Psychological impact of COVID-19 pandemic in Western frontline healthcare professionals. A systematic review

Longitudinal associations of depression, anxiety, and stress among healthcare workers assisting patients with end-stage cancer during the COVID-19 pandemic: the moderator role of emotional exhaustion

BACKGROUND

This study aimed to analyze the moderating role of emotional exhaustion in the relationships between longitudinal associations of depression, anxiety, and stress among healthcare workers assisting end-of-life cancer patients during the COVID-19 pandemic.

METHODS

A longitudinal study involving a final sample of 122 healthcare workers (61.5% females, mean age = 39.09 ± 11.04 years) was conducted. These participants completed the Maslach Burnout Inventory (MBI) and the Depression Anxiety Stress Scales-21 (DASS-21).

RESULTS

Results of correlation analysis showed that emotional exhaustion was correlated with both T1 and T2 measures of depression, anxiety, and stress. Results of the moderation analysis indicated that emotional exhaustion moderated the relationships between consecutive measures of depression and anxiety. Each of the moderation models explained about half of the variance for depression and anxiety. When considering stress, results did not show a moderating role for emotional exhaustion.

CONCLUSIONS

Overall, the results of this study highlight that emotional exhaustion moderated depression and anxiety over time. Psychological interventions to promote psychological mental health among healthcare workers assisting patients with end-stage cancer should carefully consider these findings.

Stress, Mental Health, Sleep, and Healthy Habits in Spanish Healthcare Professionals Along the Pandemic: A Case-Control, and Follow-Up Study

OBJECTIVE

The aim of this study was to assess short and medium-term impact of the coronavirus disease-2019 (COVID-19) pandemic on stress, mental health, and sleep in Spanish healthcare professionals (HCP), and analyze the association between healthy habits, anxiety, and depression during the same period.

METHODS

An online survey including five validated scales (the Perceived Stress Scale, the Goldberg Anxiety and Depression Scales, the Pre-Sleep Arousal Scale, and the Pittsburgh Sleep Quality Index), and some questions about healthy habits were completed by HCP in charge of patients without and with coronavirus. Once for the control group (baseline), and twice for the case group (baseline and follow-up).

RESULTS

Overall 563 questionnaires were included. Moderate-severe stress was reported by 98.1% of subjects, anxiety and depression by 55.1% and 78.7% respectively, and poor sleep quality by 96.6%. Anxiety was reported more frequently by females and singles. HCP in charge of COVID-19 patients showed, in the baseline, a higher frequency of anxiety compared to controls (58.9% vs. 42.8%, p=0.002), and of depression (82.1% vs. 67.6%, p=0.001), that persisted in the follow-up assessment. Furthermore, HCP in charge of COVID-19 patients also exhibited more elevated mean scores for stress (p=0.005) and poor sleep (p=0.019). A decrease of sunlight exposure was associated with an increase of anxiety and depression symptoms, and less physical activity with depression.

CONCLUSION

Stress, sleep, and mental problems were common in Spanish HCP, especially in those in charge of COVID patients. These findings persisted throughout the pandemic, and may impact in the post-pandemic mental health of HCP.

The association between psychological reactions, resilience, and work engagement among Palestinian critical care nurses in West Bank

AIM

This study aimed to assess the association between psychological reactions (e.g., stress, anxiety, and depression), resilience, and work engagement among Palestinian critical care nurses in the West Bank and examine the correlation of psychological reactions and resilience with work engagement.

BACKGROUND

Work engagement is associated with psychological reactions and resilience, particularly among critical care nurses. There is a lack of studies on work engagement and these factors in Palestine.

METHODS

A cross-sectional, descriptive correlational design was adopted. A convenience sample consisting of 273 critical care nurses from private and governmental hospitals was recruited to participate. Depression, Anxiety, Stress Scale-21 (DASS-21), Connor-Davidson Resilience Scale-25 (CDRS-25), Utrecht Work Engagement Scale-9 (UWES-9), and demographic data were used to collect data during the period from March 20 to May 20, 2023.

RESULTS

Findings demonstrated that 53.9% of the nurses reported mild-to-moderate levels of depression, 49.8% reported moderate-to-severe levels of anxiety, and 49.1% reported moderate-to-severe levels of stress. Additionally, 57.5% and 52.7% of them had low resilience and work engagement, respectively. Moreover, work engagement negatively correlated with depression (r = -0.796, P < 0.01), anxiety (r = -0.654, P < 0.01), and stress (r = -0.796, P < 0.01), while positively correlated with resilience (r = 0.42, P < 0.01) and gender (r = 0.121, P < 0.05). Depression, anxiety, stress, resilience, and gender were the main predictors of work engagement.

DISCUSSION

The majority of the nurses suffered from depression, anxiety, and stress. Additionally, more than half of the participants had low resilience and work engagement. Moreover, increased depression, anxiety, and stress were correlated with decreased work engagement, while high resilience and gender as being female positively correlated with high work engagement.

CONCLUSION AND IMPLICATIONS FOR NURSING AND HEALTH POLICY

Policymakers and hospital administrators should develop interventions to improve critical care nurses' resilience and minimize psychological reactions, which have a significant influence on work engagement. Future studies should be conducted to examine the effectiveness of these interventions.

Healthcare worker burnout: exploring the experiences of doctors working in a maternity unit in Namibia

BACKGROUND

Globally, healthcare workers (HCWs) in maternity units are at high risk of developing burnout. Burnout can lead to multiple harmful impacts on HCWs, their patients, and the broader healthcare system. Little is known about the burden of burnout among sub-Saharan African HCWs. Although evidence suggests that maternity unit doctors in a hospital complex in Namibia are at risk of developing burnout, no studies have been conducted on doctors in this department yet.

METHODS

Through participant observation and a mixed-methods needs assessment, this study aimed to explore the drivers, experiences, and impact of burnout symptoms among doctors in this department, and current support mechanisms in place. Survey data was collected from 18 participants and seven in-depth interviews were conducted. Burnout risk was assessed using the Burnout Assessment Tool.

RESULTS

Seven out of 18 participants were at very high risk for burnout and three were at risk, showing a high prevalence of burnout risk. Burnout risk remained similar between levels of staff, while gender qualitatively impacted burnout-related experiences. Drivers of burnout were identified at personal, occupational, and systemic levels.

CONCLUSIONS

Over half of participants were at risk or at very high risk of burnout. Results highlighted a need for support and identified areas for intervention and further research. Such areas include blame culture, lack of trust between colleagues, and systemic drivers of burnout. This study contributes to the understanding of burnout among HCWs in sub-Saharan Africa.

Nursing students' emotions, educational concerns, and the impact of study careers and professional futures during the COVID-19 pandemic: a cross-sectional study

BACKGROUND

COVID-19 is a challenge to education systems worldwide. The aim of the study was to explore the impact of COVID-19-pandemic-related emotions and COVID-19-related concern for education on the study careers and professional futures of nursing students.

METHODS

The study was completed between March and June 2023 using a multi-stage sampling design. A total of 1126 nursing students were recruited to complete the questionnaire. The self-administered questionnaire consisted of basic characteristics of the subjects, the COVID-19-pandemic-related emotions scale, the COVID-19-related concern for education scale, and the impact of the COVID-19 on study careers and professional futures scale (SCPFI-19 S). One-way ANOVA/t-test, correlation coefficient analysis, and hierarchical linear regression analysis were used to explore factors influencing changes in study careers and professional futures, and the relationship between COVID-19-pandemic-related emotions and COVID-19-related concern for education.

RESULTS

Univariate analysis of variance indicated that residence, willingness, and whether to engage in nursing after graduation were related to SCPFI-19 S (P < 0.05). COVID-19-pandemic-related emotions and COVID-19-related concern for education were significantly and positively associated with SCPFI-19 S (r = 0.566, P < 0.01; r = 0.199, P < 0.01). Stratified multiple regression analysis showed that COVID-19-pandemic-related emotions and COVID-19-related concern for education of nursing students were significant predictors of SCPFI-19 S.

CONCLUSION

Overall, both COVID-19-pandemic-related emotions and COVID-19-related concern for education were significantly correlated with SCPFI-19 S. In future interventions, schools should consider structures and strategies to support students' mental health and educational trajectories during current and future epidemics or similar crises.

The effect of a mindfulness-based intervention on stress overload, depression, and mindfulness among nurses: A randomized controlled trial

BACKGROUND

Nurses experience various health-related issues due to the nature of their work.

AIM

This study aimed to examine the effect of a mindfulness-based intervention on stress overload, depression and mindfulness among nurses. A secondary objective was to examine the role of the setting (i.e., in and out of the hospital as a natural setting) on mindfulness-based intervention effectiveness.

METHODS

A randomized controlled trial with three groups' pretest-posttest design was used in this study. A total of 195 nurses were recruited-65 intervention-inside hospital, 60 intervention-outside hospital, and 63 control. The mindfulness-based intervention was delivered by a certified mindfulness practitioner over 4 weeks in Jordan. Data were collected using a demographics questionnaire, the Stress Overload Scale Short, the Center for Epidemiologic Studies Depression Scale-Revised, and the Five Facet Mindfulness Questionnaire.

RESULTS

Multivariate analysis showed a statistically significant effect of the intervention on the linear combination of the dependent variables V = 0.44, F[6, 368] = 17.56, p < .001. Follow-up analyses showed that a mindfulness-based intervention significantly decreased stress overload, depression, and increased mindfulness levels among nurses in intervention groups compared with the control group. In addition, conducting a mindfulness-based intervention outside the hospital has a better effect on mindfulness levels than the inside hospital.

LINKING EVIDENCE TO ACTION

The effect of a mindfulness-based intervention on stress overload, depression, and mindfulness should be considered when planning for nurses' well-being and the quality of care provided. Nurse managers are encouraged to use the study's findings to promote nurses' well-being.

Experiences of Spanish out-of-hospital emergency workers with high levels of depression during the COVID-19 pandemic: a qualitative study

BACKGROUND

The COVID-19 pandemic had a major psychological impact on health care workers (HCWs). This study was embedded in a larger quantitative study on the mental health care of out-of-hospital HCWs in Spain. To better understand this, a qualitative study was conducted to explore the experiences, coping strategies, and influencing factors of out-of-hospital HCWs who scored high (> 25 points) on the Depression Anxiety Stress Scale (DASS-21) in a previous quantitative mental health study.

METHODS

A qualitative study was conducted using six in-depth interviews with individuals who scored high on the depression scale and agreed to be contacted by email between May and June 2021, using the phenomenological approach. The data were analysed using Brawn and Clare's method.

RESULTS

The main results findings related to four themes. The emotional impact of assuming a professional role with high self-demands and responsibilities; Factors influencing the development of negative emotions such as the cruelty of the pandemic, the helplessness in relation to health management and policy, the changing role of the professional and the relationship with society; Personal protection through coping strategies to manage negative emotions such as support from colleagues and family; Good practices for the future looking for different management strategies that can influence individuals and their personal, professional, and social relationships.

CONCLUSION

The strong impact of the circumstances experienced points to the need to develop psychological support programmes that can protect people's mental health from depression during a crisis and improve the relationship between workers and their managers.

Cross-Sectional Study of the Psychological Well-Being of Healthcare Workers in a Large European University Hospital after the COVID-19 Initial Wave

BACKGROUND

The SARS-CoV-2 pandemic greatly impacted healthcare workers (HCWs) dedicated to caring for COVID-19 patients. The study was conducted in a large European hospital to study the psychological distress of HCWs engaged in COVID-19 wards in the early phase of the pandemic.

METHODS

A questionnaire was sent to 1229 HCWs aimed at collecting the following information: 1) sociodemographic data; 2) depression, anxiety, and stress scales (DASS-21); 3) event impact scale (IES-R); 4) perceived stress scale (PSS); and 5) work interface analysis. The responses were collected through Google® forms and then statistically analyzed. Regardless of the outcome of the questionnaire, all subjects were offered psychological support voluntarily.

RESULTS

Approximately two-thirds of the workers reported no symptoms according to the DASS-21 scales, while the IES-R and PSS scales showed 36% and 43%, respectively. There were no statistically significant differences in the levels of depression investigated through the different scales in the various occupational categories. Symptoms of anxiety, stress, and depression were more pronounced in women, while the highest stress levels were observed in the younger age groups. The highest scores were observed on the DAS-21 scales of anxiety and IES-R but not on the others. Only 51 workers, most of them with previous SARS-CoV-2 infection, sought clinical psychological counseling, and more than half received subsequent psychological support.

CONCLUSIONS

Our results agree with most of the literature data that anxiety, depression, and stress are associated with gender (female), age (18-44 vs. over 55), and having cared for patients with COVID-19.

Psychological interventions for healthcare professionals during the COVID-19 pandemic: A systematic review

Healthcare professionals were especially vulnerable to pandemic, both to become infected and to develop a psychological problem. The aim of this systematic review is to analyze the effectiveness of psychological interventions for healthcare professionals in reducing the experienced psychological impact. From the 405 identified studies, 10 were included in this review. Four databases were searched and the risk of bias of included studies was assessed. The studies considered were randomized controlled trials. The screening and selection process was conducted by two independent reviewers. All studies presented results related with depression, anxiety, and stress during pandemic. Six were delivered using new technologies. The most effective were two psychological interventions with frequent contact and feedback provided by a mental health professional. The psychological interventions compared with non-intervention groups presented more significant results than those compared with another intervention. The highlights of this systematic review were the urgency of designing effectiveness psychological interventions for healthcare professionals to reduce the emotional burden associate with this job. These interventions should be maintained over the time, supported by a professional and provided from the workplace. These proposals presented promising results but were more psychological resources than psychological interventions.

The mediation effect analysis of nurse's mental health status and burnout under COVID-19 epidemic

Aim

The objective of this study is to investigate the mental health status of nurses during the outbreak of novel coronavirus pneumonia. Additionally, we aim to analyze the relationship between anxiety, depression, and burnout among nurses. The findings will provide a scientific basis for promoting the psychological health of nurses.

Methods

Using a cross-sectional study, nurses in Quanzhou in May 2020 completed a general information questionnaire, the 7-item Generalized Anxiety Disorder Questionnaire (GAD-7), Patient Health Questionnaire-9 (PHQ-9), and the Maslach Burnout Inventory (MBI). Data analysis was conducted using structural equation model.

Results

372 questionnaires were returned, with a response rate of 92.5%. The prevalence of anxiety and depression among the participants were 45.2 and 41.4%, respectively. The prevalence of severe burnout among nurses was found to be 7.3%. There was a correlation between nurses' anxiety, depression, and job burnout. The correlation coefficients between anxiety and job burnout, depression and job burnout, and anxiety and depression were found to be statistically significant (p < 0.001). Depression plays a mediating role between anxiety and jod burnout (0.584/1.413, 41.3%).

Conclusion

The COVID-19 epidemic has resulted in moderate to high levels of job burnout among nurses. In this context, depression has been found to play a mediating role in the relationship between anxiety and job burnout. It is imperative for hospital administrators to prioritize the mental health of nurses and the provide necessary support to ensure their well-being.

Prevalence, Knowledge and Perceptions of Smoking and Tobacco Products and Vape Among SEPAR Members

Introduction

The professional dedicated to respiratory health has an exemplary role in tobacco control, promoting smoking cessation in their patients. However, multiple circumstances cause a low implementation. Therefore, the objective of the study is to identify the consumption, knowledge and perception of tobacco and its emerging products in a representative sample of professionals involved in the treatment of respiratory patients integrated into the Spanish Society of Pneumology and Thoracic Surgery (SEPAR).

Methods

Descriptive analysis of a structured online interview addressed to 5340 SEPAR members.

Results

In a sample of 802 respondents, more than 33% have smoked at some time and 6.6% continue to smoke. More than 66% consider smoking as a chronic disease. More than 90% consider their role model important and advise their patients to quit smoking, but less than half carry out a smoking intervention. Only 35% of them believe that the ban on smoking in health centers is always complied. More than 75% do not consider nicotine delivery devices an option for smoking cessation or harm reduction. 22% are unaware of water pipes and 29% of heated tobacco.

Conclusions

Professionals specialized in respiratory diseases are highly sensitized to smoking. Despite this, there are still weak points such as the insufficient implementation of smoking cessation interventions or the scant training in smoking and in new emerging products.

Coping Strategies Used by Health Care Workers in Ecuador During the COVID-19 Pandemic: Observational Study to Enhance Resilience and Develop Training Tools

BACKGROUND

The COVID-19 pandemic has generated immense health care pressure, forcing critical decisions to be made in a socially alarmed environment. Adverse conditions have led to acute stress reactions, affective pathologies, and psychosomatic reactions among health personnel, which have been exacerbated by the successive waves of the pandemic. The recovery of the entire health system and its professionals has been hindered, making it essential to increase their resilience.

OBJECTIVE

This study aimed to achieve 2 primary objectives. First, it sought to identify coping strategies, both individual and organizational, used by health care workers in Ecuador to navigate the acute stress during the early waves of the pandemic. Second, it aimed to develop training materials to enhance team leaders' capabilities in effectively managing high-stress situations.

METHODS

The study used qualitative research techniques to collect information on institutional and personal coping strategies, as well as consensus-building techniques to develop a multimedia psychological tool that reinforces the resilience of professionals and teams in facing future crises.

RESULTS

The findings from the actions taken by health care workers in Ecuador were categorized into 4 types of coping strategies based on Lazarus' theories on coping strategies. As a result of this study, a new audiovisual tool was created, comprising a series of podcasts, designed to disseminate these strategies globally within the Spanish-speaking world. The tool features testimonials from health care professionals in Ecuador, narrating their experiences under the pressures of providing care during the pandemic, with a particular emphasis on the coping strategies used.

CONCLUSIONS

Ensuring the preparedness of health professionals for potential future outbreaks is imperative to maintain quality and patient safety. Interventions such as this one offer valuable insights and generate new tools for health professionals, serving as a case study approach to train leaders and improve the resilience capacity and skills of their teams.

Deep learning framework for rapid and accurate respiratory COVID-19 prediction using chest X-ray images

COVID-19 is a contagious disease that affects the human respiratory system. Infected individuals may develop serious illnesses, and complications may result in death. Using medical images to detect COVID-19 from essentially identical thoracic anomalies is challenging because it is time-consuming, laborious, and prone to human error. This study proposes an end-to-end deep-learning framework based on deep feature concatenation and a Multi-head Self-attention network. Feature concatenation involves fine-tuning the pre-trained backbone models of DenseNet, VGG-16, and InceptionV3, which are trained on a large-scale ImageNet, whereas a Multi-head Self-attention network is adopted for performance gain. End-to-end training and evaluation procedures are conducted using the COVID-19_Radiography_Dataset for binary and multi-classification scenarios. The proposed model achieved overall accuracies (96.33% and 98.67%) and F1_scores (92.68% and 98.67%) for multi and binary classification scenarios, respectively. In addition, this study highlights the difference in accuracy (98.0% vs. 96.33%) and F_1 score (97.34% vs. 95.10%) when compared with feature concatenation against the highest individual model performance. Furthermore, a virtual representation of the saliency maps of the employed attention mechanism focusing on the abnormal regions is presented using explainable artificial intelligence (XAI) technology. The proposed framework provided better COVID-19 prediction results outperforming other recent deep learning models using the same dataset.

The Impact of DNP Scholarly Projects on Healthcare Organizations: A Road Map for Success

Many DNP scholarly projects occur in healthcare organizations, often taking various forms based on specific academic requirements. Projects require site mentorship, project facilitation, and institutional review board resources. This article highlights the impact of DNP scholarly projects on healthcare organizations and provides a road map for success for healthcare leaders and site mentors.

Occupational stress and burnout among intensive care unit nurses during the pandemic: A prospective longitudinal study of nurses in COVID and non-COVID units

Background

Intensive care unit (ICU) nurses are highly prone to occupational stress and burnout, affecting their physical and mental health. The occurrence of the pandemic and related events increased nurses' workload and further exacerbated their stress and burnout. This work investigates occupational stress and burnout experienced by ICU nurses working with COVID and non-COVID patients.

Method

A prospective longitudinal mixed-methods study was conducted with a cohort of ICU nurses working in medical ICU (COVID unit; n = 14) and cardiovascular ICU (non-COVID unit; n = 5). Each participant was followed for six 12-h shifts. Data on occupational stress and burnout prevalence were collected using validated questionnaires. Physiological indices of stress were collected using wrist-worn wearable technologies. Participants elaborated on the causes of stress experienced each shift by completing open-ended questions. Data were analyzed using statistical and qualitative methods.

Results

Participants caring for COVID patients at the COVID unit were 3.71 times more likely to experience stress (p < 0.001) in comparison to non-COVID unit participants. No differences in stress levels were found when the same participants worked with COVID and non-COVID patients at different shifts (p = 0.58) at the COVID unit. The cohorts expressed similar contributors to stress, based in communication tasks, patient acuity, clinical procedures, admission processes, proning, labs, and assisting coworkers.

Conclusion

Nurses in COVID units, irrespective of whether they care for a COVID patient, experience occupational stress and burnout.

Factors Related to Psychological Distress in Suicide Prevention Supporters during the COVID-19 Pandemic

PURPOSE

Psychological distress and related factors in suicide prevention supporters during the COVID-19 pandemic were clarified.

METHODS

A web-based survey for supporters from helplines or psychiatric institutions was conducted from May to July 2021. It included items about profession, stress and anxiety, and the Kessler Psychological Distress Scale.

RESULTS

818 participants were analyzed. Psychological distress was significantly higher among healthcare workers in psychiatric institutions than among helpline volunteers. The factor most related to psychological distress in both professions was insufficient rest with overwork. Distress in helpline volunteers was related to their lack of ability to support people with suicidal thoughts and suicide attempts, excessive media coverage related to COVID-19, and trouble dealing with complainers. Distress in healthcare workers was related to their lack of ability to provide sufficient support to their clients due to infection prevention measures.

CONCLUSION

Psychological distress among suicide prevention supporters during the pandemic has been affected by overwork, the fact that helpline volunteers cannot be trained in suicide prevention, and the fact that healthcare workers can only provide insufficient support to their clients due to infection prevention measures. To maintain suicide prevention during pandemics, it is necessary to implement measures that are tailored to the factors of psychological distress in supporters.

Moral distress in carers for people with an intellectual disability who died during the COVID-19 pandemic, a template analysis extending the Barlem and Ramos model of moral distress

BACKGROUND

This article aims to understand moral distress in carers of people with an intellectual disability during the COVID-19 pandemic.

METHOD

Nine staff carers of seven people with an intellectual disability, who had been participants of the IDS-TILDA study in Ireland, who died during the COVID-19 pandemic participated in in-depth, semi-structured telephone interviews. Template analysis was used to analyze the interviews.

RESULTS

Obstructions in performing their duties left carers feeling powerless and experiencing moral conflict distress, moral constraint distress and moral uncertainty distress. Most managed to connect to the moral dimension in their work through peer support, understanding they fulfilled the wishes of the deceased, and/or thinking about how they or others did the best they could for the person they were caring for.

CONCLUSIONS

This research demonstrates that while restrictions may have been effective in reducing the spread of COVID-19, they were potentially damaging to carer wellbeing.

Clinical and organizational impact of the use of different cardiac troponin assays for the diagnosis of myocardial infarction without persistent elevation of the ST segment at presentation (NSTEMI) in 12 Italian emergency departments (EDs): the TROCAR study

The management of acute chest pain is one of the challenges for emergency departments (EDs) worldwide. This study aims to provide insights into clinical and organizational aspects related to the use of different cardiac troponin tests for the diagnosis of NSTEMI. A prospective observational study was conducted among 12 Italian EDs. Eligible participants had chest pain of suspected cardiac origin and accessed EDs from January 2017 to March 2019. A 30-day follow-up was performed to gather information about the main cardiac outcomes. Tests validity and performance were assessed by computing sensitivity, specificity, positive and negative predictive values and area under the ROC curve. The independent association between adverse event end point at 30 days and type of troponin was evaluated by multiple logistic regression models, using odds ratio and 95% confidence interval. 2913 patients were included. Almost 72% were affected by comorbidities and most of them stayed in the EDs for more than 3 h, with significant differences among the different troponin assays. The results of follow-up at 30 days for the outcomes considered for the patients who were ruled out in 3 h or less did not differ significantly compared to those ruled out after 3 h or more. After adjustment for confounders, patients admitted to an ED that used a high-sensitivity troponin were at a lower risk of having a MACE (OR = 0.53, 95%CI 0.35-0.90) and a non-significant lower risk of myocardial infarction (OR = 0.68, 95% CI 0.41-1.13, p = 0.1314) at 30 days compared to patients admitted to an ED that used a standard troponin. Appropriate troponin testing is extremely important for differential diagnosis and for addressing proper treatment and safe procedures for patients who are not admitted to the hospital.

Anxiety, Stress, and Depression Among Healthcare Professionals During the COVID-19 Pandemic: A Cross-Sectional Study in Morocco

The COVID-19 pandemic has caused an enormous psychological impact worldwide. This study aimed to assess anxiety, depression, stress, and compensatory behaviors among Moroccan healthcare workers (HCWs) during COVID-19. This descriptive cross-sectional study was conducted using a snowball sampling strategy. This descriptive cross-sectional study was conducted using a snowball sampling strategy. Online surveys were sent to groups of HCWs working in Casablanca and Fez cities. Post-traumatic stress disorder (PTSD) was measured using the Impact of Event Scale revised (IES-R) scale, and the DASS-21 was used to measure anxiety, depression, and stress among participants. Compensatory behaviors used by HCWs to manage these symptoms were also investigated. The majority of participants (72.5%) experienced moderate to severe distress during the COVID-19 pandemic. The majority of participants (53.1%) reported symptoms of mild to extremely severe depression. Overall, nurses, female, and frontline HCWs experienced more stress, anxiety, and depression (P < .001). Leisure activities (29%), sport (19%), and drinking tea/coffee (19%) were the most common compensatory behaviors. Our findings suggest that psychological support and interventions targeting high-risk HCWs with heavy psychological distress are needed. It is of paramount importance to improve the psychological endurance and safeguard the mental and physical well-being of HCWs, who find themselves on the frontline of health and humanitarian crises, when they are needed the most.

Validation of the humour styles questionnaire in healthcare professionals

AIM

The aim of this study is to determine the reliability and validity of the Humour Styles Questionnaire (HSQ) in a sample of Spanish healthcare professionals.

DESIGN

A cross-sectional study.

METHODS

The version of HSQ translated into Spanish by Cayssials and Pérez was used to validate on a sample of healthcare professionals (N = 250). The reliability analysed the Crombach's α coefficient and Pearson's correlation coefficient between the factors and the total scale score. The Exploratory Factor Analysis was carried out with Kaiser's criteria for the extraction of factors with Varimax rotation.

RESULTS

HSQ in this study sample reproduced the similar structure of the original version with four factors (affiliative, self-enhancing, aggressive and self-defeating humour). These factors explained 44.46% of the total variance and Cronbach's ranged from 0.64-0.79. Global HSQ scale reliability was 0.82.

CONCLUSION

The HSQ is a valid and reliable instrument for assessing humour in healthcare professionals.

Exploring Shared Trauma in the Time of COVID: A Simulation-Based Survey Study of Mental Health Clinicians

From fear of contracting the virus, isolation from physical distancing, to navigating lifework balance, the COVID-19 pandemic is expected to leave long-lasting psychosocial impacts on many. Shared trauma refers to similar psychological reactions to an extraordinary community event when experienced by both the clinicians and clients. We examined the experiences mong mental health clinicians in Canada and the United States (n = 196) in this online survey study during the second phase of the pandemic (Spring 2021). In addition to using traditional survey items (e.g., demographics, scales, and short answers), we also used video-recorded Simulated Clients (SC; i.e., professional actors) as a novel method to elicit the participants' assessment of the SCs and the psychosocial impacts of the COVID-19 pandemic. Using shared trauma as a theoretical framework, we analyzed both quantitative and qualitative data. Quantitative results suggested that although these mental health clinicians certainly reported experiencing psychosocial impacts of the pandemic themselves, these shared experiences with client and general populations did not greatly impact how they understood the SCs. Qualitative results helped further contextualize the clinicians' own personal and professional lives. Implications for clinical practice and further research related to shared trauma are discussed.

The role of face masks within in-patient psychotherapy: Results of a survey among inpatients and healthcare professionals

Introduction

Face-to-face medical and psychotherapeutic treatments during the Corona pandemic often involve patients and health care providers wearing face masks. We performed a pilot survey assessing the subjective experience of wearing face masks during psychotherapy sessions regarding (i) feasibility, (ii) psychotherapeutic treatment and (iii) communication, emotion and working alliance in patients and healthcare professionals.

Methods

A total of n = 62 inpatients (RR = 95.4%) and n = 33 healthcare professionals (RR = 86.8%) at an academic department of Psychosomatic Medicine and Psychotherapy participated in this survey anonymously. The items of the questionnaire were created by the interprofessional expert team and were based on existing instruments: (i) the Therapeutic Relationship Questionnaire and (ii) the German translation of Yalom's Questionnaire on Experiencing in Group Psychotherapy.

Results

The majority of patients rate their psychotherapy as highly profitable despite the mask. In individual therapy, face masks seem to have a rather low impact on subjective experience of psychotherapy and the relationship to the psychotherapist. Most patients reported using alternative facial expressions and expressions. In the interactional group therapy, masks were rather hindering. On the healthcare professional side, there were more frequent negative associations of face masks in relation to (i) experiencing connectedness with colleagues, (ii) forming relationships, and (iii) therapeutic treatment.

Discussion

Information should be given to patients about the possible effects of face masks on the recognition of emotions, possible misinterpretations and compensation possibilities through alternative stimuli (e.g., eye area) and they should be encouraged to ask for further information. Especially in group therapy, with patients from other cultural backgrounds and in cases of need for help (e.g., hearing impairment) or complex disorders, appropriate non-verbal gestures and body language should be used to match the intended emotional expression.

Prevalence and associated factors of mental health outcomes among healthcare workers in Northern Colombia: A cross-sectional and multi-centre study

Background

Mental health outcomes in Healthcare Workers (HCWs) has been few evaluated during COVID-19 pandemic in low-and middle-income countries. Our aim was carry-out a study to identify the prevalence of stress, anxiety, depressive symptoms in HCWs and associated factors to severe illness in a northern region in Colombia.

Method

A cross-sectional, hospital-based survey was conducted to assess mental health outcomes in 1,149 HCWs in Colombia. The study used Perceived Stress Scale (PSS-10), 7-item Generalized Anxiety Disorder (GAD-7), and 9-item Patient Health Questionnaire (PHQ-9) to evaluate stress, anxiety, and depression symptoms, respectively.

Results

682 HCWs completed the questionnaire. The 58,21% (397/682) were nurses, 31,23% were physicians (213/682), and 10,56% (72/682) were other health professionals. The proportion of HCWs with stress, anxiety, and depressive symptoms were 59,97%, 44,87%, and 23,02%, respectively. HCWs in emergency room and Intensive Care Units (ICU) have 2-3-fold increase risk to have severe symptoms of stress. Staff in ICU have 64% more likely to have severe anxiety symptoms, and 97% more likely to have severe depression symptoms.

Limitations

Including HCWs only in the northern region in Colombia; a non-probabilistic sample, and a cross-sectional design to identify causality.

Conclusion

A higher proportion on mental health outcomes has been reported in HCWs in Colombia. There are work areas related with severe mental symptoms such as ICU and emergency room. Hospitals and patient-care institutions in Latin-America needs consider the mental and physical health of HCWs during outbreaks and identify health staff at-risk to implementing support strategies to mitigate adverse mental outcomes.

Study of the Psychometric Properties of the Spanish Version of the Measure of Moral Distress for Health Care Professionals (MMD-HP-SPA)

BACKGROUND

The early detection of moral distress requires a validated and reliable instrument. The aim of this study was to carry out an advanced analysis of the psychometric properties of the moral distress scale for health professionals (MMD-HP-SPA) by performing a validation of the construct and its internal and external reliability.

METHODS

We performed a multicentre cross-sectional study in health professionals belonging to the Andalusian public health system. Construct validity was performed by exploratory (n = 300) and confirmatory (n = 275) factor analysis (EFA/CFA) in different subgroups; we also analysed the internal consistency and temporal reliability of the scale.

RESULTS

384 doctors and 191 nurses took part in the survey. The overall mean for moral distress was 128.5 (SD = 70.9), 95% CI [122.7-134.3], and it was higher in nurses at 140.5 (SD = 74.9) than in doctors at 122.5 (SD = 68.1), F = 8.37 p < 0.01. The EFA produced a model of five components which accounted for 54.8% of the variance of the model. The CFA achieved a goodness of fit of Chi2 = 972.4; AIC = 1144.3; RMSEA = 0.086; CFI = 0.844; TLI = 0.828; NFI = 0.785.

CONCLUSIONS

The MMD-HP-SPA scale has solid construct validity, excellent internal consistency, optimal temporal reliability, and underlying dimensions which effectively explore the causes of moral distress in health professionals, thus guaranteeing its use in hospital and community settings.

The Impact of the COVID-19 Crisis on the Practices and Mental Health of Psychologists in Belgium: Between Exhaustion and Resilience

While the COVID-19 pandemic has created psychological distress in the general population and increased the need for psychological care, little research has been done on how mental health practitioners (MHP) have been affected by the pandemic, and these health professionals have received little attention from public authorities. In this article, we focus on psychologists and the impact that the pandemic has had on their mental health and practices by exploring the adaptive and innovative responses generated. This study is based on an online survey (including multiple choice questions, several validated scales, and eight free text items) completed by 187 psychologists (86% female) one year after the beginning of the COVID-19 pandemic in Belgium (February-April 2021). Most participants considered that the crisis had an impact on their well-being and mental health. However, the prevalence of symptoms of depression and anxiety was relatively low (17%; 12%). On the other hand, the majority of psychologists (72%) suffered from a medium level of burnout (BO), 7% suffered from a high level of BO, and only 21% had low levels of BO. Psychologists working in face-to-face settings had the highest scores on the "exhaustion" subscale of the BO, and those working primarily with patients in precarious situations had significantly higher scores of BO and exhaustion. Qualitative analysis of free text items showed that MHP were resilience and developed new frameworks and modes for proactive interventions in order to reach their patients, meet the psychological and social population's needs, and maintain their relationships with the network. In a crisis or pandemic context, public policies should take into account the psychological and social needs of the most socially precarious populations in reinforcing and supporting mental health professionals working in this sector.

Anxiety, Depression, and Post-Traumatic Stress Disorder (PTSD) Symptomatology According to Gender in Health-Care Workers during the COVID-19 Pandemic in Peru Shortened Title: "Psychological Impact of the Pandemic on Women"

OBJECTIVE

The current study will evaluate the association that the COVID-19 pandemic has had with health-care workers and identify the factors that influenced the female gender being more affected.

METHODS

This is a cross-sectional study conducted in two hospitals in Arequipa (a Peruvian city). The participants were health-care workers. We applied a questionnaire with sociodemographic information and three scales: the Generalized Anxiety Disorder-7, the Patient Health Questionnaire-9, and the Primary Care Post-Traumatic Stress Disorder (PTSD) Screen for DSM-5. The main outcomes were anxiety, depression, and PTSD scores. The exposure of interest was gender. The scores of the scales were estimated by medians and percentiles 25-75 (p25-p75), and we used linear regression to estimate the crude and adjusted coefficients and their respective confidence intervals at 95% (CI 95%).

RESULTS

There were 109 participants, and 43.1% were women. The anxiety, depression, and PTSD median (p25-p75) scores in the study population were 6 (2-11), 6 (2-10), and 1 (0-3), respectively. The adjusted analysis showed that the female sex had 4.48 (CI 95% 2.95-6.00), 4.50 (CI 95% 2.39-6.62), and 1.13 (CI 95% 0.50-1.76) higher points on average for the scales of anxiety, depression, and PTSD symptoms in comparison to males, respectively.

CONCLUSIONS

Female health-care workers showed increased scores of mental health issues in comparison to male health-care workers.

A COVID-19 Patient's Request to Die and Ensuing Conflict: Psychodynamic Considerations

The role of psychodynamic theory in consultation-liaison (C-L) work, and particularly the importance of countertransference, has been well established. The psychological impact of the COVID-19 pandemic on healthcare workers is a new factor that must now be taken into account as C-L psychiatrists traverse a changed healthcare landscape. In this article, we highlight the case of a critically ill COVID-19 patient who endorsed a desire for hastened death. This request generated significant conflict between the physicians and nurses caring for him, and it became challenging for the C-L team to perform our typical liaison function. We briefly review the existing literature on the psychological impact of the pandemic on healthcare workers, and examine how psychodynamic factors within this context impacted the events that unfolded. Themes under consideration include the effect of mass trauma on clinician defense mechanisms, and specifically the impact on countertransference toward patients who express a desire for hastened death. C-L psychiatrists themselves are not immune to such reactions and must be particularly attentive to emergent conflict in such cases. Interdisciplinary meetings to discuss and process these disagreements may be effective in repairing staff ruptures.

Global Healthcare Needs Related to COVID-19: An Evidence Map of the First Year of the Pandemic

The COVID-19 pandemic has exposed gaps and areas of need in health systems worldwide. This work aims to map the evidence on COVID-19-related healthcare needs of adult patients, their family members, and the professionals involved in their care during the first year of the pandemic. We searched the databases MEDLINE, Embase, and Web of Science. Two reviewers independently screened titles and abstracts and assessed full texts for eligibility. Disagreements were resolved by consensus. Descriptive data were extracted and inductive qualitative content analysis was used to generate codes and derive overarching themes. Thirty-six studies met inclusion criteria, with the majority reporting needs from the perspective of professionals (35/36). Professionals' needs were grouped into three main clusters (basic, occupational, and psycho-socio-emotional needs); patients' needs into four (basic, healthcare, psycho-socio-emotional, and other support needs); and family members' needs into two (psycho-socio-emotional and communication needs). Transversal needs across subgroups were also identified and grouped into three main clusters (public safety, information and communication, and coordination and support needs). This evidence map provides valuable insight on COVID-19-related healthcare needs. More research is needed to assess first-person perspectives of patients and their families, examine whether needs differ by country or region, and evaluate how needs have evolved over time.

Salud mental en los trabajadores de la salud y otros grupos poblacionales en relación con la pandemia del COVID-19

Introducción: a lo largo de la historia de la humanidad han ocurrido muchas pandemias causando grandes afectaciones en la salud física y mental. El propósito de esta revisión es presentar un análisis del compromiso de la salud mental en diversos grupos poblacionales. Métodos: con los descriptores ansiedad, estrés, depresión, enfermedad mental, trastorno mental, personal de salud, COVID-19, SARS-CoV-2, se realizó una búsqueda en las bases de datos Embase, Scopus, PubMed, Web of Science (ISI), Google Scholar, y Google para realizar una revisión narrativa de las afectaciones mentales ocurridas en niños y adolescentes, estudiantes universitarios, enfermos de alto riesgo, pacientes con la infección, adulto mayor y personal de salud. Discusión: de acuerdo con la OMS la pandemia por COVID-19 persiste y habrá que esperar las consecuencias o secuelas a largo plazo. Se han realizado múltiples estudios que evalúan las afectaciones mentales en los diversos grupos, revelando un incremento en las cifras de ansiedad, estrés, depresión y estrés postraumático. Conclusiones: se deben diseñar y aplicar estrategias para realizar el diagnóstico temprano de las alteraciones de la salud mental en la población en general y en especial en el personal de salud de primera línea. Es de esperar que a mediano y largo plazo surjan secuelas relacionadas con el aislamiento con énfasis en niños y adolescentes.

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

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

Impact of the COVID-19 pandemic on the development of burnout syndrome in healthcare providers: prevalence and predictive factors

BACKGROUND

In Tunisia, the pandemic is still ongoing, resulting in the burnout of healthcare providers.

AIMS

This study aimed to assess the impact of the management of COVID-19 patients on the physical and mental health of healthcare providers, and to identify the independent and predictive variables for the three components of severe burnout: emotional exhaustion, depersonalization, and lack of personal accomplishment at work.

METHODS

It was a cross-sectional survey. Data were collected between February 8, and April 11, 2021. Healthcare providers, who were positive for COVID, completed the questionnaire. The primary endpoint was to assess the degree of burnout in healthcare providers by adopting the original version of the severe Maslach Burnout Inventory: emotional exhaustion (≥30), depersonalization (≥12), and lack of personal accomplishment at work (≤ 33). A descriptive analysis followed by a bi- and multivariate analysis was performed to identify independent and predictive factors for each component of burnout.

RESULTS

700 healthcare providers were audited. Emotional exhaustion was ≥ 30 in 86%, depersonalization was ≥ 12 in 61%, and lack of personal accomplishment at work was ≤ 33 in 69%. Of the 700 healthcare providers, 93% were working at the same time in the COVID units, 85% had not received compensatory rest. Healthcare provider who had been infected by COVID-19 was the only independent predictive variable of severe emotional exhaustion and severe depersonalization. Healthcare provider who had been infected by COVID-19 and did not have a compensatory rest were two independent predictive variables of severe lack of personal accomplishment at work.

CONCLUSION

Healthcare provider who had been infected by COVID-19 was the only predictive variable of severe emotional exhaustion and severe depersonalization. Healthcare provider who had been infected by COVID-19 and did not have a compensatory rest were two independent and predictive variables of severe lack of personal accomplishment at work.

Evaluating the impact of coronavirus disease on burnout among healthcare workers using maslach burnout inventory tool: A systematic review

Background

Burnout has been prevalent among healthcare workers (HCWs). However, the effect of the Coronavirus Disease (COVID-19) pandemic on this phenomenon in HCWs is unclear.

Objective

This systematic review aims to evaluate the impact of COVID-19 on burnout of HCWs using Maslach Burnout Inventory (MBI).

Methods

A systematic search was performed on PubMed database for articles published between 1 December 2019 and 30 June 2021. Search strategy combined terms for HCWs, COVID-19, burnout, and MBI. The main outcome of interest was burnout, including both mean prevalence and MBI scores for high emotional exhaustion (EE), high depersonalisation (DP) and low personal accomplishment (PA).

Results

Four cohort studies, 90 cross-sectional studies and one randomised-controlled trial were included for review. Only one cohort study compared burnout data among HCWs before and during COVID-19. It reported a statistically significant increase in mean EE and PA scores from 21.9 to 24.8 ( p = .001), and 42.7 to 48.7 ( p = .001), respectively. The remaining studies only evaluated burnout data during COVID-19 but were missing burnout data prior to the pandemic for comparison. Across these studies, the overall mean prevalence of burnout among HCWs was 39.95%, with mean MBI EE scores of 22.07, DP scores of 7.83, and PA scores of 32.53. Burnout outcomes were generally comparable across specific healthcare professions such as doctors and nurses.

Conclusion

Whilst quality research elucidating the effect of pandemic on burnout is lacking, current burnout prevalence among HCWs during COVID-19 is notable.

Strategies for the Psychological Support of the Healthcare Workforce during the COVID-19 Pandemic: The ERNST Study

The COVID-19 pandemic led to the implementation of interventions to provide emotional and psychological support to healthcare workers in many countries. This ecological study aims to describe the strategies implemented in different countries to support healthcare professionals during the outbreak. Data were collected through an online survey about the measures to address the impact of the pandemic on the mental health of healthcare workers. Healthcare professionals, researchers, and academics were invited to respond to the survey. Fifty-six professionals from 35 countries contributed data to this study. Ten countries (28.6%) reported that they did not launch any national interventions. Both developed and developing countries launched similar initiatives. There was no relationship between the existence of any type of initiative in a country with the incidence, lethality, and mortality rates of the country due to COVID-19, and per capita income in 2020. The 24 h hotline for psychological support was the most frequent intervention. Tools for self-rescue by using apps or websites were extensively used, too. Other common interventions were the development of action protocols, availability of regular and updated information, implantation of distance learning systems, early detection of infection programs for professionals, economic reinforcements, hiring of staff reinforcement, and modification of leave and vacation dates.

Mitigating psychological distress in healthcare workers as COVID-19 waves ensue: a repeated cross-sectional study from Jordan

BACKGROUND

Jordan has experienced several COVID-19 waves in the past 2 years. Cross-sectional studies have been conducted to evaluate distress in healthcare practitioners (HCPs), but there is limited evidence with regards to the impact of continuing pandemic waves on levels of distress in HCPs. We previously studied psychological distress in HCPs during the start of the pandemic (period 1, when cases were infrequent and the country was in lockdown), and demonstrated that HCPs were experiencing considerable stress, despite the country reporting low caseloads at the time. In this study, we sought to utilize the same methodology to reexamine levels of distress as COVID-19 peaked in the country and HCPs began managing large numbers of COVID-19 cases (period 2).

METHODS

A cross-sectional online survey utilizing a tool previously used during period 1 was completed by HCPs working in various settings. Demographic, professional and psychological factors such as distress, anxiety, depression, burnout, sleep issues, exhaustion, and fear were assessed; and coping strategies also were measured. Items in the tool were assessed for reliability and validity. A multivariable regression was used to identify factors that continued to impact distress during period 2.

RESULTS

Samples in both periods (n = 937, n = 876, respectively) were relatively comparable in demographic characteristics, but in period 2, a greater proportion of nurses and healthcare practitioners reported working in general hospitals. During the pandemic peak (period 2), 49.0% of HCPs reported high levels of distress (compared to 32% in period 1); anxiety and depression scores were approximately 21% higher in period 2; and 50.6% reported fatigue (compared to 34.3% in period 1). Variables significantly associated with greater distress in period 2 included experiencing burnout, experiencing sleep disturbances, being fatigued, having fatalistic fears, and having fears related to workload. Conversely, being male, reporting satisfaction at work, and using positive coping practices were associated with a significantly lower odds of being in distress.

CONCLUSIONS

Between the two periods (early pandemic and first wave), COVID-19-related mental health continued to deteriorate among HCPs, highlighting the need to do more to support HCP front-liners facing COVID-19 surges.

Tackling the Pandemic a Year Later: Burnout Among Home Palliative Care Clinicians

CONTEXT

The COVID-19 pandemic strongly challenged healthcare workers, disrupting their work routine and impacting on their professional life. A previous investigation explored levels of burnout and psychological morbidity among palliative care professionals (PCPs) during COVID-19 first wave.

OBJECTIVE

To update data about burnout and psychological morbidity among PCPs after a year of COVID-19 pandemic.

METHODS

The same questionnaires on burnout (Maslach Burnout Inventory, MBI) and psychological morbidity (General Health Questionnaire 12 items, GHQ-12) were administered a year after. Differences in MBI and GHQ-12 scores obtained in the two studies (COVID2020 and COVID2021), as well as distributions of PCPs showing burnout symptoms and psychological morbidity were analyzed and compared. We also explored the association between the three dimensions of burnout and socio-demographic and professional characteristics.

RESULTS

The sample consisted of 145 PCPs (59% physicians and 41% nurses). Response rate (70.4%) was quite similar to the previous study (73.2%). No differences were observed in the frequency of burnout between COVID2021 and COVID2020; the PCPs in COVID2021 reported marginally higher level of EE (P = .049) and this result is confirmed in physicians (P = .010) while no difference was observed in nurses (P = .326). In addition, the percentage of cases showing psychological morbidity significantly decreased.

CONCLUSION

Our findings show stable levels of burnout and decreasing levels of psychological morbidity among PCPs one year after the onset of the COVID-19 pandemic. However, more research is needed to detail the significance of emotional exhaustion dimension, a variable influenced by the survey.

Bienestar psicológico en enfermeras que realizan terapia de reemplazo renal en tiempos de COVID-19

Introducción: La pandemia por COVID-19 ha generado deterioro de la salud mental en los profesionales del sector salud, siendo desconocida su situación en las enfermeras al cuidado de pacientes con enfermedad renal crónica. Objetivo: Identificar el bienestar psicológico y sus diferencias de acuerdo a las variables demográficas y profesionales en enfermeras que realizan hemodiálisis en tiempos de COVID-19. Material y Método: Estudio cuantitativo, descriptivo transversal, realizado en 52 enfermeras que realizan terapia de reemplazo renal en unidades de cuidado intensivo y de terapia renal en tiempos de COVID-19. Fueron obtenidas variables de tipo sociodemográfico, académico, laboral y se empleó la escala PGWBI para establecer los niveles de bienestar psicológico. Se utilizó el test de Mann-Whitney y Kruskall-Wallis realizando el post test de Dunn para comparar diferencias entre las variables estudiadas. Resultados: La edad promedio fue de 36,56±6,95 años. Los niveles de bienestar psicológico fueron positivos en todas las categorías de la escala, con excepción de la ansiedad y la depresión. De igual forma, se encontró que las variables género, estado civil, estabilidad, antigüedad laboral, remuneración salarial y formación académica, muestran comportamiento diferenciado en las categorías que evalúa el instrumento. Conclusiones: Se identificaron altos niveles de bienestar psicológico en enfermeras que prestan cuidados en pacientes en terapia de reemplazo renal en tiempos de pandemia por COVID-19, donde factores como el estado civil, formación post gradual y tener estabilidad laboral con mejores ingresos salariales, influencian positivamente las categorías que contribuyeron a los resultados de bienestar psicológico de las enfermeras evaluadas.

Health Professionals in a COVID-19 Reference Hospital: Post-traumatic Stress Disorder (PTSD) Levels and Their Associations With Psychological Resilience and Quality of Life

Introduction

The coronavirus disease 2019 (COVID-19) pandemic has affected the quality of life of both the general population and health professionals and has increased the levels of psychopathology among them. The present study aims to map the levels of post-traumatic stress disorder (PTSD), psychological resilience, and quality of life of healthcare professionals who work in a COVID-19 reference hospital in Athens, Greece, one year after the onset of the pandemic. Also, this study focuses on investigating the relationships among the study variables and demographics and examining possible mediating effects.

Methods

The sample consisted of 400 health professionals from Sotiria Hospital, of whom 102 were men. Participants were asked to complete the Post-Traumatic Stress Scale, Connor-Davidson Resilience Scale, and the WHO Quality of Life Questionnaire. The survey was conducted from May to July 2021.

Results

The findings show statistical differences in resilience levels regarding marital status and employee education. Also, 13.5% of the staff reported significant PTSD levels, which relate to low levels of psychological resilience and every pillar of quality of life.

Conclusions

Thus, research findings indicate that resilience levels could have a protective effect on the development of PTSD symptoms. Therefore, the design of group interventions that aim at building health workers’ resilience will be discussed.

Burnout Syndrome in a Military Tertiary Hospital Staff during the COVID-19 Contingency

(1) Background: Burnout syndrome (BOS) is defined as a psychological state of physical and mental fatigue associated with work. The COVID-19 pandemic greatly impacted the physical and mental wellbeing of health professionals. The objective of this work was to determine the impact on personnel, monitoring the frequency of BOS throughout the pandemic. (2) Methods: The Maslach Burnout Inventory (MBI) was self-applied in four periods of the pandemic according to sociodemographic and employment characteristics. In this study, all hospital personnel were included; the association of BOS with sex, age, type of participant (civilian or military), military rank and profession was analyzed. (3) Results: The frequency of BOS was 2.4% (start of the pandemic), 7.9% (peak of the first wave), 3.7% (end of the first wave) and 3.6% (peak of the third wave). Emotional exhaustion (EE) was the most affected factor, and the groups most affected were men under 30 years of age, civilians, chiefs and doctors, especially undergraduate medical doctors and specialty resident doctors, and nursing personnel were less affected. (4) Conclusions: The low BOS levels show that the containment measures and military training implemented by the hospital authorities were effective, although the chief personnel were more affected in the first wave. It is probable that this combination allowed the containment of BOS, which was not observed in civilians.

Mental Health and Associated Demographic and Occupational Factors among Health Care Workers during the COVID-19 Pandemic in Latvia

Background and Objectives: The COVID-19 pandemic has negatively impacted the health care system. Front-line health care workers (HCWs) are at a higher risk of mental health adverse outcomes. The aim of this study was to evaluate the frequency of the symptoms of depression and anxiety and associated demographic and occupational factors among front-line HCWs in Latvia. Materials and Methods: A cross-sectional quantitative study was performed in a population of HCWs during the first wave of the COVID-19 pandemic in Latvia. The participants were interviewed between 28 April 2020 and 2 June 2020. Answers from 864 HCWs were obtained. The participants reported their demographics, work-related information, contacts with COVID-19-positive patients and completed two standardised questionnaires that assessed the symptoms of anxiety (GAD-7) and depression (PHQ-9). The gathered data were analysed by a chi-squared test and binary logistic regression. The data analysis was performed using SPSS v25. Results: A total of 209 (24.8%) participants had depression symptoms and 145 (17.2%) had anxiety symptoms. Health care workers older than 50 had a lower risk of both depression (OR 0.422 (95% CI, 0.262–0.680)) and anxiety (OR 0.468 (95% CI, 0.270–0.813)). General practitioners had more frequent symptoms of depression and anxiety than participants who worked at hospitals (32.8% (n = 63) versus 19.4% (n = 73) and 27.1% (n = 52) versus 10.3% (n = 39), respectively (p = 0.037; p < 0.000)). Working more than 48 h during the week was associated with a higher risk of depression (OR 2.222 (95% CI, 1.315–3.753)) and anxiety (OR 2.416 (95% CI, 1.272–4.586)). Conclusions: The vulnerability of the health care system before the COVID-19 pandemic led to significant mental health adverse outcomes of HCWs during the COVID-19 pandemic in Latvia. A further cohort study is needed to evaluate the dynamics of mental health and other predisposing factors of HCWs.

Emotions in the Time of COVID-19: Affections and Impacts among the Spanish Primary Care Workforce

BACKGROUND

The literature review shows that most studies on the psychological impact of COVID-19 on healthcare professionals have focused on hospital staff, with few specifically addressing the primary care workforce. This study aims to explore primary care workers' verbal accounts of the emotions they experienced.

METHODS

This is a qualitative study carried out between July and December 2020 in Spain. Semi-structured interviews and focus groups were conducted with primary care workers. Data were analysed through thematic content analysis. Participants were selected using purposive sampling.

RESULTS

A total of 53 primary care workers participated in the study, of whom 38 were individually interviewed, and 15 participated in three focus groups. Our analysis revealed themes in two categories: (1) from infection to affection; and (2) affected, but not patients-a discourse based on the acceptance of their experience as part of their work in primary care, creating an ideological construct or "shield" based on emotional self-management.

CONCLUSIONS

Self-reflection on the emotional impact of COVID-19 is scarce. Examples of emotional affections include an obsessive focus on hygiene, the inability to establish clear boundaries between the personal and the professional spheres, and experiencing-and having to self-manage-emotional strain.

Psychological Impact of the COVID-19 Pandemic on Out-of-Hospital Health Professionals: A Living Systematic Review

Health professionals (HPs), especially those working in the front line, have been one of the groups most affected by the COVID-19 pandemic. The objective of this study is to identify the best available scientific evidence on the impact of the COVID-19 pandemic on the mental health of out-of-hospital HPs in terms of stress, anxiety, depression, and self-efficacy. A living systematic review of the literature was designed, consulting the electronic online versions of the CINHAL, Cochrane Library, Cuiden, IBECS, JBI, LILACS, Medline PyscoDoc, PsycoINFO, Scopus, and Web of Science databases in November 2021. Original research was selected, published in either English, Spanish, French, Italian, or Portuguese. In total, 2082 publications were identified, of which 16 were included in this review. The mental health of out-of-hospital HPs was affected. Being a woman or having direct contact with patients showing suspicious signs of COVID-19 or confirmed cases were the factors related to a greater risk of developing high levels of stress and anxiety; in the case of depressive symptoms, it was having a clinical history of illnesses that could weaken their defenses against infection. Stopping unpleasant emotions and thoughts was the coping strategy most frequently used by these HPs.

Quality of Life, Insomnia and Coping Strategies during COVID-19 Pandemic in Hospital Workers. A Cross-Sectional Study

COVID-19 became a pandemic in a few months, leading to adverse health outcomes, reducing the quality of life, affecting the sleep/wake cycle, and altering coping strategies, especially among hospital personnel. Life quality, insomnia, and coping strategies were thus assessed among hospital personnel during the first wave of the COVID-19 pandemic in Italy. This cross-sectional study was conducted from May to November 2020 through an online survey. There were 558 participants (28.5% males and 71.5% females) enrolled in two different metropolitan areas (in North and South of Italy, respectively). Three standardized questionnaires were administered: European Quality of life–5 Dimensions (EQ-5D), Athens Insomnia Scale (AIS), and Brief COPE. Differences in sociodemographic characteristics and work-related factors were also investigated in order to identify possible predictors through a generalized linear model and logistic regression analysis. Results showed good perceived life quality and high insomnia prevalence. After sample stratification, the statistical analysis highlighted that personal (gender, age, educational level) and work-related factors (employment in COVID wards, remote working) played different roles in predicting quality of life, insomnia, and coping attitude. Active, Planning, and Acceptance were the most frequently adopted coping strategies. Despite women confirming their attitude in reacting to the difficulties, adopting emotion-focused coping strategies, they showed a higher probability to develop insomnia, so a gender perspective should be considered in the health protection of this working category. An integrated approach should be implemented at individual, interpersonal and organizational levels aiming to monitor psychological distress, favor regular sharing and communication between peers, and also allow conciliation of work with family life. At the organizational level, preventive and protective measures adequate to work-related risk to COVID-19 should be adopted.

Quality of Life among Pediatric Neurocognitive, Speech, and Psychomotor Rehabilitation Professionals during the COVID-19 Pandemic: A Longitudinal Study on an Italian Sample

Objective: The aim was to estimate the perceived quality of life and its relationship with sociodemographic and professional factors, perception of susceptibility to COVID-19, and stress. Design: It was a longitudinal study. Subjects: Professionals, working in Italian centers for pediatric neurocognitive, speech, and psychomotor rehabilitation. Methods: Participants were interviewed online twice during the COVID-19 outbreak in Italy. The questionnaire included: (i) The measures of health-related quality of life to perform the Summary Index of Unhealthy Days, (ii) modified items from the “Standard questionnaire on risk perception of an infectious disease outbreak” and (iii) the items of the General Health Questionnaire. Results: One hundred and thirty professionals out of 130 participated in the first interview, while only 50 therapists took part in the second interview (dropout rate: 61%). The Summary Index of Unhealthy Days was 8 days at the first interview, and it decreased to 6 days at the second interview; however, the reduction was not significant (F = 3.22; p = 0.079). The multivariable analysis showed that the rehabilitation providers with moderate or severe stress level were more likely to have a negative perception of the quality of life (ORadj = 7.155; 95% CI: 2.8–18.2), and this result was confirmed at the second interview. Conclusions: Our results showed that in a severe public health emergency, the mental health and quality of life of rehabilitation professionals must be a topic of focus to enhance psychological resilience, to prevent burnout and to reduce rehabilitation errors.

The Effect of Personality Traits on the Quality of Life of Health Professionals in COVID-19 Reference Hospital

Introduction and objectives

Coronavirus disease 2019 (COVID-19) has affected the quality of life of both general population and the healthcare workers and has increased the psychopathology levels. The objective of this research was to study the personality traits and the quality of life of healthcare professionals during the COVID-19 pandemic, in order to organize and apply interventions for the well-being of the staff.

Materials and methods

The study sample consisted of 400 healthcare workers, in Thoracic Diseases General Hospital "Sotiria". Participants were asked to provide sociodemographic information and to complete: (1) the WHOQOL-BREF, (2) the NEO-FFI. The questionnaire was administered in person to the hospital staff. The data were collected between May and July 2021, in Athens, Greece.

Results

Younger healthcare professionals had a better quality of life and with regard to gender differences, males reported higher scores of physical and psychological health compared to females. Also regarding personality traits, neuroticism and extroversion have a statistically significant effect on the quality of life. In contrast, education level, work area and specialty did not appear to affect the quality of life of hospital staff.

Conclusions

From our research findings, it appears that quality of life has been affected by the COVID-19 pandemic. Interventions are needed to apply mindfulness, increase well-being and form groups with the hospital staff in order to share their experiences. 

[Factors associated with the intensity of anxiety and depression symptoms in health workers of two centres of reference for COVID 19 patient care in Antioquia, Colombia - a latent class analysis]

Objective: To classify the staff of two reference institutions for COVID-19 care in Antioquia according to the intensity of anxiety and depression symptoms, and to determine the factors associated with these classes.Methods:Cross-sectional study in which the GAD-7, PHQ-9, fear of COVID-19, and the Copenhagen Burnout scale were used. Latent class analysis was performed to identify the classes, and the factors associated with these were determined using multinomial logistic regression.Results: 486 people participated. The three-class model had the best fit: class I with low scores on the scales; class II with mild degrees of anxiety and depression, and intermediate levels of fear of COVID-19 and perceived stress; and class III with moderate and severe degrees of anxiety, depression, and perceived stress. The factors associated with belonging to class III were age (OR=0.94; 95%CI, 0.91-0.96), change of residence to avoid exposing relatives (OR=4.01; 95%CI, 1.99-8.09), and a history of depressive disorder (OR=3.10; 95%CI, 1.27-7.56), and anxiety (OR=5.5; 95%CI, 2.36-12.90). Factors associated with class II were age (OR=0.97; 95%CI, 0.95-0.99), history of depressive disorder (OR=3.41; 95%CI, 1.60-7.25), living with someone at risk of death from COVID-19 (OR=1.86; 95%CI, 1.19-2.91), family member being healthcare staff (OR=1.58; 95%CI, 1.01-2.47), and change of residence to avoid exposing relatives (OR=1.99; 95%CI, 1.11-3.59).Conclusions: Three classes of participants were obtained, two of them with anxiety and depression symptoms. Younger age and a history of mental disorder were factors associated with the two classes of symptomatic patients; other factors may be causes or consequences of the symptoms.

Students’ Perceptions of Verbal and Non-Verbal Communication Behaviors during and after the COVID-19 Pandemic

Aiming at shedding light on the implications the COVID-19 pandemic has had on the students’ social and personal lives, this study has focused on the verbal and non-verbal communication and on the surveyees’ personal lives during the pandemic as well as on the perspective of changing their communication behaviors after the pandemic. The 409 respondents, students at Politehnica University of Timisoara, took part in a survey, conducted between 1 April and 30 May 2021, that was posted on isondaje.ro, a Romanian online survey platform. The research has suggested the following results: the adjustment of the verbal communication by speaking in a more articulated manner or more loudly; the overuse of the upper part of the face to compensate for the concealed parts of the face due to face mask wearing; the analysis of the factors underlying the respondents’ actions, i.e., relational attitudes, various greeting forms, various non-verbal reactions, which are aspects that are likely to change even after the pandemic. The results have also presented the changes that interpersonal communication could go through under the pressure of the restrictions imposed by the pandemic, but also the ways through which people try to protect their most valuable asset, i.e., communication, which defines humanity and makes us unique as human beings.

Analyzing the Impact of COVID-19 Trauma on Developing Post-Traumatic Stress Disorder among Emergency Medical Workers in Spain

The early stages of the COVID-19 pandemic presented the characteristics of a traumatic event that could trigger post-traumatic stress disorder. Emergency Medical Services workers are already a high-risk group due to their professional development. The research project aimed to analyse the impact of the COVID-19 pandemic on EMS professionals in terms of their mental health. For this purpose, we present a descriptive crosssectional study with survey methodology. A total of 317 EMS workers (doctors, nurses, and emergency medical technicians) were recruited voluntarily. Psychological distress, post-traumatic stress disorder, and insomnia were assessed. The instruments were the General Health Questionnaire-12 (GHQ-12), the Davidson Trauma Scale (DTS-8), and the Athens Insomnia Scale (AIS-8). We found that 36% of respondents had psychological distress, 30.9% potentially had PTSD, and 60.9% experienced insomnia. Years of work experience were found to be positively correlated, albeit with low effect, with the PTSD score (r = 0.133). Finally, it can be stated that the COVID-19 pandemic has been a traumatic event for EMS workers. The number of professionals presenting psychological distress, possible PTSD, or insomnia increased dramatically during the early phases of the pandemic. This study highlights the need for mental health disorder prevention programmes for EMS workers in the face of a pandemic.

Investigating Psychological Differences between Nurses and Other Healthcare Workers from Asia-Pacific Region during the Early Phase of the Coronavirus Disease 2019 (COVID-19): A Machine Learning Approach (Preprint)

Background

As the COVID-19 pandemic evolves, challenges in frontline work continue to impose a significant psychological impact on nurses. However, there is a lack of data on how nurses fared compared to other health care workers in the Asia-Pacific region.

Objective

This study aims to investigate (1) the psychological outcome characteristics of nurses in different Asia-Pacific countries and (2) psychological differences between nurses, doctors, and nonmedical health care workers.

Methods

Exploratory data analysis and visualization were conducted on the data collected through surveys. A machine learning modeling approach was adopted to further discern the key psychological characteristics differentiating nurses from other health care workers. Decision tree–based machine learning models (Light Gradient Boosting Machine, GradientBoost, and RandomForest) were built to predict whether a set of psychological distress characteristics (ie, depression, anxiety, stress, intrusion, avoidance, and hyperarousal) belong to a nurse. Shapley Additive Explanation (SHAP) values were extracted to identify the prominent characteristics of each of these models. The common prominent characteristic among these models is akin to the most distinctive psychological characteristic that differentiates nurses from other health care workers.

Results

Nurses had relatively higher percentages of having normal or unchanged psychological distress symptoms relative to other health care workers (n=233-260 [86.0%-95.9%] vs n=187-199 [74.8%-91.7%]). Among those without psychological symptoms, nurses constituted a higher proportion than doctors and nonmedical health care workers (n=194 [40.2%], n=142 [29.5%], and n=146 [30.3%], respectively). Nurses in Vietnam showed the highest level of depression, stress, intrusion, avoidance, and hyperarousal symptoms compared to those in Singapore, Malaysia, and Indonesia. Nurses in Singapore had the highest level of anxiety. In addition, nurses had the lowest level of stress, which is the most distinctive psychological outcome characteristic derived from machine learning models, compared to other health care workers. Data for India were excluded from the analysis due to the differing psychological response pattern observed in nurses in India. A large number of female nurses emigrating from South India could not have psychologically coped well without the support from family members while living alone in other states.

Conclusions

Nurses were least psychologically affected compared to doctors and other health care workers. Different contexts, cultures, and points in the pandemic curve may have contributed to differing patterns of psychological outcomes amongst nurses in various Asia-Pacific countries. It is important that all health care workers practice self-care and render peer support to bolster psychological resilience for effective coping. In addition, this study also demonstrated the potential use of decision tree–based machine learning models and SHAP value plots in identifying contributing factors of sophisticated problems in the health care industry.

The Burden of Burnout among Healthcare Professionals of Intensive Care Units and Emergency Departments during the COVID-19 Pandemic: A Systematic Review

The primary aim was to evaluate the burnout prevalence among healthcare workers (HCWs) in intensive care units (ICUs) and emergency departments (EDs) during the COVID-19 pandemic. The secondary aim was to identify factors associated with burnout in this population. A systematic review was conducted following PRISMA guidelines by searching PubMed, Embase, PsychINFO, and Scopus from 1 January to 24 November 2020. Studies with information about burnout prevalence/level during the pandemic regarding ICU/ED HCWs were eligible. A total of 927 records were identified. The selection resulted in 11 studies. Most studies were conducted in April/May 2020. Samples ranged from 15 to 12,596 participants. The prevalence of overall burnout ranged from 49.3% to 58%. Nurses seemed to be at higher risk. Both socio-demographic and work-related features were associated with burnout. Many pandemic-related variables were associated with burnout, e.g., shortage in resources, worry regarding COVID-19, and stigma. This review highlighted a substantial burnout prevalence among ICU/ED HCWs. However, this population has presented a high burnout prevalence for a long time, and there is not sufficient evidence to understand if such prevalence is currently increased. It also outlined modifiable factors and the need to improve emergency preparedness both from an individual and structural level.