 0.03). The decrease in work-related ruminations at W8 mediated the decrease in posttraumatic stress symptoms at W12 (p = 0.048).

Conclusion

The "MyHealthToo" online CBT intervention may help reduce ruminations about work and posttraumatic stress symptoms among healthcare workers during a major health crisis. Work-related ruminations may represent a relevant target of online interventions to improve mental health among healthcare workers.

A latent profile analysis of psychological resilience associated with work fatigue among Chinese nurses

Nurses' psychological resilience has been studied using a variable-centered rather than a person-centered approach, impeding a comprehensive understanding of the holistic expression of these different forms of psychological resilience. This study aimed to examine the characteristics of psychological resilience in a sample of Chinese nurses during COVID-19 using latent profile analysis (LPA) and the relationships between these unique profiles and nurses' work fatigue. A total of 471 Chinese nurses were recruited from three hospitals in Hebei Province between June and July 2020. The participant samples were investigated with the psychological resilience scale and the work fatigue inventory. LPA showed that a three-profile model of psychological resilience best fit this study. The resulting profiles were low psychological resilience, medium psychological resilience, and high psychological resilience. Notably, there were significant differences in nurses' work fatigue among different profiles of psychological resilience. The study provided a new view of nurses' psychological resilience, which may be used to effectively reduce nurses' work fatigue and evaluate nursing work status comprehensively.

Work engagement and sense of coherence as predictors of psychological distress during the first phase of the COVID-19 pandemic in Chile

Objectives

The aim of this study was to analyse the relationship between sense of coherence, work engagement, and work environment variables as predictors of the level of psychological distress during the first phase of the COVID-19 pandemic in Chile.

Methods

Cross-sectional descriptive study collected between April 22 and December 16, 2020, using non-probabilistic snowball sampling. The study variables and instruments were socio-demographic variables, work engagement (UWES-9 scale), sense of coherence (Antonovsky SOC-13 scale), and psychological distress (GHQ-12 scale). Multivariate analysis and binary logistic regression were performed including the scores of the three questionnaires and other variables such as effectiveness, safety, stress, health perception, and sex. Finally, the CHAID technique was applied to create a segmentation tree.

Results

72.7 % of participants had high levels of psychological distress, more predominantly among women, with work stress and low sense of coherence acting as the most influential mediators in generating psychological distress, and even more so when both were combined. Low work engagement and the availability of safe and effective means to prevent infection were predictors of psychological distress among workers.

Conclusion

During the first phase of the COVID-19 pandemic, factors that contributed to psychological distress in the Chilean population were identified. These included a fair or poor perception of health, being a woman, work-related stress, availability of safety measures, low level of work engagement, and low level of sense of coherence. Identifying these factors may help prevent similar effects in future phases of the current pandemic or in future pandemics.

Determinants of burnout in Canadian health care workers during the COVID-19 pandemic

Background: Health care workers (HCWs) are among the most vulnerable groups to experience burnout during the coronavirus (COVID-19) pandemic. Understanding the risk and protective factors of burnout is crucial in guiding the development of interventions; however, the understanding of burnout determinants in the Canadian HCW population remains limited.Objective: Identify risk and protective factors associated with burnout in Canadian HCWs during the COVID-19 pandemic and evaluate organizational factors as moderators in the relationship between COVID-19 contact and burnout.Methods: Data were drawn from an online longitudinal survey of Canadian HCWs collected between 26 June 2020 and 31 December 2020. Participants completed questions pertaining to their well-being, burnout, workplace support and concerns relating to the COVID-19 pandemic. Baseline data from 1029 HCWs were included in the analysis. Independent samples t-tests and multiple linear regression were used to evaluate factors associated with burnout scores.Results: HCWs in contact with COVID-19 patients showed significantly higher likelihood of probable burnout than HCWs not directly providing care to COVID-19 patients. Fewer years of work experience was associated with a higher likelihood of probable burnout, whereas stronger workplace support, organizational leadership, supervisory leadership, and a favourable ethical climate were associated with a decreased likelihood of probable burnout. Workplace support, organizational leadership, supervisory leadership, and ethical climate did not moderate the associations between contact with COVID-19 patients and burnout.Conclusions: Our findings suggest that HCWs who worked directly with COVID-19 patients, had fewer years of work experience, and perceived poor workplace support, organizational leadership, supervisory leadership and ethical climate were at higher risk of burnout. Ensuring reasonable work hours, adequate support from management, and fostering an ethical work environment are potential organizational-level strategies to maintain HCWs' well-being.

Mapping the needs of healthcare workers caring for COVID-19 patients using the socio-ecological framework: a rapid scoping review

Undoubtedly, the mental health of healthcare workers (HCWs) was negatively affected because of caring for patients during the COVID-19 pandemic. However, literature is limited on mapping the challenges and needs of HCWs during COVID-19 pandemic. A widely used framework in public health for mapping evidence includes the socio-ecological models, suggesting behavior can be influenced by individual, interpersonal, organizational, and community factors. The aim of this rapid scoping review was to use the socio-ecological model to map and compile lessons learnt from the literature regarding primarily the challenges and needs and secondly available psychological interventions for HCWs caring for COVID-19 patients. PubMed, CINAHL and Scopus databases were searched, with 21 studies finally included examining challenges and needs of HCWs and 18 studies presenting psychological interventions. Organizational-level challenges and needs such as inadequate staff preparation and supplies of protective equipment, flexible work policies and paid rest periods were the most reported. Individual-level challenges and needs included COVID-19-related fears and reduced mental health, whereas interpersonal-related needs included support provision. Community-level challenges included societal stigma. Certain psychological interventions were found to be promising for HCWs, but these were utilized to address only individual-level challenges and needs. Given that well-being entails an interaction of factors, multi-level interventions addressing multiple socio-ecological levels (interpersonal, organizational, community) and that place HCWs in their social context should be administrated to increase and maintain intervention' effects long-term and possibly aid in better coping with future pandemics.

Mental health and insomnia problems in healthcare workers after the COVID-19 pandemic: A multicenter cross-sectional study

BACKGROUND

Healthcare workers (HCWs) are at increased risk of contracting coronavirus disease 2019 (COVID-19) as well as worsening mental health problems and insomnia. These problems can persist for a long period, even after the pandemic. However, less is known about this topic.

AIM

To analyze mental health, insomnia problems, and their influencing factors in HCWs after the COVID-19 pandemic.

METHODS

This multicenter cross-sectional, hospital-based study was conducted from June 1, 2023 to June 30, 2023, which was a half-year after the end of the COVID-19 emergency. Region-stratified population-based cluster sampling was applied at the provincial level for Chinese HCWs. Symptoms such as anxiety, depression, and insomnia were evaluated by the Generalized Anxiety Disorder-7, Patient Health Questionnaire-9, and Insomnia Severity Index. Factors influencing the symptoms were identified by multivariable logistic regression.

RESULTS

A total of 2000 participants were invited, for a response rate of 70.6%. A total of 1412 HCWs [618 (43.8%) doctors, 583 (41.3%) nurses and 211 (14.9%) nonfrontline], 254 (18.0%), 231 (16.4%), and 289 (20.5%) had symptoms of anxiety, depression, and insomnia, respectively; severe symptoms were found in 58 (4.1%), 49 (3.5%), and 111 (7.9%) of the participants. Nurses, female sex, and hospitalization for COVID-19 were risk factors for anxiety, depression, and insomnia symptoms; moreover, death from family or friends was a risk factor for insomnia symptoms. During the COVID-19 outbreak, most [1086 (76.9%)] of the participating HCWs received psychological interventions, while nearly all [994 (70.4%)] of them had received public psychological education. Only 102 (7.2%) of the HCWs received individual counseling from COVID-19.

CONCLUSION

Although the mental health and sleep problems of HCWs were relieved after the COVID-19 pandemic, they still faced challenges and greater risks than did the general population. Identifying risk factors would help in providing targeted interventions. In addition, although a major proportion of HCWs have received public psychological education, individual interventions are still insufficient.

Study Protocol for the Residents' Mental Health Investigation, a Dynamic Longitudinal Study in Italy (ReMInDIt)

Medical residents constitute a vulnerable population susceptible to mental health disorders. In Italy, this was evident during the COVID-19 pandemic, when medical residents served on the front line and provided significant support to healthcare services. Therefore, the working group on "Public Mental Health" of the Medical Residents' Council of the Italian Society of Hygiene, Preventive Medicine, and Public Health (S.It.I.) designed the "Residents' mental health investigation, a dynamic longitudinal study in Italy" (ReMInDIt). This longitudinal study aims to assess the mental status of medical residents and to explore potential cause-effect relationships between risk/protective factors (identified among sociodemographic, residency program, and lifestyle characteristics) and mental health outcomes (anxiety and depressive symptoms). Data will be collected from a study population of 3615 residents enrolled in Italian residency programs in public health, occupational medicine, and forensic medicine through an online questionnaire that includes validated tools, requires 10 min for completion, and is disseminated by the residents' Councils. It will be followed by a follow-up administration after 12 months. The ReMInDIt study will play a significant role in generating evidence crucial for enhancing mental health services and promoting protective factors for the mental well-being of this important segment of healthcare professionals.

Trajectories of symptoms of depression, distress, and resilience in healthcare workers during the COVID-19 pandemic and toward its end in Czechia

BACKGROUND AND OBJECTIVES

The mental health of healthcare workers (HCWs) may have improved after the COVID-19 pandemic. We aimed to model the trajectories of psychological distress, depressive symptoms, and resilience during the COVID-19 pandemic and toward its end in HCWs in Czechia and investigate, which COVID-19 work stressors were associated with these trajectories.

METHODS

The study included 322 HCWs from the Czech arm of the international HEROES Study who participated in an online questionnaire in two waves during the pandemic and one wave toward its end. Growth mixture modeling identified trajectory patterns of depressive symptoms (measured with Patient Health Questionnaire), distress (General Health Questionnaire), and resilience (Brief Resilience Scale). Logistic regression was applied to estimate the association of COVID-19 stressors with mental health trajectories, adjusting for baseline characteristics.

RESULTS

Trajectory classes revealed both high and low depressive symptoms (high in 61% of participants), distress (high in 82% of participants), and resilience (low in 32% of participants). Depressive symptoms and distress trajectories demonstrated the same shape, first increasing during the pandemic and decreasing toward its end, while resilience remained constant. Exposure to COVID-19 stressors, in particular, the experience of stigmatization, discrimination, and violence, was associated with high depressive symptoms and distress trajectories, but not with resilience.

CONCLUSIONS

Interventions provided to HCWs during crises such as pandemic should target distress and depressive symptoms and need to address stigmatization, discrimination, and violence.

Stress, anxiety, depression and sleep disturbance among healthcare professional during the COVID-19 pandemic: An umbrella review of 72 meta-analyses

The outbreak of SARS-CoV-2, which causes COVID-19, has significantly impacted the psychological and physical health of a wide range of individuals, including healthcare professionals (HCPs). This umbrella review aims provide a quantitative summary of meta-analyses that have investigated the prevalence of stress, anxiety, depression, and sleep disturbance among HCPs during the COVID-19 pandemic. An umbrella review of systematic reviews and meta-analyses reviews was conducted. The search was performed using the EMBASE, PubMed, CINAHL, MEDLINE, PsycINFO, and Google Scholar databases from 01st January 2020 to 15th January 2024. A random-effects model was then used to estimate prevalence with a 95% confidence interval. Subgroup analysis and sensitivity analyses were then conducted to explore the heterogeneity of the sample. Seventy-two meta-analyses involved 2,308 primary studies were included after a full-text review. The umbrella review revealed that the pooled prevalence of stress, anxiety, depression, and sleep disturbance among HCPs during the COVID-19 pandemic was 37% (95% CI 32.87-41.22), 31.8% (95% CI 29.2-34.61) 29.4% (95% CI 27.13-31.84) 36.9% (95% CI 33.78-40.05) respectively. In subgroup analyses the prevalence of anxiety and depression was higher among nurses than among physicians. Evidence from this umbrella review suggested that a significant proportion of HCPs experienced stress, anxiety, depression, and sleep disturbance during the COVID-19 pandemic. This information will support authorities when implementing specific interventions that address mental health problems among HCPs during future pandemics or any other health crises. Such interventions may include the provision of mental health support services, such as counseling and peer support programs, as well as the implementation of organizational strategies to reduce workplace stressors.

The Relationship Between Psychological Conditions and Gastrointestinal Symptoms of Medical Students During the COVID-19 Pandemic

Objective

This study aims to explore the nexus between students' psychological well-being and the manifestation of gastrointestinal symptoms (GISs) amid the health lockdown enforced in Xi'an, focusing on the student populace of Xi'an Medical College and Shaanxi University of Traditional Chinese Medicine.

Materials and methods

A survey encompassing psychological parameters and GISs was administered to a randomized cohort of 1327 college students drawn from Xi'an Medical College and Shaanxi University of Traditional Chinese Medicine. The survey instrument was developed utilizing the Questionnaire Star platform. Subsequent to data collection, analysis was performed using GraphPad Prism 9 and SPSS 22.0.

Results

Comparative analysis revealed statistically significant disparities (P < 0.05) in various GISs between the periods during and preceding the health lockdown, encompassing symptoms such as nausea/vomiting, acid reflux, postprandial fullness/early satiety, anorexia, decreased appetite, bloating, abdominal discomfort, abdominal pain, diarrhea, and constipation. Notably, the mean score for Generalized Anxiety Disorder 7 (GAD-7) was 3.31±3.92, indicating mild anxiety, while the mean score for Patient Health Questionnaire-2 (PHQ-2) was 1.15±1.28, suggesting mild depression. Detailed evaluation of anxiety revealed prevalence rates of 34% among respondents, with 34.2% of these individuals reporting concurrent GISs, while among those evaluated for depression (38.8% of the sample), 44.2% reported concurrent GISs. Furthermore, multiple linear regression analysis unveiled a negative correlation between GISs during the health lockdown and lifestyle scores, while positive correlations were observed with GISs preceding the lockdown, anxiety, and depression. The formulated multiple linear regression equation for GISs during the health lockdown is delineated as follows: 14.693-0.342 life style + 0.725GISs before health lockdown + 0.218anxiety + 0.564 depression.

Conclusion

This investigation underscores the substantial impact of anxiety and depression on the student body, accentuating their role in precipitating GISs during health lockdown situations. The psychological well-being of medical students during exigent circumstances such as natural disasters warrants heightened attention, necessitating proactive measures aimed at emotional regulation to mitigate the onset of GISs.

Remote Short Sessions of Heart Rate Variability Biofeedback Monitored With Wearable Technology: Open-Label Prospective Feasibility Study

BACKGROUND

Heart rate variability (HRV) biofeedback is often performed with structured education, laboratory-based assessments, and practice sessions. It has been shown to improve psychological and physiological function across populations. However, a means to remotely use and monitor this approach would allow for wider use of this technique. Advancements in wearable and digital technology present an opportunity for the widespread application of this approach.

OBJECTIVE

The primary aim of the study was to determine the feasibility of fully remote, self-administered short sessions of HRV-directed biofeedback in a diverse population of health care workers (HCWs). The secondary aim was to determine whether a fully remote, HRV-directed biofeedback intervention significantly alters longitudinal HRV over the intervention period, as monitored by wearable devices. The tertiary aim was to estimate the impact of this intervention on metrics of psychological well-being.

METHODS

To determine whether remotely implemented short sessions of HRV biofeedback can improve autonomic metrics and psychological well-being, we enrolled HCWs across 7 hospitals in New York City in the United States. They downloaded our study app, watched brief educational videos about HRV biofeedback, and used a well-studied HRV biofeedback program remotely through their smartphone. HRV biofeedback sessions were used for 5 minutes per day for 5 weeks. HCWs were then followed for 12 weeks after the intervention period. Psychological measures were obtained over the study period, and they wore an Apple Watch for at least 7 weeks to monitor the circadian features of HRV.

RESULTS

In total, 127 HCWs were enrolled in the study. Overall, only 21 (16.5%) were at least 50% compliant with the HRV biofeedback intervention, representing a small portion of the total sample. This demonstrates that this study design does not feasibly result in adequate rates of compliance with the intervention. Numerical improvement in psychological metrics was observed over the 17-week study period, although it did not reach statistical significance (all P>.05). Using a mixed effect cosinor model, the mean midline-estimating statistic of rhythm (MESOR) of the circadian pattern of the SD of the interbeat interval of normal sinus beats (SDNN), an HRV metric, was observed to increase over the first 4 weeks of the biofeedback intervention in HCWs who were at least 50% compliant.

CONCLUSIONS

In conclusion, we found that using brief remote HRV biofeedback sessions and monitoring its physiological effect using wearable devices, in the manner that the study was conducted, was not feasible. This is considering the low compliance rates with the study intervention. We found that remote short sessions of HRV biofeedback demonstrate potential promise in improving autonomic nervous function and warrant further study. Wearable devices can monitor the physiological effects of psychological interventions.

AI-Led Mental Health Support (Wysa) for Health Care Workers During COVID-19: Service Evaluation

BACKGROUND

The impact that the COVID-19 pandemic has had on health care workers' mental health, in particular, cannot be ignored. Not only did the pandemic exacerbate mental health challenges through elevated stress, anxiety, risk of infection, and social isolation, but regulations to minimize infection additionally hindered the conduct of traditional in-person mental health care.

OBJECTIVE

This study explores the feasibility of using Wysa, an artificial intelligence-led mental health app, among health care workers.

METHODS

A national tertiary health care cluster in Singapore piloted the use of Wysa among its own health care workers to support the management of their mental well-being during the pandemic (July 2020-June 2022). The adoption of this digital mental health intervention circumvented the limitations of in-person contact and enabled large-scale access to evidence-based care. Rates and patterns of user engagement were evaluated.

RESULTS

Overall, the opportunity to use Wysa was well-received. Out of the 527 staff who were onboarded in the app, 80.1% (422/527) completed a minimum of 2 sessions. On average, users completed 10.9 sessions over 3.80 weeks. The interventions most used were for sleep and anxiety, with a strong repeat-use rate. In this sample, 46.2% (73/158) of health care workers reported symptoms of anxiety (Generalized Anxiety Disorder Assessment-7 [GAD-7]), and 15.2% (24/158) were likely to have symptoms of depression (Patient Health Questionnaire-2 [PHQ-2]).

CONCLUSIONS

Based on the present findings, Wysa appears to strongly engage those with none to moderate symptoms of anxiety. This evaluation demonstrates the viability of implementing Wysa as a standard practice among this sample of health care workers, which may support the use of similar digital interventions across other communities.

Prevalence and correlates of mental health problems among different occupations of medical workers during COVID-19 outbreak in China

Background

Health workers involved in the fight to prevent the COVID-19 outbreak were exposed to hazards. Detailed information on mental health problems in different medical occupations is crucial. To examined the prevalence of mental health issues in three medical occupations as well as the relationships between mental health problems and correlates in each occupation.

Methods

This study utilizing the Questionnaire Star program was conducted among medical workers working at medical institutions in China from February 17 to 24, 2020. The Self-Reporting Questionnaire (SRQ-20), the Zung Self-rating Anxiety Scale (SAS), and the Zung Self-rating Depression Scale (SDS) were used to assess mental health problems.

Results

The prevalence of any mental health problems in the three occupations was 43.6, 34.6, and 32.9% for nurses, paramedical workers (PMWs), and doctors, respectively. Three occupations shared some correlates, such as being overworked, not having enough time to rest, support from colleagues, and previous mental health status. There were specific factors for each occupation. For doctors, age, educational level, living status, support from family, and previous physical status were related factors in mental health problems. Working in a designated hospital for treating COVID-19, having COVID-19 event exposures, and receiving support from family were associated with the mental health problems of the nurses. PMWs' mental health problems was linked to educational level and care from supervisors or heads of department.

Conclusion

Different medical occupations have distinct impacts on mental health issues. Policy makers and mental health professionals working to prepare for potential disease outbreaks should be aware of multiple factors in different occupations.

Interventions to reduce burnout and improve the mental health of nurses during the COVID-19 pandemic: A systematic review of randomised controlled trials with meta-analysis

This systematic review aims to investigate and determine the effectiveness of interventions on improving mental health (anxiety, depression, stress or mental well-being) and/or reducing burnout of nurses working in hospitals during the COVID-19 pandemic. A search was conducted on studies from conception to December 2022 in databases: PubMed, Embase, Cochrane Central Register of Controlled Trials, CINAHL, PsycINFO, Scopus and Web of Science and in ProQuest Thesis & Dissertations Global Database, Google Scholar and ClinicalTrials.gov. A total of 17 randomised controlled trials that evaluated different interventions were included. The outcomes were anxiety (n = 11), depression (n = 5), stress (n = 13) mental well-being (n = 7) and burnout (n = 7). Not all interventions led to positive outcomes. Grading of Recommendations Assessment, Development and Evaluation (GRADE) appraisal and risk of bias assessment using the Cochrane tool for randomised controlled trials (RoB 2.0) revealed poor quality of currently available literature, with low to very low certainty. Meta-analysis showed high heterogeneity among the five different outcomes, with subgroup analysis showing greater success in interventions conducted on nurses involved in the care of COVID-19 patients. More well-designed trials are necessary to reinforce current evidence to improve the mental health of nurses, to not only protect their quality of life but also to ensure the quality of patient care.

Validation of the Pandemic Grief Risk Factors and Its Relationship With Work-Related Stress and Grief Reaction Among Healthcare Workers Who Witnessed Patient Deaths

BACKGROUND

The Pandemic Grief Risk Factors (PGRFs) was developed as a self-report tool to compile a comprehensive list of unique risk factors related to grief when experiencing a coronavirus disease 2019 (COVID-19) loss. We explored the reliability and validity of the PGRF among healthcare workers who witnessed their patients' deaths during the COVID-19 pandemic. Further, we examined whether the general severity of PGRF may have been associated with work-related stress and pandemic grief reactions.

METHODS

An online survey was conducted among tertiary hospital healthcare workers (doctors and nursing professionals) who had witnessed the deaths of patients they cared for. Pandemic Grief Scale for healthcare workers, the Stress and Anxiety to Viral Epidemics-3 items, the Patient Health Questionnaire-9, and the Generalized Anxiety Disorder-7 responses were collected.

RESULTS

In total, 267 responses were analyzed. The single-factor structure of the Korean version of the PGRF showed a good fit for the model. The scale demonstrated good internal consistency and convergent validity with other depression and anxiety rating scales. The mediation analysis revealed that work-related stress directly influenced pandemic grief reactions positively, and depression, anxiety, and general severity of grief risk factors partially mediated the association positively.

CONCLUSION

Among healthcare workers who witnessed the deaths of their patients due to COVID-19, the Korean version of the PGRF was valid and reliable for measuring the overall severity of PGRF. The PGRF can be used to identify individuals at risk for dysfunctional grief.

A latent profile analysis of doctors' joy in work at public hospitals

Introduction

When doctors' work stress increases, their joy in work decreases, severely affecting the quality of care and threatening patient safety. Analysis of the latent categories of joy in work of doctors in public hospitals and the differences in the characteristics of each category can help uncover hidden messages that enhance doctors' joy in work.

Methods

Questionnaires were administered to 426 doctors working in public hospitals using the general information questionnaire and the public hospital doctor's joy in work evaluation scale. Upon identifying their potential categories using latent profile analysis, chi-square test, and multinomial logistic regression were performed to analyze the differences in the characteristics of each category.

Results

The 426 public hospital doctors could be divided into three potential categories: "low joy in work" (11.27%), "medium joy in work" (59.86%), and "high joy in work" (28.87%). Most of the doctors did not have much joy in work, with 71.13% of them having "low to medium joy in work." Doctors who work in secondary or tertiary hospitals, have a personnel agency or contract, and are older than 45 years are more likely to belong to the "low joy in work" category. Some of the protective factors are having an average monthly income (RMB) of 10,001-15,000 yuan and having a fair or good self-rated health status.

Conclusion

There are obvious classification characteristics of doctors' level of joy in work. Hospital managers can take commensurate actions to improve their joy in work, thereby improving patient safety and the quality of medical services.

Process evaluation of PsyCovidApp, a digital tool for mobile devices aimed at protecting the mental health of healthcare professionals during the COVID-19 pandemic: a mixed method study

Introduction

PsyCovidApp, a digital intervention aimed at safeguarding the mental health of healthcare workers during the COVID-19 pandemic, demonstrated in a randomized clinical trial to yield significant improvements solely among healthcare workers undergoing psychotherapy or receiving psychotropic medication.

Objectives

(1) To identify contextual factors and mechanisms of action that influenced the impact of PsyCovidApp during the aforementioned trial; (2) To pinpoint enhancements for optimizing its efficacy.

Materials and methods

For the first objective, a process evaluation was conducted, amalgamating quantitative techniques (surveying 216 healthcare professionals who had utilized PsyCovidApp during the trial) and qualitative methods (in-depth interviews with 16 healthcare workers). The second objective involved a panel of seven experts, utilizing the RAND-UCLA methodology.

Results

The quantitative study (response rate = 40%) revealed that 22% of respondents had not fully accessed the content of PsyCovidApp. The average usage time was 22.7 min/day, being higher (p < 0.05) among consumers of psychotropic medications. Contents related to relaxation and mindfulness were most highly rated. Acceptability and usefulness scores ranged between 7.3-7.5/10 points, with higher ratings (p < 0.05) among women and older healthcare workers. The qualitative study uncovered that the primary barriers to using PsyCovidApp were workload, lack of time, and exhaustion. Its primary mechanisms of action included emotion identification, mental health regulation (e.g., insomnia, intense emotions), and learning of techniques and skills. The expert panel reached a consensus on 29 proposals to optimize PsyCovidApp.

Conclusion

The knowledge derived from this study could inform the design and implementation of future similar digital tools.

Effects of mindfulness-based interventions on reducing psychological distress among nurses: A systematic review and meta-analysis of randomized controlled trials

PURPOSE

Nurses increasingly use mindfulness as an effective mental health intervention to reduce psychological distress. The effectiveness of mindfulness-based interventions remains inconclusive, which may lead to implementation of interventions in an inefficient or ineffective manner. This study aimed to examine the effects of mindfulness-based interventions on reducing stress, anxiety, and depression among nurses.

DESIGN

Systematic review and meta-analysis.

METHODS

Randomized controlled trials (RCTs) were searched using six databases published through May 20, 2023, which evaluated the effects of mindfulness-based interventions on reducing psychological distress among nurses. To assess the quality of methodology included in the RCTs, version 2 of the Cochrane risk-of-bias instrument for RCTs with five domains was used. Standardized mean difference (SMD) with 95% confidence interval (CI) were calculated using the random-effects model in the meta-analyses. Publication bias was assessed using Egger's regression test. Further, the robustness effect size of the pooled analysis was assessed using leave-one-out sensitivity analysis.

FINDINGS

A total of 16 RCTs were included in the final analysis. Overall, the modalities appeared to alleviate stress (pooled SMD: -0.50 [95% CI: -0.82 to -0.18]; p < 0.001) and depression (pooled SMD: -0.42 [95% CI: -0.78 to -0.06]; p = 0.02) among nurses.

CONCLUSION

Mindfulness-based interventions appear to alleviate stress and depression in nurses. Future research evaluating mindfulness-based interventions among working nurses with more rigorous methodological and larger sample size.

CLINICAL RELEVANCE

Support for nurses' mental health must be included while implementing personal and professional development plans.

"Trust people you've never worked with" - A social network visualization of teamwork, cohesion, social support, and mental health in NHS Covid personnel

Background

The unprecedented rapid re-deployment of healthcare workers from different care pathways into newly created and fluid COVID-19 teams provides a unique opportunity to examine the interaction of many of the established non-technical factors for successful delivery of clinical care and teamwork in healthcare settings. This research paper therefore aims to address these gaps by qualitatively exploring the impact of COVID work throughout the pandemic on permanent and deployed personnel's experiences, their ability to effectively work together, and the effect of social dynamics (e.g., cohesion, social support) on teamwork and mental health.

Methods

Seventy-five interviews were conducted across the UK between March and December 2021 during wave 2 and 3 of COVID-19 with 75 healthcare workers who were either permanent staff on Intensive Care/High Dependency Units used as COVID wards, had been rapidly deployed to such a ward, or had managed such wards. Work Life Balance was measured using the WLB Scale. Interview transcripts were qualitatively coded and thematic codes were compared using network graph modeling.

Results

Using thematic network analysis, four overarching thematic clusters were found, (1) teamwork, (2) organizational support and management, (3) cohesion and social support, and (4) psychological strain. The study has three main findings. First, the importance of social factors for teamwork and mental health, whereby team identity may influence perceptions of preparedness, collaboration and communication, and impact on the collective appraisal of stressful events and work stressors. Secondly, it demonstrates the positive and negative impact of professional roles and skills on the development of teamwork and team identity. Lastly the study identifies the more pronounced negative impact of COVID work on deployed personnel's workload, mental health, and career intentions, exacerbated by reduced levels of social support during, and after, their deployment.

Conclusion

The thematic network analysis was able to highlight that many of the traditional factors associated with the successful delivery of patient care were impeded by pandemic constraints, markedly influencing personnel's ability to work together and cope with pandemic work stressors. In this environment teamwork, delivery of care and staff well-being appear to depend on relational and organizational context, social group membership, and psycho-social skills related to managing team identity. While results hold lessons for personnel selection, training, co-location, and organizational support during and after a pandemic, further research is needed into the differential impact of pandemic deployment on HCWs mental health and teamwork.

[Response to the COVID-19 Health Crisis from a Gender Perspective: Lessons Learned]

OBJECTIVE

To delve deeper from a gender perspective into the lessons learned during the COVID-19 pandemic to address future health crises.

METHOD

Study with key informants with experience in public health and gender from the Ministerio de Sanidad, ministries of the autonomous communities, Institut Català de la Salut, Hospital de La Princesa, Escuela Andaluza de Salud Pública and Universidad País Vasco.

SOURCE OF INFORMATION

individual open-ended questionnaire on health and health inequalities/gender inequalities related to COVID-19. After presenting the findings, the key informants group discussed them in a meeting until reaching a consensus on the lessons learned.

RESULTS

The lack of clinical statistics by sex could compromise epidemiological surveillance, losing the opportunity to characterize the disease. The performance of essential services fell more on women, exhausting them with double and triple shifts; with the differences according to sex in the clinical presentation of COVID-19, and the criteria for hospitalization/admission to the intensive care unit, their access to health care decreased. Increased: gender violence and mental health problems; delaying recognition of the second effects of vaccines in women; partially due to information biases in clinical trials. The gender perspective was lacking in academic, healthcare, and health management areas.

CONCLUSIONS

Women's gender dimensions determined their higher frequency of COVID-19 and played a fundamental role in its control. Broadly considering the lessons learned will strengthen prevention systems and be able to provide effective responses to future health crises.

Posttraumatic growth of medical staff during COVID-19 pandemic: A scoping review

BACKGROUND

The COVID-19 pandemic has imposed unprecedented stress and challenges upon medical staff, potentially resulting in posttraumatic growth (PTG). This scoping review aims to synthesize the existing knowledge on PTG among medical staff during the pandemic by identifying its current status and potential influencing factors. The findings may provide a foundation for future research and interventions to enhance the medical staff's psychological resilience and well-being.

METHODS

Literature was systematically searched on PTG among medical staff during the COVID-19 pandemic from 01 January 2020 to 31 December 2022. The following databases were searched: PubMed, Web of Science, Embase, CINAHL, PsycINFO, Cochrane Library, China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Service System (SinoMed), and Wanfang Data. Eligibility criteria included: (1) medical staff as research subjects; (2) a focus on "posttraumatic growth" or "alternative posttraumatic growth" related to the COVID-19 outbreak and pandemic; (3) discussion of the situation and influencing factors of PTG; and (4) study types, such as qualitative, quantitative, and mixed methods. Two researchers independently selected and extracted study characteristics (study design, study population, region, measurement instruments, and primary outcomes) from the included literature. The data were synthesized qualitatively and descriptively.

RESULTS

Thirty-six papers from 12 countries met the inclusion criteria. Moderate PTG levels were observed among healthcare workers during the COVID-19 pandemic, with emphasis on "interpersonal relationships," "changes in life philosophy," and "growth in personal competence." Influencing factors included trauma exposure, sociodemographics, psychological characteristics (resilience and positive qualities), coping, and social support.

CONCLUSIONS

This review discovered moderate PTG levels among medical staff during the COVID-19 pandemic, with critical areas in interpersonal relationships, life philosophy, and personal competence. The identified influencing factors can inform future research and interventions to enhance healthcare workers' psychological resilience and well-being.

Attitudes and experiences related to the deaths of COVID-19 patients among nursing staff: A qualitative evidence synthesis

AIM

To identify and synthesize the experiences and attitudes of nursing staff regarding the deaths of COVID-19 patients.

REVIEW METHODS

A qualitative evidence synthesis was carried out, using Noblit and Hare's meta-ethnographic approach. The review protocol was listed in PROSPERO (CRD42022330928). Studies published from January 2020 to January 2022 that met the criteria were searched in PubMed, Web of Science, Scopus, CINAHL, CUIDEN and PsycInfo. A total of 12 articles were included.

RESULTS

Thirty-three metaphors emerged, which were grouped into three main themes: Determining factors of care, Feelings about death and Strategies for coping with death. Nurses reported the high emotional toll, the absence of family and the lack of staff, protocol and training as determining factors. Furthermore, staff had doubts about the quality of care that COVID-19 patients received. As coping strategies, nurses developed avoidance behaviours towards COVID-19 patients, selective memories, resilience, and/or leaving the profession.

CONCLUSIONS

The difficulty in providing adequate nursing care and the high number of deaths has increased anxiety and stress among nurses. These factors, alongside their lived experiences of seeing patients suffering, many dying alone without family members, have had psychological repercussions on nursing staff.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

The results demonstrate a high emotional toll and doubts surrounding their caregiving role caused by the lack of professional training needed to face a pandemic. This research shows what has been learned for future pandemics and highlights basic components that could provide a foundation for coping interventions for healthcare professionals.

IMPACT

WHAT PROBLEM DID THE STUDY ADDRESS?: The challenges posed by COVID-19 patient deaths for nursing staff around the world and also by the pandemic circumstances in which those deaths occurred. WHAT WERE THE MAIN FINDINGS?: The high number of deceased patients who were isolated from family members, communication with family members and doubts surrounding care given during the pandemic have created feelings of fear, stress and anxiety, as well as obsessive thoughts that have changed nursing staff's perception of death due to COVID-19. WHERE AND ON WHOM WILL THE RESEARCH HAVE AN IMPACT?: Results will be useful for preparing for future pandemics, and for policymakers and health staff in supporting healthcare professionals by creating programmes to help them cope with the emotional toll they have felt after dealing with death in such unprecedented circumstances.

REPORTING METHOD

The authors have adhered to the PRISMA guidelines and the eMERGe Reporting Guidance.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Psychological Burden of Systemic Racism-Related Distress in New York City Healthcare Workers During the COVID-19 Pandemic

BACKGROUND

Little is known about the relationship among systemic racism, psychological symptoms (depression, anxiety, and/or post-traumatic stress disorders), and burnout in healthcare workers (HCWs).

OBJECTIVE

To determine whether distress related to awareness of systemic racism contributes to psychological symptoms and/or burnout in HCWs. We explored whether this form of racism-related distress may moderate the relationship between race, ethnicity, psychological symptoms, and burnout.

DESIGN

A cross-sectional survey was conducted from November 19, 2020, through January 11, 2021. Statistical analysis was conducted from May 3, 2022, to June 15, 2022.

PARTICIPANTS

Frontline HCWs at an urban tertiary care hospital in New York City.

MAIN MEASURES

Distress related to awareness of systemic racism (SR) and racial disparities in COVID-19 outcomes (RD), psychological symptoms, and burnout.

KEY RESULTS

Two thousand one of 4654 HCWs completed the survey (response rate 43.0%). Most HCWs reported experiencing distress related to awareness of systemic racism (1329 [66.4%]) and to racial disparities in COVID-19 outcomes (1137 [56.8%]). Non-Hispanic Black participants (SR odds ratio (OR) 2.84, p < .001; RD OR 2.34, p < .001), women (SR OR 1.35, p = .01; RD OR 1.67, p < .001), and those with history of mental illness (SR OR 2.13, p < .001; RD OR 1.66, p < .001) were more likely to report SR- and RD-related distress, respectively. HCWs who experienced "quite-a-bit to extreme" SR-related distress were more likely to screen positive for psychological symptoms (OR 5.90, p < .001) and burnout (OR 2.26, p < .001).

CONCLUSIONS

Our findings suggest that distress related to awareness of systemic racism, not race/ethnicity, was associated with experiencing psychological symptoms and burnout in HCWs. As the medical community continues to critically examine the role of systemic racism in healthcare, our work is a first step in characterizing its toll on the psychological well-being of HCWs.

The nurse faculty role: A lived experience of mentoring nurses while coping with anxiety during the COVID-19 pandemic

WHAT IS KNOWN ON THE SUBJECT?: Anxiety is common in women, nurses and nurse educators and can negatively impact overall mental well-being and work-life satisfaction. Anxiety increased during the COVID-19 pandemic. Hope is a personal resource that can be employed to help cope with anxiety. Professional identity, 'our why', is important to recognize and revisit as a way to add value to daily work in anxious times. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Compassion fatigue has contributed to burnout and turnover of nurses and nursing faculty. Knowing our 'why' helps understand the motivation in our work. Using hope as a personal resource, and sharing my lived experience, could be useful to other nursing faculty struggling with anxiety. WHAT ARE THE IMPLICATIONS FOR MENTAL HEALTH NURSING?: There is a need for mental health resources within healthcare and education systems to support nurses and nurse educators not only during the COVID-19 pandemic but through future healthcare crises. Support programmes and interventions need to be developed to sustain and retain both nurses and nursing faculty.

ABSTRACT

BACKGROUND: Providing patient care and nurse education in today's healthcare environment is high-stress, often resulting in high-anxiety among both nurses and nurse educators. The impact of the COVID-19 pandemic on nurse faculty is largely unexplored.

AIMS

The aim was to share the experience of living and work working with anxiety in the nurse faculty role during the COVID-19 pandemic.

MATERIALS & METHODS

This is a lived experience narrative of one nurse faculty member.

RESULTS

Through daily purposeful self-motivation and reflection, yoga, and brief outdoor respites, the author was able to strengthen professional identity, to see value in her work and to activate the personal resource of hope (Nursing Management, 52, 2021, 56; Journal of Occupational and Organizational Psychology, 93, 2020, 187).

DISCUSSION

'Nursing faculty are essential to the profession' and likely experienced 'emotional exhaustion' during the pandemic (Nursing Education Perspectives, 42, 2021, 8) in their efforts to buoy students. It needs to be acknowledged that nursing faculty can experience anxiety, secondary trauma (International Journal of Environmental Research and Public Health, 17, 2020, 8358) and compassion fatigue, through listening to students' experiences and offering reinforcement during chaotic times.

CONCLUSION

Little is known about what nursing faculty experienced as they attempted to support students (Nursing Education Perspectives, 42, 2021, 285). It is hoped that by sharing this lived experience, nurses and nurse faculty will understand how employing hope as a personal resource and re-engaging with their professional identity will help them cope with the significant stresses that future healthcare pandemics or disasters may bring.

Mental health status and related factors influencing healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis

BACKGROUND

The mental health of healthcare workers during the coronavirus-2019 pandemic was seriously affected, and the risk of mental health problems was high. The present study sought to systematically evaluate the mental health problems of healthcare workers worldwide during the pandemic and to determine the latest global frequency of COVID-19 associated mental health problems.

METHODS

Data in the Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, Elsevier, MEDLINE, PubMed, PsycINFO and the Web of Science before November 11, 2022, were systematically searched. Cohort, case-control and cross-sectional studies were included. The meta-analysis used a random effects model to synthesize the comprehensive prevalence rate of mental health problems. Subgroup analyses were performed based on time of data collection; whether the country was or was not developed; continent; doctors and nurses; doctors/nurses vs. other healthcare workers; and psychological evaluation scale.

RESULTS

A total of 161 studies were included, including 341,014 healthcare workers worldwide, with women accounting for 82.8%. Occupationally, 16.2% of the healthcare workers were doctors, 63.6% were nurses and 13.3% were other medical staff. During the pandemic, 47% (95% confidence interval [CI], 35-60%) of healthcare workers reported job burnout, 38% (95% CI, 35-41%) experienced anxiety, 34% (95% CI 30-38%) reported depression, 30% (95% CI, 29-31%) had acute stress disorder, and 26% (95% CI, 21-31%) had post-traumatic stress disorder.

CONCLUSIONS

The study found that there were common mental health problems among health care workers during the COVID-19 pandemic. The most common was job burnout, followed by anxiety, depression, acute stress and post-traumatic stress disorder. Although the global pandemic has been brought under control, its long-term impact on the mental health of healthcare workers cannot be ignored. Additional research is required to develop measures to prevent, monitor and treat psychological disorders among healthcare workers.

Lived experiences of South African rehabilitation practitioners during coronavirus disease 2019

Background

In South Africa, the sharp rise in people with severe illness because of coronavirus disease 2019 (COVID-19) in early 2020, meant that health systems needed to adapt services and operations, including rehabilitation services. Important insights into the lived experiences of rehabilitation personnel enacting these adaptations in an African context are limited.

Objectives

The aim of this study was to explore the lived experiences of rehabilitation practitioners working in the public sector in South Africa during the COVID-19 pandemic.

Method

A phenomenological approach and a duo-ethnographic design were used. A recruitment letter was circulated requesting volunteers. Maximum variation sampling was used to select the 12 participants of this study. Data were collected through interviews via Zoom, and critical conversations were facilitated by a non-rehabilitation partner who is known for challenging health inequities. The interviews were audio-recorded and transcribed verbatim. Data were analysed through elements of qualitative content and thematic analysis. Data were coded, categorised, clustered into concepts and formulated into themes.

Results

Three themes were identified: (1) 'Management became the enemy', (2) 'Tired of being resilient' and (3) 'Think out of the box…think on our feet'.

Conclusion

The results of this study highlighted new ways of practice, innovative adaptations, and usage of resources and platforms.

Contribution

This study highlights the re-imagining of accessible rehabilitation services that could lead to deeper onto-epistemological shifts amongst the rehabilitation practitioners.

Nurses' coping strategies caring for patients during severe viral pandemics: A mixed-methods systematic review

BACKGROUND

Nurses play an essential role in responding to severe viral disease which bring considerable challenges to their personal and professional well-being. This subsequently can affect the delivery of care and healthcare systems' organisational capacity to respond. Understanding nurses' experiences of these challenges will help inform healthcare policies.

AIM

To explore the experiences and coping strategies of nurses caring for patients during severe viral disease pandemics.

DESIGN

A mixed-methods systematic review informed by the Joanna Briggs Institute (JBI) methodology.

METHODS

A mixed-methods systematic review. Five electronic databases Medline, CINAHL, PsychInfo, ASSIA and Scopus were searched on 4th April 2021. Results were reported in accordance with PRISMA. The findings were analysed and reported in the context of the Self-Regulatory Common-Sense Model.

RESULTS

In total, 71 peer-review primary research articles describing nurses' experiences of caring for patients during SARS, MERS, Swine flu H1N1, Avian influenza or SARS-CoV-2 / COVID-19 published in English from 2003 to 2021 were included. We found links between nurses' perception of the health threats, their emotional reactions, and coping strategies. Perceived health threats were influenced by organisational factors including frequent changes in clinical guidelines and workplace protocols, onerous workloads and working hours, unavailability of PPE, and lack of knowledge and training in pandemic management. These impacted nurses' physical, psychological and social well-being. Nurses also reported helpful and unhelpful coping strategies to manage the health threats.

CONCLUSIONS

It is vital for stakeholders, policymakers, government and healthcare institutions to recognise and monitor the wider impact on healthcare workers from health emergencies. In addition, support to develop and implement effective systems and individual mechanisms to offset the anticipated impact pre and post pandemics/epidemics is needed. Our findings can inform those strategies for similar future health emergencies.

RELEVANCE TO CLINICAL PRACTICE

Nurses are often the first point of contact in providing direct care to patients, hence they are at high risk of being infected. The findings from this review can help managers and policymakers in developing programmes to enhance resilience in the nursing workforce.

NO PATIENT OR PUBLIC CONTRIBUTION

This was a literature review study.

Self-help digital mental health intervention in improving burnout and mental health outcomes among healthcare workers: A narrative review

Background

Healthcare workers face burnout from high job demands and prolonged working conditions. While mental health services are available, barriers to access persist. Evidence suggests digital platforms can enhance accessibility. However, there is a lack of systematic reviews on the effectiveness of digital mental health interventions (DMHIs) for healthcare professionals. This review aims to synthesize evidence on DMHIs' effectiveness in reducing burnout, their acceptability by users, and implementation lessons learned.

Method

This Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA)-guided review included 12 RCTs on DMHIs for healthcare professionals, published before 31 May 2024. The primary focus was on burnout, with secondary outcomes related to mental health and occupation. Quality appraisal used Cochrane risk of bias tools. A narrative synthesis explored DMHIs' effectiveness, acceptability, utilization, and implementation lessons.

Results

Significant improvements in mental health outcomes were observed in 10 out of 16 RCTs. Burnout and its constructs showed significant improvement in five RCTs. Studies that measured the acceptability of the interventions reported good acceptability. Factors such as attrition, intervention design and duration, cultural sensitivities, flexibility and ease of use, and support availability were identified as key implementation considerations.

Conclusions

Web-based DMHIs positively impact burnout, mental health, and occupational outcomes among healthcare professionals, as shown in most RCTs. Future research should enhance DMHIs' effectiveness and acceptability by addressing identified factors. Increasing awareness of DMHIs' benefits will foster acceptance and positive attitudes. Lessons indicate that improving user engagement and effectiveness requires a multifaceted approach.

Symptoms of Posttraumatic Stress During the COVID-19 Pandemic in the Governmental Public Health Workforce and General Population

We aimed to estimate the prevalence of COVID-19-related posttraumatic stress symptoms (PTSS) in the governmental public health workforce and in US adults, assess differences in reporting PTSS within subgroups, and evaluate whether frontline workers reported higher levels of PTSS than persons in other jobs. We used data from 2 nationally representative studies: the 2021 Public Health Workforce Interests and Needs Survey (PH WINS) and the COVID-19 and Life Stressors Impact on Mental Health and Well-being (CLIMB) study. Our study found that the state and local governmental public health workforce was more likely to report PTSS than the general adult population. Almost a quarter of public health agency employees (24.7%) and 21.1% of adults reported at least 3 symptoms of posttraumatic stress. Differences in levels of PTSS appeared within demographic groups for both samples. Personal care and service frontline workers had 4.3 times the odds of reporting symptoms of posttraumatic stress than non-frontline workers.

Effect of salidroside on neuroprotection and psychiatric sequelae during the COVID-19 pandemic: A review

The coronavirus disease 2019 (COVID-19) pandemic has affected the mental health of individuals worldwide, and the risk of psychiatric sequelae and consequent mental disorders has increased among the general population, health care workers and patients with COVID-19. Achieving effective and widespread prevention of pandemic-related psychiatric sequelae to protect the mental health of the global population is a serious challenge. Salidroside, as a natural agent, has substantial pharmacological activity and health effects, exerts obvious neuroprotective effects, and may be effective in preventing and treating psychiatric sequelae and mental disorders resulting from stress stemming from the COVID-19 pandemic. Herein, we systematically summarise, analyse and discuss the therapeutic effects of salidroside in the prevention and treatment of psychiatric sequelae as well as its roles in preventing the progression of mental disorders, and fully clarify the potential of salidroside as a widely applicable agent for preventing mental disorders caused by stress; the mechanisms underlying the potential protective effects of salidroside are involved in the regulation of the oxidative stress, neuroinflammation, neural regeneration and cell apoptosis in the brain, the network homeostasis of neurotransmission, HPA axis and cholinergic system, and the improvement of synaptic plasticity. Notably, this review innovatively proposes that salidroside is a potential agent for treating stress-induced health issues during the COVID-19 pandemic and provides scientific evidence and a theoretical basis for the use of natural products to combat the current mental health crisis.

Impact of Yoga on anxiety, stress and sleep quality among health care professionals during a public health crisis

BACKGROUND

Health care professionals (HCPs) working on the frontlines of health care emergencies/pandemics often experience elevated anxiety, stress and reduced quality of sleep. Yoga is a mind-body practice that has been proven to effective in improving physical and mental health.

OBJECTIVE

To evaluate the effectiveness of integrated Yoga intervention on mental health measures and sleep quality among HCPs working during the COVID-19 pandemic.

METHODS

This quasi-experimental study was conducted on 110 HCPs, including Doctors and nursing staff, with an age range of 20 to 65 years who were recruited through a convenience sampling method and assigned to a Yoga group (n = 55) or a control group (n = 55). The Yoga group received a weekly one-hour Yoga session followed by a 30-minute self-practice three times a week at home for one month. The control group followed routine activity. Heart rate (HR), Blood Pressure, stress measures (Perceived Stress and visual analogue Scale for Stress), COVID-related anxiety, Sleep Quality, Quality of life and Preservative Thinking were assessed before and after the intervention.

RESULTS

A significant decrease in stress measures, COVID-19-related anxiety and fear, and perseverative thinking was noticed in the Yoga group. Sleep quality and quality of life also improved significantly. The control group showed no significant change. At one month, the Yoga group showed significantly greater improvement in stress measures, COVID-19-related anxiety and fear, perseverative thinking, sleep quality and quality of life compared to the control group.

CONCLUSION

Yoga practice during the public health crisis would help reduce anxiety and stress and improve sleep among HCPs. Further randomized controlled trials are warranted.