Factors associated with the psychological impact of severe acute respiratory syndrome on nurses and other hospital workers in Toronto

Evaluation of Posttraumatic Stress Disorder Screening Measures of Emergency Medical Services Clinicians in Urban and Suburban New York During the Coronavirus Disease 2019 Pandemic

OBJECTIVE

The objective of this study was to assess the psychological impact of the coronavirus disease 2019 (COVID-19) pandemic on the self-reported rates of posttraumatic stress disorder (PTSD) among emergency medical services (EMS) clinicians in urban and suburban settings that were one of the primary epicenters during the first wave of the COVID-19 pandemic.

METHODS

Anonymous surveys containing the PTSD Checklist-Specific (PCL-S) were sent electronically between November 2020 and April 2021 to EMS clinicians working in 2 EMS agencies. A threshold score ≥ 36 was considered a positive screen for PTSD symptomology; a score ≥ 44 was considered a presumptive PTSD diagnosis.

RESULTS

Of the 214 surveys sent, 107 responses were returned. The total PCL-S scores suggested PTSD symptoms were present in 33% of responding EMS clinicians (95% confidence interval [CI], 24.1%-42.5%), and 25% (95% CI, 17.6%-34.7%) met the criteria for a presumptive diagnosis of PTSD. Regression revealed increasing PCL-S scores were associated with thoughts of job resignation (+3.8; 95% CI, 1.1-6.4; P = .006), whereas lower PCL-S scores were related to the degree that respondents believed emotional support was available at their institution (-3.6; 95% CI, -6.8 to -0.4; P = .03).

CONCLUSION

Sixth months after the first wave of the COVID-19 pandemic, one third of participating EMS clinicians screened positive for PTSD symptoms. Pandemic planning must address the mental health of EMS clinicians to reduce subsequent burnout and maintain a healthy workforce.

Distress, demoralization, and fulfillment among palliative care providers during the COVID-19 pandemic

OBJECTIVES

Prolonged distress is a risk factor for burnout among health-care providers (HCP) and may contribute to demoralization. We examined sources of distress during the COVID-19 pandemic and associations with demoralization.

METHODS

This prospective cross-sectional survey of HCP was conducted among palliative care providers of an academic medical center. Participants completed a survey evaluating sources of distress and the Demoralization Scale-II (DS-II) to measure the intensity of demoralization.

RESULTS

Of 106 eligible participants, 74 (70%) completed the survey. DS-II median (range) score was 2 (0-19). There were no statistically significant associations with demographic characteristics. Participants reported high rates of distress for multiple reasons and high rates of sense of fulfillment (90%) and satisfaction (89%) with their profession.

SIGNIFICANCE OF RESULTS

Our study identified high levels of distress but low demoralization rates. Further study to evaluate fulfillment and satisfaction as protective factors against demoralization and burnout is indicated.

It Was Like Going to a Battlefield: Lived Experience of Frontline Nurses Supporting Two Hospitals in Wuhan During the COVID-19 Pandemic

Introduction

The literature indicates that pandemics significantly impact the mental health of frontline health workers. While the effects of COVID-19 on the mental health of frontline nurses have been studied, their lived experiences remain insufficiently explored.

Objective

This study aims to investigate the lived experience of nurses who were deployed to support Wuhan during the COVID-19 pandemic.

Methods

This study adopted a qualitative study design. A purposive sample of fifteen nurses were recruited from a group of nurses who supported Wuhan during COVID-19 pandemic. The data was collected during May and June 2020. Data collection occurred in May and June 2020, employing semistructured interviews conducted via telephone. Interpretative phenomenological analysis (IPA) was utilized to analyze the collected data by two independent researchers. This report follows the COREQ checklist.

Results

Frontline nurses supporting Wuhan likened their experience to being on a battlefield. Four superordinate themes emerged: (1) mobilization for combating COVID-19; (2) rapid adaption to a dynamic high-stress environment; (3) navigating psychological distress; and (4) the journey home.

Conclusion

This study offers comprehensive insights into the lived experience of nurses deployed from other provinces to assist COVID patients in Wuhan. The findings indicate that despite facing a variety of challenges, these frontline nurses were capable of rapid adaptation and successfully fulfilled their roles. Recommendations for future preparedness in public health emergencies are provided. Additionally, follow-up research is warranted to explore the long-term effects of frontline experience on the mental health of the nurses and their family members.

From pervasive chaos to evolutionary transition: The experience of healthcare providers during the COVID-19 pandemic

AIM

The outbreak of the COVID-19 pandemic confronted healthcare providers, especially physicians and nurses, with many unprecedented changes and physical and psychological pressures. This study aimed to explore the healthcare providers' experiences providing healthcare services for patients during the COVID-19 pandemic in "Golestan, Northeast Iran".

DESIGN

Qualitative, conventional content analysis.

METHODS

A total of 13 eligible participants were recruited through the purposeful sampling method. Data were gathered using semi-structured in-depth individual interviews. Transcripts were analysed using an inductive content analysis based on the Elo and Kyngas model. The COREQ checklist was used to prepare the manuscript.

RESULTS

The analysis of the data in this study led to the development of 16 subthemes and 5 themes emerged as follows pervasive chaos, imposed difficulties, paradoxical perceptions, committed efforts, and constructive transition.

CONCLUSION

The experience of HCPs during the COVID pandemic in "Iran" showed that despite the physical, mental, emotional, and social consequences, a kind of constructive evolution and transition has also taken place in personal, professional, and organizational dimensions. It is suggested that managers while strengthening and protecting the capabilities and skills that have emerged, to reduce the tensions of HCPs, have developed programs for comprehensive support from them in physical, psychological, social, and financial dimensions.

RELEVANCE TO CLINICAL PRACTICE

It is necessary to improve inter-professional cooperation, empathy, teamwork, professional commitment, and continuous learning in crises.

Worsening psychological wellbeing of Australian hospital clinical staff during three waves of the coronavirus (COVID-19) pandemic

Objective This study aimed to assess and compare the psychological wellbeing of Australian hospital clinical staff at three timepoints during the coronavirus disease 2019 (COVID-19) pandemic. Methods An anonymous, online, cross-sectional survey was conducted at three timepoints during the COVID-19 pandemic (T1: May-June 2020; T2: October-December 2020; T3: November 2021-January 2022). The surveys were completed by nurses, midwives, doctors and allied health staff employed at a large metropolitan tertiary health service located in Melbourne, Australia. The Depression, Anxiety and Stress Scale (DASS-21) assessed respondents' psychological wellbeing in the past week. General linear models were used to measure the effects of survey timepoint on DASS-21 subscale scores, adjusting for selected sociodemographic and health characteristics. Results A total of 1470 hospital clinical staff completed at least one survey (T1: 668 (14.7%), T2: 358 (7.9%) and T3: 444 (9.8%)). Respondents' sociodemographic characteristics were similar across the three timepoints and within professional discipline groups. Respondents' psychological wellbeing was worse at T3 compared to the earlier survey timepoints. Adjusting for respondent characteristics, depression, anxiety and stress scores were significantly higher for respondents of the third survey compared to the first (P  < 0.001). Conclusions There was a significant and persistent negative impact on the psychological wellbeing of hospital clinical staff in Australia across waves of the COVID-19 pandemic. Hospital clinical staff would benefit from ongoing and continued wellbeing support during and after pandemic waves.

Psychological effect of COVID-19 pandemic on healthcare professionals of Yemen and coping strategies

COVID-19 pandemic has triggered psychological stress such as anxiety and depression among people around the globe. Due to the nature of the job, healthcare professionals (HCPs) are at high risk of infection and are facing social stigma as well. This research was conducted with the objective to evaluate the psychological influence of the COVID-19 pandemic among HCPs in Yemen and the coping strategies adopted thereof. A web-based, as well as face-to-face cross-sectional study was carried out from July to December 2021 among HCPs of Yemen. The generalized anxiety disorder (GAD-7), patient health questionnaire (PHQ-9), and Brief-COPE scales were applied for the evaluation of anxiety, depression, and coping strategies. A total of 197 HCPs participated in the study where 28.4% and 43.1% had anxiety and depression respectively. The prevalence of both anxiety and depression in the majority were found of the minimal to none and mild categories (71.6% vs. 56.9% respectively). The respondents who had received training on COVID-19 had statistically significant lower GAD-7 scores than those who did not (6.32 vs. 8.02 respectively). A significant statistical difference was observed between physicians versus nurses regarding depression based on the working area (p < 0.05). The physician and pharmacist had a significant positive association with brief COPE scores at the 50th centile compared to other HCPs. The female respondents had statistically significant higher mean Brief COPE scores than male respondents (78.11 vs. 69.50 respectively). Our findings illustrate the requirement for efficient policies through administrative, clinical, and welfare perspectives from the regulatory body in preparedness and preventive measures towards such a pandemic that aids HCPs to provide service in a stress-free condition and assurance of a better healthcare system..

The prevalence of mental distress changes before and during the COVID-19 pandemic: a study on physicians in Turkey

BACKGROUND

The emergence of the COVID-19 pandemic may adversely affect the physicians' mental health differently.

AIMS

This study aimed to investigate the degree of changes in mental distress in physicians through two cross-sectional studies before and during the COVID-19 pandemic and explore factors associated with the change of mental distress status of participants between two-time periods.

METHODS

This cross-sectional, web-based survey collected demographic data and mental health measurements with the 12-item General Health Questionnaire from 416 and 522 physicians before and during COVID-19, respectively. Mixed-effects ordinal logistic regression analyses were performed to assess the factors associated with the change of mental distress status.

RESULTS

During the outbreak, a total of 319 of the 522 participants reported a clinically significant level of mental distress compared with 123 of 416 participants before COVID-19. Higher levels of mental distress were observed in all socio-demographic groups during COVID-19 compared with before, with more than two-fold higher prevalence of mental health deterioration in general.

CONCLUSIONS

This study suggests a significant deterioration in mental health status after the occurrence of COVID-19 compared with before. The mental health of physicians working in all medical specialty groups, especially those in internal and surgical specialties, may require special attention.

Predictors of somatic symptom burden in healthcare professionals during the COVID-19 pandemic: an 8-week follow-up study

BACKGROUND

Literature investigating the impact of COVID-19 on healthcare professionals barely addresses predictors of somatic symptom burden during the COVID-19 pandemic.

AIMS

As biopsychosocial models propose that not only the disease but also sociodemographic and psychosocial factors contribute to the development and maintenance of symptoms, this study investigates the predictive value of these factors for bothersome somatic symptoms in SARS-CoV-2 negative healthcare professionals.

METHODS

German healthcare professionals were assessed with self-rating questionnaires and underwent SARS-CoV-2 IgG antibody tests at baseline and 8 weeks later between April and August 2020. Differences in psychosocial variables between the time points were analyzed and regression analyses were performed to predict somatic symptoms at follow-up.

RESULTS

1185 seronegative healthcare professionals completed both assessments. Previous somatic symptom burden, higher levels of anxiety, being a nurse, younger age, higher psychological symptom burden, lower efficiency, and higher fatigability at baseline predicted somatic symptom burden at follow-up. Comparisons between baseline and follow-up showed a significant improvement in psychological impairment and deterioration of physical exhaustion.

CONCLUSIONS

Our study applies a biopsychosocial perspective to bothersome somatic symptoms during the COVID-19 pandemic and contributes to the identification of potential risk factors as a starting point for future interventions that could support the handling of symptoms.

Anxiety among healthcare workers during the COVID-19 pandemic: a longitudinal study

Background

During the COVID-19 pandemic, many healthcare workers faced extreme working conditions and were at higher risk of infection with the coronavirus. These circumstances may have led to mental health problems, such as anxiety, among healthcare workers. Most studies that examined anxiety among healthcare workers during the COVID-19 pandemic were cross-sectional and focused on the first months of the pandemic only. Therefore, this study aimed to investigate the longitudinal association between working in healthcare and anxiety during a long-term period (i.e., 18 months) of the COVID-19 pandemic.

Methods

Data were used from online questionnaires of the Lifelines COVID-19 prospective cohort with 22 included time-points (March 2020-November 2021). In total, 2,750 healthcare workers and 9,335 non-healthcare workers were included. Anxiety was assessed with questions from the Mini-International Neuropsychiatric Interview, and an anxiety sum score (0-7) was calculated. Negative binomial generalized estimating equations (GEE), adjusted for demographic, work and health covariates, were used to examine the association between working in healthcare and anxiety.

Results

Anxiety sum scores over time during the COVID-19 pandemic were similar for healthcare workers and non-healthcare workers. No differences between the anxiety sum scores of healthcare workers and non-healthcare workers were found [incidence rate ratio (IRR) = 0.97, 95% CI = 0.91-1.04].

Conclusion

This study did not find differences between healthcare workers and non-healthcare in perceived anxiety during the COVID-19 pandemic.

Mental health of healthcare workers during the first year of the COVID-19 pandemic in the Netherlands: a longitudinal study

Purpose

In March 2020, the WHO declared COVID-19 a pandemic. Previous virus outbreaks, such as the SARS outbreak in 2003, appeared to have a great impact on the mental health of healthcare workers. The aim of this study is to examine to what extent mental health of healthcare workers differed from non-healthcare workers during the first year of the COVID-19 pandemic.

Methods

We used data from a large-scale longitudinal online survey conducted by the Corona Behavioral Unit in the Netherlands. Eleven measurement rounds were analyzed, from April 2020 to March 2021 (N = 16,615; number of observations = 64,206). Mental health, as measured by the 5-item Mental Health Inventory, was compared between healthcare workers and non-healthcare workers over time, by performing linear GEE-analyses.

Results

Mental health scores were higher among healthcare workers compared to non-healthcare workers during the first year of the pandemic (1.29 on a 0-100 scale, 95%-CI = 0.75-1.84). During peak periods of the pandemic, with over 100 hospital admissions or over 25 ICU admissions per day and subsequently more restrictive measures, mental health scores were observed to be lower in both healthcare workers and non-healthcare workers.

Conclusion

During the first year of the COVID-19 pandemic, we observed no relevant difference in mental health between healthcare workers and non-healthcare workers in the Netherlands. To be better prepared for another pandemic, future research should investigate which factors hinder and which factors support healthcare workers to maintain a good mental health.

Mental health during the omicron pandemic: A comparison between medical staff and non-medical staff

BACKGROUND

A considerable number of people suffered from mental disorders due to coronavirus disease 2019 (COVID-19). As the virus mutated, the effect of COVID-19 changed. This study intends to compare the mental health between the medical staff and non-medical staff during the Omicron pandemic, and to analyze the relevant risk factors.

METHODS

The cross-sectional study was conducted by a set of online questionnaires, 1246 medical staff and 1246 non-medical staff were selected after a 1:1 propensity score matching. The questionnaires included the demographic characteristics, the Coronavirus Anxiety Scale (CAS), the Center for Epidemiologic Studies Depression Scale (CES-D), the Insomnia Severity Index Scale (ISI), and the Psychological Resilience Scale(CD-RISC).

RESULTS

Compared with medical staff, non-medical staff scored higher on CAS and CES-D (both P < 0.001). Non-medical staff had higher prevalence of anxiety (55.0 % versus 47.3 %; adjusted OR = 1.45, 95 % CI = 1.23-1.70), depression (62.4 % versus 53.4 %; adjusted OR = 1.46, 95 % CI = 1.23-1.73) and insomnia (46.5 % versus 43.4 %; adjusted OR = 1.21, 95 % CI = 1.02-1.43). Multivariate logistic regression analysis showed that being female, being younger than 40 years, having an annual income of <50,000 yuan, paying attention to omicron, in the course of an infection and below bachelor degree influenced anxiety, depression and insomnia of the medical staff and non-medical staff to different degree.

LIMITATIONS AND CONCLUSIONS

This study only collected data through the network. Therefore, the validity was reduced to some extent. The outbreak of the Omicron epidemic posed a significant challenge to public mental health, with non-medical staff at the highest risk for mental health problems.

Reflections of nurses in the fight against COVID-19 in Hubei: a qualitative study

OBJECTIVES

To explore the reflections and experiences of nurses who were deployed to the frontline to combat COVID-19 in Wuhan, China. In order to gain insights that can be useful in developing cultivating positive professional values and attitudes towards future public health emergencies.

DESIGN

Qualitative study using semistructured interviews. Data were transcribed and analysed using the Colaizzi's 7-step method. The study is reported in accordance with the consolidated Standards for Reporting Qualitative Research.

SETTING

Telephonic interviews with nine participants who were deployed from Nanjing to Hubei Province for the fight against COVID-19.

PARTICIPANTS

Of 11 volunteer nurses deployed to Hubei Province for the fight against COVID-19, two nurses did not finish the interview because of their working hours. The remaining nine were recruited through purposive sampling using the following criteria: nurses who were deployed at the first stage and those who verbally agreed and signed an informed consent form to participate in the study.

RESULTS

Three thematic categories and subthemes that were identified from the analysis were as follows: (1) 'Assertive attitude to fight against the pandemic', included three subthemes: 'Inner calling towards professional accountability for saving lives', 'Extrinsic support that facilitates the commitment to the nursing profession' and 'Holistic value ascribed to the nursing profession'. (2) 'Challenges associated with the anti-pandemic mission', included 'overcoming challenges around the strict requirements for personal protection' and 'Fear and uncertainty over the rapid progression of the disease'. (3) 'Unbearable heaviness and lightness of being a nurse', with two subthemes: 'the heavy crown of the anti-pandemic hero' and 'eternal reverence without regrets'.

CONCLUSIONS

As reflected by the nurses on frontline combating COVID-19, it was necessary to inculcate professional nursing values in them, as only their dedication and selflessness could improve humanity's chances against the disease.

Impact of the COVID-19 pandemic crisis on turnover intention among nurses in emergency departments in Thailand: a cross sectional study

BACKGROUND

During the COVID-19 pandemic in Thailand, a large volume of COVID-19 patients were referred to hospital emergency departments (EDs). This increased job demand and job strain among ED nurses, resulting in a high risk of intention to leave their organization.

AIMS

To investigate turnover intention during the COVID-19 pandemic among ED nurses and examine the effect of organizational resources, maladaptive regulation, and job burnout on nurses' turnover intention.

METHOD

This cross-sectional study investigated 322 ED nurses. We divided participants into two groups: dark-red zone areas (pandemic crisis areas) and non-red zone areas (non-pandemic crisis areas). Descriptive statistics, Pearson's correlation analysis, and multiple linear regression (forward stepwise method) were used to analyze factors that predicted turnover intention.

RESULTS

Most participants were female and the mean age was 34.54 years. During COVID-19 pandemic crisis, 72.8% of ED nurses in dark-red zone areas desired to leave their organization. The factors of motivation, exhaustion, and cognitive impairment positively influenced turnover intention among ED nurses in dark-red zone areas. Low availability of organizational resources was associated with an increase in the turnover intention rate. Maladaptive regulation, exhaustion, and cognitive impairment positively influenced turnover intention among ED nurses in non-red zone areas.

CONCLUSION

Exhaustion and cognitive impairment stand as significant facets of burnout linked to the intention of turnover among ED nurses. To address this, we recommend fostering secure workplace settings and implementing interventions that alleviate job demands and strains for ED nurses, potentially reducing turnover intentions.

Worsening of mental health outcomes in nursing home staff during the COVID-19 pandemic in Ireland

BACKGROUND

Mental health issues in nursing home staff during the COVID-19 pandemic have been significant; however, it is not known if these issues persist following widespread vaccination and easing of restrictions.

OBJECTIVE

To quantify the mental health of nursing home staff at different timepoints during the COVID-19 pandemic in the Republic of Ireland.

DESIGN/METHODS

Two identical, online, cross-sectional, nationwide, anonymous surveys of Republic of Ireland nursing home staff at two timepoints (survey 1 (S1, n = 390): November 2020 to January 2021; survey 2 (S2, N = 229: November 2021 to February 2022) during the COVID-19 pandemic. Convenience sampling was used with staff self-selecting for participation. Methods included the World Health Organisation's Well-Being Index (WHO-5), the Impact of Events Scale-Revised (IES-R), the Moral Injury Events Scale (MIES), two Likert-scale items regarding suicidal ideation and planning, the Work Ability Score (WAS), the Brief Coping Orientation to Problems Experienced (Brief-COPE) Scale, and a 15-item questionnaire assessing perceptions of the outbreak with one additional Likert-scale item on altruism. Descriptive analysis examined differences between staff based on their classification in one of three groups: nurses, healthcare assistants (HCA) and nonclinical staff. Pseudonymous identifiers were used to link responses across surveys.

RESULTS

An insufficient number of participants completed both surveys for linked analyses to be performed; therefore, we performed an ecological comparison between these two independent surveys. More staff reported moderate-severe post-traumatic stress symptoms (S1 45%; S2 65%), depression (S1: 39%; S2 57%), suicidal ideation (S1: 14%; S2 18%) and suicidal planning (S1: 9%; S2 15%) later in the pandemic. There was a higher degree of moral injury at S2 (S1: 20.8 standard deviation (SD) 9.1; S2: 25.7 SD (11.3)) and use of avoidant (maladaptive) coping styles at S2 (S1: 20.8 (6.3); S2 23.0 (6.3)) with no notable differences found in the use of approach (adaptive) coping styles. Staff reported more concerns at S2 regarding contracting COVID-19, social stigma, job stress, doubts about personal protective equipment and systems and processes.

CONCLUSION

In comparison to our previous survey, mental health outcomes appear to have worsened, coping did not improve, and staff concerns, and worries appear to have increased as the pandemic progressed. Follow-up studies could help to clarify is there are any lingering problems and to assess if these issues are related to the pandemic and working conditions in nursing homes.

Middle Eastern nurses' views/experiences of work and well-being with the support measures during past disease outbreaks and COVID-19: a qualitative systematic review

BACKGROUND

The potential psychological health impact of pandemics on nurses has been increasingly widely recognised, as have recommendations to establish support measures for nurses' well-being. Despite the availability of support measures significant number of nurses still experienced burnout and mental distress during Covid-19. Few efforts have been made in the wider literature to understand how nurses experience well-being support or how they perceive it affects their well-being during pandemics. In the Middle East, understanding and exploring well-being support measures during pandemics from nurses' perspectives has not received significant attention.

OBJECTIVE

To investigate nurses' perspectives and experiences of well-being support measures during prior pandemics and the Covid-19 pandemic in the Middle East.

METHODS

A systematic qualitative review was undertaken utilising the JBI model as a framework. Searches were carried out in databases comprised CINAHL, MEDLINE, NUsearch Library of Nottingham University and Google Scholar. Moreover, a manual search through reference lists for relevant studies were carried out.

DATA EXTRACTION AND SYNTHESIS

Eleven studies were included in the review. The findings from the included qualitative studies were extracted using the JBI-QARI data extraction tool for qualitative research. The results were synthesised using a meta-synthesis in line with the JBI approach.

RESULTS

The included studies yielded an aggregate of 111 findings and were categorised into 14 categories, followed by four synthesised findings. These were: [1] nurses experienced challenges during MERS, yet different strategies were implemented by leaders and nurses to manage these challenges; [2] some well-being support measures were unfulfilled during Covid-19; [3] additional aspects compounded negatively on nurses' well- being; and [4] nurses showed maturity during Covid-19.

CONCLUSION

In comparison to prior health emergencies, well-being support measures during Covid-19 were not sufficiently adopted. Nurse policymakers and managers should consider these support measures to correspond with nurses' needs and explore the contextual factors that affect their implementation.

TRIAL REGISTRATION

PROSPERO (CRD42022344005).

Mental condition and function of resilience among families of frontline medical workers during COVID-19: Potential influencing factors and mediating effect

BACKGROUND

Studying the role of psychological resilience in self-perceived stress and mental disorders among family members of medical workers can help us understand its importance in mental health care and guide us to develop psychological intervention strategies for family members of medical workers.

METHODS

A total of 671 family members of medical workers were enrolled. Self-perceived stress, resilience, depression symptoms, anxiety symptoms, and post-traumatic stress disorder (PTSD) symptoms were measured in our research.

RESULTS

The prevalence of anxiety, depression, and PTSD symptoms among relatives of medical workers were 49.0 %, 12.2 %, and 20.3 % respectively during the COVID-19 epidemic. According to the Multivariate regression model, compared with family members of doctor, family members of nurse and medical technologists were more likely to report anxiety symptoms. Female members of medical staff were more likely to have PTSD symptoms than male counterparts; and family members of medical technologist appeared to less likely have PTSD symptoms than family members of either doctor or nurse. The mediation analysis confirmed that mental resilience mediated the relationship between self-perceived stress and anxiety symptoms.

LIMITATIONS

Single cross-sectional study design without the follow-up comparative analysis, only self-reported measurements were adopted, and inadequate pre-set demographic variables.

CONCLUSIONS

To the best of our knowledge, our study firstly demonstrated the risk of psychological distress present in the family members of medical providers during the COVID-19 epidemic. Meanwhile, our findings highlighted the importance of mental resilience in family members of frontline medical workers as it mediated the relationship between self-perceived stress and anxiety symptoms.

Burnout and Mental Health and Well-Being of School Nurses After the First Wave of the COVID-19 Pandemic: A National Cross-Sectional Survey

The aim of this study was to examine the associations between job stressors, COVID-19-related concerns, burnout, and mental health and well-being among school nurses, and whether any of these associations are mediated by burnout. Based on stratified proportional sampling, data collection was conducted by an online questionnaire distributed to 600 school nurses in Taiwan. A total of 256 participants aged between 27 and 62 years (mean = 47.08; standard deviation = 7.28) returned questionnaires. Results showed that burnout was the main mediating variable that fully mediated the relationship between COVID-19-related concerns and mental health and well-being. The effects of job stressors on mental health and well-being included direct negative effects (β = -.29) and indirect negative effects (β = -.67) through mediating factors. School health managers should be more aware of burnout and mental health and well-being among school nurses under the impact of COVID-19.

Healthcare workers' mental health and perception towards vaccination during COVID-19 pandemic in a Pediatric Cancer Hospital

The consistent increase of Coronavirus disease 2019 (COVID-19) cases parallel with the rate of deaths and the controversial response regarding the vaccines caused an increase in the burden of psychological diseases. This study aimed to evaluate the psychological condition of healthcare workers (HCWs) in a pediatric cancer hospital and to identify the knowledge, attitude, and perception (KAP) of HCWs toward COVID-19 vaccination. A cross-sectional observational study was conducted between April to May 2021. A validated, confidential survey was employed to measure the mental health of HCWs and the KAP toward COVID-19 vaccines. The total responses were 395, of which 11.4% physicians, 18.5% pharmacists, and 70.1% were nurses. Sixty-six percent of HCWs had different degrees of anxiety and depression. Nurses significantly accounted for the highest anxiety levels (P = 0.003), while the cumulative anxiety score was significantly higher in HCWs who had a positive history of COVID-19 infection (P = 0.026). Although 67.6% of HCWs believe that "vaccines are essential for us,", the vaccination rate was 21.3%. The Factors associated with not receiving the vaccine were younger ages (P = 0.014), nurses (P = 3.6987 × 10^-7), negative history of COVID-19 infection (P = 0.043) and believing that infections can happen after taking the vaccine (P = 1.5833 × 10^-7). Healthcare organizations must take serious intervention to decrease the mental load on HCWs and facilitate the vaccination process.

Investigating Physical Activity Habits and Sleep Disorders in the Nursing Staff of Greece During the COVID-19 Pandemic: A Multicenter Cross-Sectional Correlational Study

INTRODUCTION

The social isolation (lockdown) used worldwide as a measure to effectively prevent the infection of COVID-19 has been shown to be responsible for the high prevalence of depression, anxiety, insomnia, and post-traumatic stress symptoms. The aim of this study was to investigate the physical activity habits and sleep disorders in the nursing staff.

METHODOLOGY

This is a multicenter cross-sectional correlational study. The study population consisted of nurses and nursing assistants. Data were collected using the Greek version of the Pittsburgh Sleep Quality Index, the Fear of the COVID-19, and the Physical exercise questionnaire of the American College of Sports Medicine. Statistical analysis of data was done with IBM SPSS v. 22.0.

RESULTS

A total of 1710 nursing personnel aged 42.3 ± 9.1 years were included. At the beginning of the COVID-19 pandemic, 190 (11.1%) participants were physically active, and 2 years after the beginning of the COVID-19 pandemic, active were 130 (7.6%) participants. Both at the beginning and two years after the beginning of the pandemic, the sleep dimensions that scored higher were subjective sleep quality (1.98 ± 0.2 vs. 1.98 ± 0.3), sleep onset latency (1.89 ± 1.5 vs. 1.64 ± 1.6), and sleep duration (1.55 ± 0.9 vs. 1.65 ± 0.8). The total sleep score was 8.64 ± 3.1 at the beginning of the pandemic and 8.11 ± 3.7 two years after the beginning of the pandemic.

CONCLUSIONS

Nurses and nurses' assistants had less physical activity habits, slept less, and had more sleep disorders 2 years after the beginning of the pandemic in relation to the beginning of the pandemic.

Prevalence and correlates of burnout among physicians in a developing country facing multi-layered crises: a cross-sectional study

Burnout among physicians is a serious concern that cultivates its seeds during their education. This study assessed the prevalence of burnout among Lebanese physicians and explored its correlates and the combined effects of the pandemic and the economic crisis on burnout. A web-based cross-sectional study was conducted in December 2020 using a snowball sampling technique. Moderate and high levels of burnout hit 90.7% of the physicians where personal, work-related, and client-related burnout were detected among 80.4%, 75.63%, and 69.6% of them respectively. A strong association was found between the higher level of burnout and female gender, younger age, being single, having a dependent child, living with an elderly or a family member with comorbidities, and insufficient sleeping hours. Physicians’ specialties, working in a public health facility, limited years of professional experience, lack of previous experience in a pandemic, and extensive working hours were also associated with increased burnout. Furthermore, low income, working in the frontline, higher threat perception, and fear of COVID-19 were contributing to higher burnout. The combined effect of threat perception and financial hardship significantly increased burnout levels. The alarming burnout level detected among physicians urges health authorities to take prompt actions to enhance the physicians’ well-being.

The psychological distress and suicide-related ideation in hospital workers during the COVID-19 pandemic: Second results from repeated cross-sectional surveys

The COVID-19 pandemic has been affecting the mental health of hospital workers. During the prolonged pandemic, hospital workers may experience much more severe psychological distress, leading to an increased risk of suicide. This study aimed to investigate changes in psychological effects on hospital workers over 12 months from the beginning of the pandemic and clarify factors associated with psychological distress and suicide-related ideation 1-year after the pandemic's beginning. These repeated, cross-sectional surveys collected demographic, mental health, and stress-related data from workers in 2 hospitals in Yokohama, Japan. The first survey, conducted in March-April 2020, contained the 12-item General Health Questionnaire (GHQ-12) assessing general distress and the Impact of Event Scale-Revised (IES-R) assessing event-related distress. In the second survey in March 2021, hospital workers at the same two hospitals were reassessed using the same questionnaire, and Item 9 of the Patient Health Questionnaire (PHQ-9) was added to assess their suicide-related ideation. The findings of the first and second surveys revealed that the average score of GHQ-12 (3.08 and 3.73, respectively), the IES-R total score (6.8 and 12.12, respectively), and the prevalence rates of severe general distress (35.0% and 44.0%, respectively) and severe event-related distress (7.0% and 17.1%, respectively) deteriorated. The second survey showed that 8.6% of the hospital workers were experiencing suicide-related ideation. Both the general and event-related distress were associated with suicide-related ideation. In these surveys, mental health outcomes among the hospital workers deteriorated over one year from the pandemic's beginning, and their severe psychological distress was the risk factor for the suicide-related ideation. Further studies are needed to compare the psychological effects on hospital workers during and after the prolonged pandemic and to explore appropriate measures to support hospital workers' mental health.

The impact of eating behaviors during COVID-19 in health-care workers: A conditional process analysis of eating, affective disorders, and PTSD

Objective

The incidence of post-traumatic stress disorder (PTSD) increased among healthcare workers (HCWs) during the outbreak of COVID-19. The purpose of this study was to examine the relationship between eating behavior and PTSD, considering the mediation effect of anxiety, depression and sleep.

Methods

A total of 101 HCWs completed a survey. The Food-Frequency Questionnaires (FFQ) were used to evaluate the diet. A special survey was conducted on the eating time of each shift mode. The PTSD Checklist-Civilian Version (PCL-C), Self-Rating Anxiety Scale (SAS), Self-Rating Depression Scale (SDS), Pittsburgh Sleep Quality Index (PSQI), and Morning-Evening Questionnaire (MEQ) were utilized to assess clinical symptoms.

Results

There was a statistically significant correlation between the night shift eat midpoint (NEMP) and PTSD symptoms, anxiety and depression as significant mediators. The last meal jet lag between night shift and day shift (NDLM) was related to PTSD symptoms significantly, and sleep and anxiety were significant mediators. The relationship between animal-based protein pattern and PTSD symptoms was statistically significant, and anxiety was the significant mediator.

Conclusions

The earlier the HCWs eat in the night shift, the lighter the symptoms of PTSD. This is mediated by improving anxiety, depression and sleep disorder. Furthermore, the consumption of animal protein could reduce symptoms of PTSD by improving anxiety.

The Effect of Psychosocial Safety Climate on Engagement and Psychological Distress: A Multilevel Study on the Healthcare Sector

All work sectors have been affected by the impact of the COVID-19 pandemic. The perception of risk combined with the lack of safety and fear for their own safety have caused severe psychological discomfort in workers. Of all the work sectors, the most affected was certainly the healthcare sector. In hospitals, medical staff were at the forefront of the battle against COVID-19, providing care in close physical proximity to patients and had a direct risk of being exposed to the virus. The main objective of the study was to investigate the perception of a psychosocial safety climate and the effect on engagement and psychological stress in a sample of 606 healthcare workers (physicians 39.6%, nurses 41.3%, healthcare assistant 19.1%), belonging to six organisations and organised into 11 working groups. Furthermore, we wanted to investigate the mediating effect of workaholism at both individual and group level. The results partially confirmed our hypotheses and the mediating effect at the individual level of working compulsively. A psychosocial safety climate in healthcare workers led to a decrease in engagement through the mediation of working compulsively. The mediating effect of working compulsively might be due to a climate that did not guarantee or preserve the psychological health and safety of healthcare workers. In this research, the most important limit concerns the number of organisations and the number of groups.

Comparison of the anxiety level between the medical staff and the public during the early phase of the coronavirus disease 2019 pandemic

Background

A sudden outbreak of the coronavirus disease 2019 (COVID-19) started in December 2019 in Wuhan, China. Up-to-date, there have been limited studies examining the anxiety status of Chinese individuals in the early phase of the pandemic period (January 30, 2020–February 15, 2020). This survey aimed to compare the level of anxiety of the medical staff with that of the public and to provide a theoretical basis for developing an effective psychological intervention.

Method

Questionnaires were sent on the Internet (http://www.wjx.cn) during this period. The anxiety levels of Chinese people were investigated using the Self-Rating Anxiety Scale (SAS), and the demographic data were collected simultaneously.

Results

A total of 1110 participants were enrolled in this study, with an effective response rate of 100%. A total of 482 respondents were medical staff (43.4%), while 628 were members of the general public (56.6%). The medical staff itself had a higher SAS score than the general public (48.36±13.40 vs. 45.74±11.79, P < 0.01), while the medical staff in Wuhan were more anxious than the public in Wuhan with a higher SAS score (54.17±14.08 vs. 48.53±11.92, P < 0.01).

Conclusion

The COVID-19 pandemic has had a significant impact on the anxiety levels of the medical staff and the public, with the medical personnel showing a higher anxiety level than the public, especially female medical staff in Wuhan. Therefore, urgent intervention programs to reduce anxiety should be implemented.

Psychological Distress in South African Healthcare Workers Early in the COVID-19 Pandemic: An Analysis of Associations and Mitigating Factors

While the global COVID-19 pandemic has been widely acknowledged to affect the mental health of health care workers (HCWs), attention to measures that protect those on the front lines of health outbreak response has been limited. In this cross-sectional study, we examine workplace contextual factors associated with how psychological distress was experienced in a South African setting where a severe first wave was being experienced with the objective of identifying factors that can protect against HCWs experiencing negative impacts. Consistent with mounting literature on mental health effects, we found a high degree of psychological distress (57.4% above the General Health Questionnaire cut-off value) and a strong association between perceived risks associated with the presence of COVID-19 in the healthcare workplace and psychological distress (adjusted OR = 2.35, p < 0.01). Our research indicates that both training (adjusted OR 0.41, 95% CI 0.21−0.81) and the reported presence of supportive workplace relationships (adjusted OR 0.52, 95% CI 0.27−0.97) were associated with positive outcomes. This evidence that workplace resilience can be reinforced to better prepare for the onset of similar outbreaks in the future suggests that pursuit of further research into specific interventions to improve resilience is well merited.

Anxiety, Depression and Post-Traumatic Stress Disorder in Physicians Compared to Nurses during the COVID-19 Pandemic: An Observational, Cross Sectional, Multicentric Study

(1) Background: The coronavirus pandemic has highlighted the precarious health situation of our country, thanks to the grueling workloads caused by understaffing and fear of contracting COVID-19. By considering this critical situation, frontline healthcare professionals who have been directly involved in the diagnosis, treatment, and care of SARS-CoV-2 patients are now at risk of developing psychological distress and other mental health symptoms, accomplices of the fear of contracting the COVID-19 and the exhausting workloads. (2) Methods: An observational, cross-sectional, multicenter study was conducted by administering an online questionnaire to all Italian physicians and nurses who worked during the COVID-19 pandemic. The questionnaire consists of socio-demographic characteristics, an assessment of anxiety levels with the State-Trait Anxiety Inventory (STAI), which also assessed trait and state anxiety, the Beck Depression Inventory (BDI) to evaluate the condition of depressive severity, and, finally, the Impact of Event Scale–Revised (IES–R), which was administered in order to quantify the post-traumatic stress disorder (PTSD) among the participants. (3) Results: A total of 770 Italian healthcare workers were enrolled in this study. Of these, 95 (12.30%) were physicians and 675 (87.70%) were nurses. By considering PTSD, anxiety, and depression levels between the physicians and nurses recruited, a significant difference was reported in the STAI-1 assessment, as both physicians and nurses reported slight and moderate levels (p = 0.033). (4) Conclusions: Physicians and nurses, who have been subjected to physical impoverishment, with the infinite physical forces spent to support the pace of work at the limits of the possible, but above all mental capacity, with the anxiety of having to face an unknown enemy, such as COVID-19. This has resulted in a significant increase in anxiety, depression, post-traumatic symptoms, and sleep disturbances, with possible repercussions not only on the quality of life of the physicians and nurses but also on the quality of assistance provided.

Relationship of Societal Adaptation with Vaccine Worries among Healthcare Workers during the COVID-19 Pandemic: The Mediating Effects of Posttraumatic Stress Disorder

Vaccine hesitancy has become a major public health problem among healthcare workers (HCWs) in this coronavirus disease 2019 (COVID-19) pandemic. The aim of this study was to examine the relationship between societal adaptation and vaccine worries and the mediating effects of posttraumatic stress disorder (PTSD) indicators in HCWs. A total of 435 HCWs (327 women and 108 men) were recruited. Their levels of societal adaptation were evaluated using the Societal Influences Survey Questionnaire (SISQ). Their severity and frequency of PTSD symptoms were examined using the Disaster-Related Psychological Screening Test (DRPST). The severity of vaccine worries was assessed using the Vaccination Attitudes Examination (VAX) Scale. The relationships among societal adaptation, PTSD, and vaccine worries were examined using structural equation modeling. The severity of societal adaptation was positively associated with both the severity of PTSD and the severity of vaccine worries. In addition, the severity of PTSD indicators was positively associated with the severity of vaccine worries. These results demonstrated that the severity of societal adaptation was related to the severity of vaccine worries, either directly or indirectly. The indirect relationship was mediated by the severity of PTSD. Societal adaptation and PTSD should be taken into consideration by the community of professionals working on vaccine hesitancy. Early detection and intervention of PTSD should be the objectives for programs aiming to lower vaccine hesitancy among HCWs.

Associations of health-related quality of life with depression and stigma in MERS-CoV survivors during the recovery period

ABSTRACT

We explored factors related to health-related quality of life (HRQOL), including psychiatric symptoms and stigma related to Middle East respiratory syndrome coronavirus (MERS-CoV) infection, among MERS-CoV survivors during the recovery period.Sixty-three MERS-COV survivors were recruited from five hospitals for a cohort study, one year after their infection in 2015. The subjects' demographic information and medical conditions associated with MERS-CoV were recorded. HRQOL was evaluated using the Short Form-8 Health Survey (SF-8). Depression, post-traumatic stress symptoms, chronic fatigue, and perceived stigma were assessed using several questionnairesThe mean physical component summary (PCS) and mean mental component summary (MCS) of the SF-8 score were below 50 T (43.47 ± 9.60, 45.74 ± 10.18). Depression, chronic fatigue, posttraumatic stress symptoms and stigma were negatively correlated with the SF-8 PCS and MCS. Multivariate logistic regression analysis showed that the PCS was associated with stigma (OR 8.66, 95% CI 1.96-38.23), whereas MCS was associated with depression (OR 26.62, 95% CI 3.56-198.85).The estimated HRQOL of MERS-CoV survivors during recovery was poor and appeared to be associated with depression and MERS-related stigma.

Dublin hospital workers' mental health during the peak of Ireland's COVID-19 pandemic

Background

Hospital-based healthcare workers have experienced significant psychological stressors during the COVID-19 pandemic.

Aim

To evaluate the mental health of hospital workers during the third wave of the COVID-19 pandemic in Dublin, Ireland.

Methods

Cross-sectional anonymous online survey of hospital workers (n = 377; 181 doctors (48.0%), 166 nurses (44.0%), 30 radiographers (8.0%)), collecting demographic information, COVID-19 exposure history and mental health measures.

Results

There were significant differences between profession groups in gender, experience, COVID-19 infection history, exposure to COVID-19 positive acquaintances, and work areas. Moderate-severe post-traumatic stress disorder (PTSD) symptoms were found in 45.1% (95% CI 40.1–50.1%) of all participants; significantly fewer doctors reported moderate-severe PTSD symptoms (26%; 95% CI 22–36%). A World Health Organisation-5 Wellbeing Index (WHO-5) score ≤ 32, indicating low mood, was reported by 52% (95% CI 47–57%) of participants; significantly fewer doctors reported low mood (46%; 95% CI 39–53%). One-week suicidal ideation and planning were reported respectively by 13% (95% CI 10–16%) and 5% (95% CI 3–7%) of participants with no between-group differences. Doctors reported significantly less moral injury than other groups. There were no significant between-group differences regarding coping styles. Work ability was insufficient in 39% (95% CI 34–44%) of staff; no between-group differences.

Conclusions

Dublin hospital workers reported high levels of PTSD symptoms, mood disturbance, and moral injury during the COVID-19 pandemic. Concerning levels of suicidal ideation and planning existed in this cohort. Differences in degrees of post-traumatic stress, moral injury, and wellbeing were found between profession groups, which should be considered when planning any supports.

Supplementary information

The online version contains supplementary material available at 10.1007/s11845-022-03056-0.

Australian and Danish nurses' and midwives' wellbeing during COVID-19: A comparison study

Background

Most investigations of nurses' and midwives' psychological wellbeing during the COVID-19 pandemic have been conducted in a single setting.

Aim

To assess and compare the psychological wellbeing of nurses and midwives in Australia and Denmark during the COVID-19 pandemic.

Methods

Nurses and midwives employed at four metropolitan health services in Australia and one in Denmark completed an anonymous online survey, which assessed depression, anxiety, and stress symptoms (The Depression, Anxiety and Stress Scale - 21 Items (DASS-21)), and sociodemographic and employment factors.

Findings

Completed surveys were received from 3001 nurses and midwives (1611 Australian and 1390 Danish). Overall, approximately one in seven of the nurses and midwives surveyed reported moderate to extremely severe levels of depression (n = 399, 13.5%), anxiety (n = 381, 12.9%) and stress (n = 394, 13.4%). Australian nurses' and midwives' scores on all DASS-21 subscales were significantly higher (representing higher levels of depression, anxiety and stress) than the scores for the Danish nurses and midwives. Fewer years of clinical experience, living in Australia and being employed on a part-time basis were significantly associated with higher levels of psychological distress.

Discussion

A considerable proportion of nurses and midwives experienced distress during the COVID-19 pandemic; however, the proportion and severity varied by country. Australian nurses and midwives experienced higher levels of distress than their Danish colleagues.

Conclusion

Nurses and midwives working in countries with relatively low numbers of COVID-19 cases and deaths are also likely to experience psychological distress. Nurses and midwives would benefit from targeted country-specific support and wellbeing initiatives.

The perceived work environment and well-being: A survey of emergency health care workers during the COVID-19 pandemic

Background

During the COVID‐19 pandemic, health care provider well‐being was affected by various challenges in the work environment. The purpose of this study was to evaluate the relationship between the perceived work environment and mental well‐being of a sample of emergency physicians (EPs), emergency medicine (EM) nurses, and emergency medical services (EMS) providers during the pandemic.

Methods

We surveyed attending EPs, resident EPs, EM nurses, and EMS providers from 10 academic sites across the United States. We used latent class analysis (LCA) to estimate the effect of the perceived work environment on screening positive for depression/anxiety and burnout controlling for respondent characteristics. We tested possible predictors in the multivariate regression models and included the predictors that were significant in the final model.

Results

Our final sample included 701 emergency health care workers. Almost 23% of respondents screened positive for depression/anxiety and 39.7% for burnout. Nurses were significantly more likely to screen positive for depression/anxiety (adjusted odds ratio [aOR] 2.04, 95% confidence interval [CI] 1.11–3.86) and burnout (aOR 2.05, 95% CI 1.22–3.49) compared to attendings. The LCA analysis identified four subgroups of our respondents that differed in their responses to the work environment questions. These groups were identified as Work Environment Risk Group 1, an overall good work environment; Risk Group 2, inadequate resources; Risk Group 3, lack of perceived organizational support; and Risk Group 4, an overall poor work environment. Participants in the two groups who perceived their work conditions as most adverse were significantly more likely to screen positive for depression/anxiety (aOR 1.89, 95% CI 1.05–3.42; and aOR 2.04, 95% CI 1.14–3.66) compared to participants working in environments perceived as less adverse.

Conclusions

We found a strong association between a perceived adverse working environment and poor mental health, particularly when organizational support was deemed inadequate. Targeted strategies to promote better perceptions of the workplace are needed.

Perceptions of Risk, Work, and Lifestyle Changes on Mental Health of Healthcare Workers Amidst the COVID-19 Pandemic

The COVID-19 outbreak is significantly affecting the mental health of healthcare workers worldwide. This study aims to investigate the mental health outcomes of healthcare workers in a health system located in southeastern US during the first peak of the pandemic and examine the association of specific factors on the mental well-being of healthcare workers. A cross-sectional survey of 388 healthcare workers was conducted. Data were collected using a 79-item questionnaire, which included the Patient Health Questionnaire (PHQ-9) instrument, the 7-item Generalized Anxiety Disorder (GAD-7) instrument, and the 22-item Impact of Event Scale-Revised (IES-R), to assess symptoms of depression, anxiety, and general distress, respectively. Data were analyzed using descriptive, bivariate, and multivariate statistics. Accordingly, 30.1%, 28.7%, and 39.4% of respondents reported depression, anxiety, and distress symptoms, respectively. Younger workers and females reported higher mental symptomologies. We identified significant, nontraditional factors associated with depression and anxiety symptoms among healthcare workers: healthcare procedure change, concern of exposing family to COVID-19, number of missed shifts, and access to psychological resources/services. These findings emphasize the importance of providing the proper training to reduce concerns of exposing family members and psychological interventions to promote mental health well-being for healthcare workers during the stressful COVID-19 pandemic.

The Consequences of the Coronavirus Disease 2019 Pandemic on Smoking Behavior: Evidence from the English Longitudinal Study of Ageing

INTRODUCTION

Smoking is a risk factor for the progression of COVID-19, with smokers having higher odds of COVID-19 progression than never-smokers. This study presents novel findings on the effect of the COVID-19 pandemic on smoking behavior in older adults.

METHODS

Panel data were obtained from the English Longitudinal Study of Ageing (N = 60160, 12% smokers, 55% women, 62% married, mean age = 67 years, 23% employed). Fixed-effect regression models were used to estimate the extent to which the COVID-19 pandemic affected smoking behavior. A separate model was estimated for men, women, employed, and retired.

RESULTS

The findings suggest a significant and positive effect of the COVID-19 pandemic on smoking behavior (β = 0.024; P < .001). The estimated effects were stronger for men and for the sample of individuals reporting being employed.

CONCLUSIONS

In this study, I provide robust evidence of the effect of the COVID-19 pandemic on smoking behavior using the English Longitudinal Study of Ageing. This large and representative dataset is uniquely suited for the analysis. I find evidence that the proportion of smokers has increased significantly as a result of the COVID-19 pandemic.

IMPLICATIONS

In the United Kingdom, the proportion of smokers increased significantly as a consequence of the COVID-19 pandemic. These findings suggest that smoking behavior may have been used as a mechanism to cope with depression, stress, and anxiety due to the COVID-19 outbreak. To the extent to which smoking behavior has been used as a coping mechanism to deal with job-related issues, targeted policy action to provide financial stability to those in worse economic situations may have beneficial effects on smoking behavior.

Modulating Elements of Nurse Resilience in Population Care during the COVID-19 Pandemic

COVID-19 has significantly affected the work environment of nurses. In the face of the challenges posed by stressors in clinical practice, some nurses adapt and prove to be resilient. In the face of the COVID-19 pandemic, the nature of care itself and the new ways of working are potentially very stressful. We aim to analyze the resilience of care nurses to the psychological impact of the COVID-19 pandemic. This study is a systematic review of nurse caregiver resilience to the COVID-19 pandemic in 2021. Our search was conducted in the WOS, Medline/PubMed, Cochrane, BVS/LILACS, and Cuiden databases. The inclusion criteria were: studies published in Spanish or English; carried out from March 2020 to May 2021 on nurses caring for patients with COVID-19; and investigating the factors influencing the psychological impact, resilience, strategies to develop it, and interventions to promote it during this pandemic and others, such as SARS, MERS, or ebola. The quality of the studies and the risk of bias were evaluated following ICROMS, STROBE and AMSTAR-2 criteria. Twenty-two studies were selected. Most of the studies highlighted the presence of stressors in nurses, emphasizing those of the environment, which converged in dysfunctional responses that hurt their resilience. The most persuasive factors were social and organizational support. Coping strategies developed by nurses and especially interventions by organizations were detected as instruments to foster resilience, but have not been well researched. Resilience has a key moderating role in mitigating the psychological impact of nurses in the face of the COVID-19 pandemic.

Healthcare Worker Mental Health After the Initial Peak of the COVID-19 Pandemic: a US Medical Center Cross-Sectional Survey

BACKGROUND

There is a paucity of data on the mental health impact of the Coronavirus disease 2019 (COVID-19) pandemic on United States (US) healthcare workers (HCWs) after the first surge in the spring of 2020.

OBJECTIVE

To determine the impact of the pandemic on HCWs, and the relationship between HCW mental health and demographics, occupational factors, and COVID-19 concerns.

DESIGN

Cross-sectional survey in an urban medical center (September-November 2020) in Baltimore, MD, in the United States.

PARTICIPANTS

A total of 605 HCWs (physicians, nurse practitioners, nurses, physician assistants, patient care technicians, respiratory therapists, social workers, mental health therapists, and case managers).

MAIN MEASURES

Measures of mental health (Patient Health Questionnaire-2, Generalized Anxiety Disorder-7, PROMIS Sleep Disturbance 4a, Impact of Event Scale-Revised, Maslach Burnout Inventory-2 item, Connor-Davidson Resilience Scale-2 item), demographics, occupational factors, and COVID-19 related concerns.

KEY RESULTS

Fifty-two percent of 1198 HCWs responded to the survey and 14.2% reported depression, 43.1% mild or higher anxiety, 31.6% sleep disturbance, 22.3% posttraumatic stress symptoms, 21.6% depersonalization, 46.0% emotional exhaustion, and 23.1% lower resilience. Relative to HCWs providing in-person care to COVID-19 infected patients none of their working days, those doing so all or most days were more likely to experience worse depression (adjusted odds ratio, 3.9; 95% CI, 1.3-11.7), anxiety (aOR, 3.0; 95% CI, 1.4-6.3), possible PTSD symptoms (aOR, 2.6; 95% CI, 1.1-5.8), and higher burnout (aOR, 2.6; 95% CI, 1.1-6.0). Worse mental health in several domains was associated with higher health fear (aORs ranged from 2.2 to 5.0), job stressors (aORs ranged from 1.9 to 4.0), perceived social stigma/avoidance (aORs ranged from 1.8 to 2.9), and workplace safety concerns (aORs ranged from 1.8 to 2.8).

CONCLUSIONS

US HCWs experienced significant mental health symptoms eight months into the pandemic. More time spent providing in-person care to COVID-19-infected patients and greater COVID-19-related concerns were consistently associated with worse mental health.

Effectiveness of psychosocial interventions in mitigating adverse mental health outcomes among disaster-exposed health care workers: A systematic review

Health care workers worldwide are at an increased risk of a range of adverse mental health outcomes, including posttraumatic stress disorder (PTSD), following the unprecedented demand placed upon them during the COVID-19 pandemic. Psychosocial interventions offered to mitigate these risks should be based on the best available evidence; however, limited information regarding the comparative effectiveness of interventions is available. We undertook a systematic review of psychosocial interventions delivered to health care workers before, during, and after disasters. Eight databases were searched, including the Cochrane Central Register of Controlled Trials, PubMed/MEDLINE, EMBASE, and PsycINFO. Our primary outcomes were changes in symptoms of PTSD, anxiety, depression, and sleep. We calculated effect sizes, where unreported, and reliable change indices to appraise intervention effectiveness. The study was registered with PROSPERO (CRD42020182774). In total, 12,198 papers were screened, 14 of which were included in the present review. Interventions based on evidence-based protocols, including individual and group-based cognitive behavioral therapy (CBT) for PTSD, anxiety, and depression were found to lead to reliable changes in PTSD and anxiety symptoms. Single-session debriefing and psychological first aid workshops showed limited efficacy. There is limited evidence on psychosocial interventions for health care workers faced with disasters, with the strongest evidence base for CBT-based approaches. Future research should include controlled evaluations of interventions and aim to target identified risk factors.

The psychological impact of COVID-19 pandemic on medical staff in Guangdong, China: a cross-sectional study

BACKGROUND

During previous pandemic outbreaks, medical staff have reported high levels of psychological distress. The aim of the current study was to report a snapshot of the psychological impact of the coronavirus disease 2019 (COVID-19) pandemic and its correlated factors on medical staff in Guangdong, China.

METHODS

On the 2nd and 3rd February 2020, soon after the start of the COVID-19 pandemic, we surveyed medical staff at four hospitals in Guangdong, China, to collect demographic characteristics, Hospital Anxiety and Depression Scale (HADS), Perceived Stress Scale (PSS-14), and Insomnia Severity Index (ISI) scores.

RESULTS

Complete responses were received from 1045 medical staff. Respondents were divided into high- and low-risk groups according to their working environment of contacting with potential or confirmed COVID-19 cases. The proportion of staff with anxiety (55.4% v. 43.0%, p < 0.001) or depression (43.6% v. 36.8%, p = 0.028) was significantly higher in the high-risk group than the low-risk group. The percentage of staff with severe anxiety was similar in the two groups. Doctors were more susceptible to moderate-to-severe depressive symptoms. The high-risk group had higher levels of clinical insomnia (13.5% v. 8.5%, p = 0.011) and were more likely to be in the upper quartile for stress symptoms (24.7% v. 19.3%, p = 0.037) than the low-risk group. Additionally, work experience negatively correlated with insomnia symptoms.

CONCLUSIONS

It is important for hospitals and authorities to protect both the physical and psychological health of medical staff during times of pandemic, even those with a low exposure risk.

Anxiety Status and Associated Factors of Health Personnel Working in a Tertiary Hospital in Turkey in the COVID-19 Pandemic

Aim: This research was conducted to evaluate the anxiety status and related factors of tertiary hospital personnel working in a densely populated area of ​​Turkey during the COVID-19 pandemic. Methods: A total of 555 participants were included in this cross-sectional, prospective study. A socio-demographic data form was created and the Beck Anxiety Scale was applied to participants for evaluating anxiety status. Results: The rate of men 64.86% (n=360) and women 35.14% (n=195). The distribution of anxiety scores was in the range of 8.39±9.16. 58.2% of them (n=323) had low, 41.8% (n=232) had high anxiety scores. Factors like age, gender, marital status, working status in areas where treatment/care is provided to suspected/positive patients with COVID-19, and fear of carrying infection from work to home are found to be statistically significantly related to anxiety. Conclusion: High anxiety scores were measured in almost half of the participants. Taking measures to improve risk factors can reduce the damaging effects of the challenging working conditions due to the ongoing COVID-19 pandemic on hospital personnel. Keywords: anxiety, COVID-19, health, health personnel, pandemics

In their own words: Experiences of emergency health care workers during the COVID-19 pandemic

BACKGROUND

During the COVID-19 pandemic, a substantial number of emergency health care workers (HCWs) have screened positive for anxiety, depression, risk of posttraumatic stress disorder, and burnout. The purpose of this qualitative study was to describe the impact of COVID-19 on emergency care providers' health and well-being using personal perspectives. We conducted in-depth interviews with emergency physicians, emergency medicine nurses, and emergency medical services providers at 10 collaborating sites across the United States between September 21, 2020, and October 26, 2020.

METHODS

We developed a conceptual framework that described the relationship between the work environment and employee health. We used qualitative content analysis to evaluate our interview transcripts classified the domains, themes, and subthemes that emerged from the transcribed interviews.

RESULTS

We interviewed 32 emergency HCWs. They described difficult working conditions, such as constrained physical space, inadequate personnel protective equipment, and care protocols that kept changing. Organizational leadership was largely viewed as unprepared, distant, and unsupportive of employees. Providers expressed high moral distress caused by ethically challenging situations, such as the perception of not being able to provide the normal standard of care and emotional support to patients and their families at all times, being responsible for too many sick patients, relying on inexperienced staff to treat infected patients, and caring for patients that put their own health and the health of their families at risk. Moral distress was commonly experienced by emergency HCWs, exacerbated by an unsupportive organizational environment.

CONCLUSIONS

Future preparedness efforts should include mechanisms to support frontline HCWs when faced with ethical challenges in addition to an adverse working environment caused by a pandemic such as COVID-19.

Burnout and well-being of healthcare workers in the post-pandemic period of COVID-19: a perspective from the job demands-resources model

Background

The present study aimed 1) to examine the effects of epidemic-related job stressors, perceived social support and organizational support on the burnout and well-being of Chinese healthcare workers in the period of COVID-19 regular epidemic prevention and control and 2) to investigate the moderating effects of social support and organizational support on the relationship between job stressors and burnout and well-being within the theoretical framework of the Job Demands-Resources (JD-R) model.

Methods

A sample of healthcare workers (N = 3477) from 22 hospitals in Beijing, China participated in the cross-sectional investigation in October 2020 and reported epidemic-related job stressors, perceived social support, organizational support, burnout, anxiety and depression symptoms.

Results

1) Medical doctors, females, people aged from 30 to 50, and those who worked in the second line during the pandemic reported higher scores of psychological symptoms and burnout in the period of regular epidemic prevention and control; 2) Epidemic-related job stressors positively predicted burnout, anxiety, and depression among healthcare workers; 3) Perceived social support and organizational support were negatively related to reported burnout, anxiety and depression symptoms; 4) Social support reduced the adverse effects of epidemic-related job stressors on anxiety and depression but enhanced the association between stressors and burnout; 5) Organizational support mitigated the adverse effects of epidemic-related job stressors on depression.

Conclusion

The results shed light on preventing burnout and enhancing the psychological well-being of healthcare workers under epidemic prevention and control measures by reducing epidemic-related job stressors and strengthening personal and organizational support systems.

The Mental Health Impact of the COVID-19 Pandemic on Canadian Critical Care Nurses

Objective

Focusing on Canadian critical care nurses (CCNs), the study objectives were to examine the impact of the COVID-19 pandemic on: mental health, quality of work life, and intent to stay in their current positions.

Research design

Mixed-methods study using an online cross-sectional survey and integration of closed- and open-ended survey data.

Setting

Canadian CCNs working in an intensive care unit, high acuity unit, or intensive care step-down unit during the COVID-19 pandemic between May 2021 to June 2021.

Main outcome measures

The survey consisted of four instruments: (1) the impact of event scale – revised, (2) the depression, anxiety, and stress scale, (3) the professional quality of life scale, and (4) intent to turnover tool, as well as one optional open-ended question.

Results

From across Canada, 425 CCNs responded. The large majority reported symptoms of post traumatic stress disorder (74%), depression (70%), anxiety (57%), and stress (61%). All (100%) reported moderate to high burnout, 87% were suffering from signs of secondary traumatic stress, and 22% intended to quit their current employment. Qualitative analysis of written comments submitted by 147 (34.5%) of the respondents depicted an immense mental health toll on CCNs that stemmed from 1) failed leadership and 2) the traumatic nature of the work environment, that led to 3) a sense of disillusionment, defeat, and an intent to leave.

Conclusion

The mental health toll of the pandemic has been significant for Canadian CCNs and highlights the urgent need for individual supports and systems level changes.

Use of the job demands-resource model to understand community pharmacists’ burnout during the COVID-19 pandemic

Background

Community pharmacists are one of the most accessible healthcare providers during the COVID-19 pandemic. Whilst playing a vital role in medication supply and patient education, exposure to the pandemic demands and prolonged stressors increase their risk of burnout.

Objectives

Using the Job Demands-Resources model, this study aims to understand the factors that led to community pharmacists’ burnout and to identify their coping strategies and perceived recommendations on interventions to mitigate burnout during the COVID-19 pandemic.

Methods

A qualitative phenomenological approach was used with focus groups and interviews of community pharmacists in Qatar who were recruited using purposeful, convenience, and snowballing sampling methods. Interviews were conducted between February and April 2021, were audio-recorded and transcribed verbatim. Using thematic analysis methodology, manual inductive and deductive (based on the model) codes from the interviews were used for synthesis of themes. 11 themes emerged from six focus groups, six dyadic interviews and mini focus groups, and four individual interviews with community pharmacists.

Results

The contributing factors to community pharmacists’ burnout have been identified as practical job demands, and emotional demands including fear of infection. On the other hand, government and workplace-specific resources, personal characteristics such as resiliency and optimism, as well as the implementation of coping strategies, have reduced their stress and burnout.

Conclusions

The use of the Job Demands-Resources model was appropriate to identify the contributing factors to community pharmacists’ burnout during the COVID-19 pandemic. Based on these factors, individual, organizational, and national strategies can be implemented to mitigate burnout in community pharmacists during the pandemic and future emergencies.

COVID-19 induced PTSD: Stressors for trauma and acute care surgeons

Background

At the peak of the pandemic, acute care surgeons at many hospitals were reassigned to treat COVID-19 patients. However, the effect of the pandemic on this population who are well versed in stressful practice has not been fully explored.

Methods

A web-based survey was distributed to the members of the Eastern Association for the Surgery of Trauma (EAST). PTSD and the personal and professional impact of the pandemic were assessed. A positive screen was defined as a severity score of ≥14 or a symptomatic response to at least 5 of the 6 questions on the screen.

Results

A total of 393 (17.8%) participants responded to the survey. The median age was 43 (IQR: 38-52) and 238 (60.6%) were male. The majority of participants were surgeons (351, 89.3%), specializing in general surgery/trauma (379, 96.4%). The main practice type and setting were hospital-based (350, 89%) and university hospital (238, 60.6%), respectively. The incidence of PTSD was 16.3% when a threshold severity score of ≥14 was used and 5.6% when symptomatic responses were assessed. Risk factors for a positive PTSD screen included being single/unmarried (p = 0.02), having others close to you contract COVID-19 (p = 0.02), having family issues due to COVID-19 (p = 0.0004), rural (p = 0.005) and suburban (p = 0.047) practice settings, a fear of going to work (p = 0.001), and not having mental health resources provided at work (p = 0.03).

Conclusion

The COVID-19 pandemic had a psychological impact on surgeons. Although acute care surgeons are well versed in stressful practice, the pandemic nevertheless induced PTSD symptoms in this population, suggesting the need for mental health resources.

Personal, professional, and psychological impact of the COVID-19 pandemic on hospital workers: A cross-sectional survey

Objectives

We aimed to evaluate the personal, professional, and psychological impact of the COVID-19 pandemic on hospital workers and their perceptions about mitigating strategies.

Design

Cross-sectional web-based survey consisting of (1) a survey of the personal and professional impact of the COVID-19 pandemic and potential mitigation strategies, and (2) two validated psychological instruments (Kessler Psychological Distress Scale [K10] and Impact of Events Scale Revised [IES-R]). Regression analyses were conducted to identify the predictors of workplace stress, psychological distress, and post-traumatic stress.

Setting and participants

Hospital workers employed at 4 teaching and 8 non-teaching hospitals in Ontario, Canada during the COVID-19 pandemic.

Results

Among 1875 respondents (84% female, 49% frontline workers), 72% feared falling ill, 64% felt their job placed them at great risk of COVID-19 exposure, and 48% felt little control over the risk of infection. Respondents perceived that others avoided them (61%), reported increased workplace stress (80%), workload (66%) and responsibilities (59%), and 44% considered leaving their job. The psychological questionnaires revealed that 25% had at least some psychological distress on the K10, 50% had IES-R scores suggesting clinical concern for post-traumatic stress, and 38% fulfilled criteria for at least one psychological diagnosis. Female gender and feeling at increased risk due to PPE predicted all adverse psychological outcomes. Respondents favoured clear hospital communication (59%), knowing their voice is heard (55%), expressions of appreciation from leadership (55%), having COVID-19 protocols (52%), and food and beverages provided by the hospital (50%).

Conclusions

Hospital work during the COVID-19 pandemic has had important personal, professional, and psychological impacts. Respondents identified opportunities to better address information, training, and support needs.

The impact of COVID-19 on the dental hygienists: A cross-sectional study in the Lombardy first-wave outbreak

The impact of COVID-19 on socio-economical activities has changed everyday life. Dental hygienists, who perform aerosol generating procedures, have been strongly affected by changes in routine procedures. This cross-sectional study aimed at carrying out an online survey among dental hygienists in Lombardy. The survey was implemented after the first-wave lockdown focusing on the level of knowledge on COVID-19 and Sars-CoV-2, the virus-related changes in their attitude and working routine, and the socio-economic effects. In this report, we included 313 questionnaires of respondents (259 Females, and 54 Males; age = 33 ± 9 years). A significant percentage of respondents acknowledged the use of “word of mouth” among colleagues (n = 114, 36%) and social networks (n = 113, 36%) to be up to date on COVID-19. About half of respondents correctly identified the main COVID-19 symptoms/signs, just 13% (n = 41) identified the routes of transmission. Three quarters of respondents (n = 234, 75%) were afraid of being infected during the clinical practice, and about half of them would be afraid to treat patients having symptoms attributable to COVID-19. Twenty-one percent (n = 67) of participants also thought about changing job. Air-polishing was identified as the highest risk procedure, and 82% (n = 256) reported that they eliminated its use. Most claimed they never had a swab or a serological test, with two respondents positive to molecular test (0.6%), and 12 positives to serological test (3.8%). More than half of the participants (65%; n = 202) complained the dental hygienist is not protected, despite a loss of earnings due to lockdown between 2,000 and 10,000 euros. This study demonstrated that dental hygienists were emotionally and economically affected by the pandemic, significantly changing their work routine. Anti-epidemic protocols are pivotal to react promptly and to contain the virus in the dental setting.

The global prevalence of depression and anxiety among doctors during the covid-19 pandemic: Systematic review and meta-analysis

BACKGROUND

This review provides an estimate of the global prevalence of depression and anxiety symptoms among doctors, based on analysis of evidence from the first year of the COVID-19 pandemic.

METHODS

A systematic review was conducted to identify suitable studies. Final searches were conducted on 3rd March 2021. Papers were initially screened by title and abstract, based on pre-agreed inclusion criteria, followed by full-text review of eligible studies. Risk of bias was assessed using the Joanna Briggs Checklist for Prevalence Studies. Data from studies rated as low or medium risk of bias were pooled using a random-effects meta-analysis. Sensitivity and subgroup analyses were conducted to explore heterogeneity.

RESULTS

Fifty-five studies were included after full-text review. Of these, thirty studies were assessed as low or medium risk of bias and were included in primary analyses. These comprised twenty-six studies of depression (31,447 participants) and thirty studies of anxiety (33,281 participants). Pooled prevalence of depression and anxiety was 20.5% (95% CI 16.0%-25.3%) and 25.8% (95% CI 20.4%-31.5%) respectively.

INTERPRETATION

Evidence from the first year of the pandemic suggests that a significant proportion of doctors are experiencing high levels of symptoms of depression and anxiety, although not conclusively more so than pre-pandemic levels. Differences in study methodology and variation in job demands may account for some of the observed heterogeneity.

LIMITATIONS

Findings must be interpreted with caution due to the high heterogeneity and moderate risk of bias evident in the majority of included studies.