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Hor SY, Wyer M, Barratt R, Turnbull M, Rogers K, Murphy M, Urwin R, Jorm C, Gilbert GL. Risk assessment and the use of personal protective equipment in an emergency department: Differing perspectives of emergency and infection control clinicians. A video-vignette survey. Am J Infect Control 2024; 52:1114-1121. [PMID: 38925501 DOI: 10.1016/j.ajic.2024.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 06/18/2024] [Accepted: 06/18/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND The use of personal protective equipment (PPE) in emergency departments (EDs) is an important defense during infectious disease emergencies. However, what counts as appropriate PPE in EDs is contentious and inconsistently implemented in practice. METHODS An online scenario-based video survey was distributed through purposive sampling, and completed by 270 ED and infection prevention and control clinicians in Australia. A descriptive content analysis was performed on the data, and differences between groups were tested using Fisher exact test. RESULTS Participants agreed that most items were required in both scenarios. Eye protection, mask use, and hand hygiene frequency were more contentious. Physicians were more likely than nurses, and ED clinicians more likely than infection prevention and control clinicians, to regard items or actions as optional rather than essential. Many ED clinicians, particularly physicians, regarded sequences as too time-consuming to be practical in a busy ED. DISCUSSION Our findings likely reflect differences in professional roles, competing priorities, and risks, and highlight important contextual characteristics of EDs, such as diagnostic uncertainty, equipment inaccessibility, and resource constraints. CONCLUSIONS To be feasible, practicable, and thereby effective, PPE guidance in the ED must be designed collaboratively with frontline ED staff, and reflects the complexities of their practice.
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Affiliation(s)
- Su-Yin Hor
- School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia.
| | - Mary Wyer
- Westmead Institute for Medical Research, Westmead, New South Wales, Australia; NSW Biocontainment Centre, Westmead Hospital, Westmead, New South Wales, Australia
| | - Ruth Barratt
- Westmead Institute for Medical Research, Westmead, New South Wales, Australia
| | - Margo Turnbull
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Kris Rogers
- School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Margaret Murphy
- Emergency Department, Westmead Hospital, Westmead, New South Wales, Australia
| | - Rachel Urwin
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Christine Jorm
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Gwendolyn L Gilbert
- Sydney Infectious Diseases Institute, University of Sydney, Sydney, New South Wales, Australia
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Moulton KL, Izuno SA, Prendergast N, Battaglioli N, Sebok‐Syer SS. Alleviating stressfeeding in the emergency department: Elucidating the tensions induced by workplace lactation space issues. J Am Coll Emerg Physicians Open 2024; 5:e13226. [PMID: 39045487 PMCID: PMC11264252 DOI: 10.1002/emp2.13226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 05/10/2024] [Accepted: 06/06/2024] [Indexed: 07/25/2024] Open
Abstract
Objectives Women remain underrepresented in the emergency medicine (EM) workforce, academic EM, and institutional leadership. In order to support women physicians in EM, we must explore factors that contribute to attrition and workplace satisfaction. For example, tensions between workplace and familial roles are important to consider as women navigate careers in EM. The logistics and stressors of workplace lactation pose a particular challenge during an already stressful time for a new mother returning to work in a busy emergency department (ED), but limited empirical data exist regarding this experience. We aimed to explore the stressors associated with workplace lactation spaces in order to better inform the creation of lactation spaces for individuals working in EDs. Methods Our team used an exploratory qualitative design to investigate lactation-specific stressors and understand their relationship to individuals' needs when lactating in EM workplace environments. A total of 40 individuals were interviewed, highlighting post-pregnancy return-to-work (RTW) experiences of medical students, residents, advanced practice professionals, nurses, fellows, and faculty. Interviews were coded and analyzed using thematic analysis. Results We identified both tangible and intangible characteristics of lactation spaces that contribute to stress for lactating individuals. Additionally, we discovered that participants frequently noted a desire to work simultaneously while pumping in order to feel they were self-actualizing in their dual roles of parent and clinician. Among tangible items, access to a computer within lactation space was a key driver of ability to fulfill dual roles. Among intangible characteristics, we identified three distinct, yet interrelated, subthemes, including the need for lactation spaces to be respectful of individuals' time, privacy, and general health and well-being. Conclusions This study suggests that meeting basic lactation needs with thoughtfully designed lactation spaces can empower individuals in their roles both as a lactating parent and a clinician. EM leadership can evaluate existing lactation spaces to ensure they meet the tangible and intangible needs of lactating physicians, trainees, advanced practice professionals, and nurses.
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Affiliation(s)
| | - Samantha A. Izuno
- Department of Emergency MedicineStanford UniversityPalo AltoCaliforniaUSA
| | - Nicole Prendergast
- Department of Emergency MedicineWake Forest UniversityWinston‐SalemNorth CarolinaUSA
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Umbetkulova S, Kanderzhanova A, Foster F, Stolyarova V, Cobb-Zygadlo D. Mental Health Changes in Healthcare Workers During COVID-19 Pandemic: A Systematic Review of Longitudinal Studies. Eval Health Prof 2024; 47:11-20. [PMID: 37143216 PMCID: PMC10160822 DOI: 10.1177/01632787231165076] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
This study provides an overview of research findings on long-term effects on healthcare workers mental health and factors associated with positive or negative changes. Medline and PubMed databases were searched for observational longitudinal studies and 18 papers were included in the review (PROSPERO: CRD42021260307). 12 articles indicated negative changes over time and six studies revealed a positive trend in a variety of mental health outcomes (anxiety, depression, insomnia, and others). Female sex, younger age, nursing occupation, frontline work, longer working hours and concerns about contracting COVID-19 were identified to be associated with negative changes. Conversely, a supportive environment, access to psychological resources, provision of sufficient personal protective equipment and availability of COVID-19 tests were linked to positive changes. Therefore, our findings can assist governmental and institutional authorities with effective interventions to improve psychological care for healthcare workers.
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Affiliation(s)
| | | | - Faye Foster
- Nazarbayev UniversitySchool of Medicine, Kazakhstan
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Stone KW, Jagger MA, Horney JA, Kintziger KW. Changes in anxiety and depression among public health workers during the COVID-19 pandemic response. Int Arch Occup Environ Health 2023; 96:1235-1244. [PMID: 37474659 PMCID: PMC10560145 DOI: 10.1007/s00420-023-02002-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 07/14/2023] [Indexed: 07/22/2023]
Abstract
OBJECTIVES The COVID-19 pandemic has negatively impacted mental health indicators, leading to an increase in symptoms of anxiety and depression in both the general population of adults and children and many occupational groups. This study aims to examine changes in anxiety and depression among a cohort of public health workers in the U.S. during the first year of the COVID-19 pandemic and identify potential risk factors. METHODS Longitudinal data were collected from a sub-sample (N = 85) of public health workers in 23 U.S. states who completed two surveys in 2020 and 2021. Information on background characteristics, personal well-being, and work environment as well as validated scales to assess generalized anxiety disorder (GAD), depressive disorder, and burnout was collected. Data were analyzed using Stata Version 17, and significant differences were determined using Pearson's Chi2 and Fisher's Exact tests. RESULTS The proportion of those reporting GAD (46.3% to 23.2%) or depression (37.8% to 26.8%) improved from Survey 1 to Survey 2 overall; symptoms of anxiety saw the largest improvement. Persistent depression was associated with sustained burnout, changes in social support, and days worked per week. CONCLUSION Public health workers experienced elevated levels of anxiety and depression during the initial pandemic response, but a reduction in these symptoms was observed in the subsequent year after vaccines had become widely available. However, unmet needs remain for ongoing workplace mental health supports to address burnout, as well as for additional emotional supports outside of work for public health professionals.
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Affiliation(s)
- Kahler W Stone
- Department of Health and Human Performance, Middle Tennessee State University, Murfreesboro, TN, 37132, USA
| | | | - Jennifer A Horney
- Epidemiology Program, University of Delaware, 100 Discovery Blvd, Room 731, Newark, DE, 19713, USA.
| | - Kristina W Kintziger
- Department of Environmental, Agricultural, and Occupational Health, College of Public Health, University of Nebraska Medical Center, Omaha, NE, 68198, USA
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Morawa E, Adler W, Schug C, Geiser F, Beschoner P, Jerg-Bretzke L, Albus C, Weidner K, Baranowski AM, Erim Y. Depressive and anxiety symptoms in the course of the COVID-19 pandemic among physicians in hospitals: results of the longitudinal, multicenter VOICE-EgePan survey over two years. BMC Psychol 2023; 11:327. [PMID: 37817222 PMCID: PMC10566070 DOI: 10.1186/s40359-023-01354-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 09/28/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND This longitudinal, multicenter web-based study explored the trajectories of depressive and anxiety symptoms during the COVID-19 pandemic among physicians over two years. METHODS At four measurement points between 4/2020 and 5/2022 depressive (Patient Health Questionnaire-2, PHQ-2) and anxiety symptoms (Generalized Anxiety Disorder Scale-2, GAD-2) among physicians in German hospitals were assessed. Time, gender and age effects were analyzed with linear mixed regression models. Comparisons with norm values for the German population during the COVID-19 pandemic were also performed and frequencies of probable depression and anxiety are reported. RESULTS The physicians (N = 340) showed a significant increase of depressive symptoms from T1 (M = 1.35, SD = 1.33) to T4 (M = 1.64, SD = 1.34) (p < .001) and of anxiety symptoms from T1 (M = 1.35, SD = 1.42) to T2 (M = 1.59, SD = 1.43) (p = .024). The main effect of gender was only significant for anxiety symptoms (p = .001): women demonstrated higher scores than men. A significant age class difference was observed only for depressive symptoms: the youngest age group (18-40 years) revealed higher values than the oldest group (> 50 years, p = .003). As compared to the general population, the physicians reported significantly elevated PHQ-2 (T1: M = 1.35, SD = 1.33; T2: M = 1.53, SD = 1.37; T3: M = 1.55, SD = 1.40; T4: M = 1.64, SD = 1.34) and GAD-2 scores (T1: M = 1.35, SD = 1.42; T2: M = 1.59, SD = 1.43; T3: M = 1.61, SD = 1.57; T4: M = 1.49, SD = 1.46) for all measurement points (all p < .001). The frequencies of probable depression (PHQ-2 ≥ 3) and anxiety (GAD-2 ≥ 3) were: 14.1% and 17.0% (T1), 16.5% and 21.9% (T2), 17.8% and 22.6% (T3) and 18.5% and 17.3% (T4), respectively. CONCLUSIONS Mental distress of physicians in German hospitals has increased in the course of the COVID-19 pandemic with gender and age-related differences. Possible causes should be explored and regular monitoring of mental health and prevention programmes for physicians should be established. TRIAL REGISTRATION The study was registered on ClinicalTrials (DRKS-ID: DRKS00021268) on 9.4.2020.
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Affiliation(s)
- Eva Morawa
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Schwabachanlage 6, Erlangen, 91054, Germany.
| | - Werner Adler
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Schwabachanlage 6, Erlangen, 91054, Germany
- Institute of Medical Informatics, Biometry, and Epidemiology, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Caterina Schug
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Schwabachanlage 6, Erlangen, 91054, Germany
| | - Franziska Geiser
- Department of Psychosomatic Medicine and Psychotherapy, University Clinic of Bonn, Bonn, Germany
| | - Petra Beschoner
- Department of Psychosomatic Medicine and Psychotherapy, Ulm University Medical Center, Ulm, Germany
| | - Lucia Jerg-Bretzke
- Department of Psychosomatic Medicine and Psychotherapy, Ulm University Medical Center, Ulm, Germany
| | - Christian Albus
- Department of Psychosomatics and Psychotherapy, Medical Faculty, University Hospital of Cologne, Cologne, Germany
| | - Kerstin Weidner
- Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Andreas M Baranowski
- Department of Psychosomatic Medicine and Psychotherapy, University Clinic of Bonn, Bonn, Germany
| | - Yesim Erim
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Schwabachanlage 6, Erlangen, 91054, Germany
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Adams GC, Le T, Alaverdashvili M, Adams S. Physicians' mental health and coping during the COVID-19 pandemic: One year exploration. Heliyon 2023; 9:e15762. [PMID: 37159705 PMCID: PMC10156641 DOI: 10.1016/j.heliyon.2023.e15762] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 04/11/2023] [Accepted: 04/20/2023] [Indexed: 05/11/2023] Open
Abstract
Numerous cross-sectional studies have examined physicians' health and coping during the COVID-19 pandemic, while longitudinal studies are lacking. This study explores the progression over one year of physicians' physical and mental health symptoms, their strategies used to cope and discusses coping strategies in relation to physical and mental health symptoms. Two surveys, one year apart, exploring physicians' physical, mental health symptoms and employed coping strategies were sent to all physicians practicing in the province of Saskatchewan, Canada. A total of 117 physicians participated in Round I (RI) (November 2020-January 2021) and 158 participated in Round II (RII) (October 2021-February 2022). Physicians' physical and mental health symptoms remained high, irrespective of their specialty or COVID-19 exposure. COVID-related Post-Traumatic Stress Disorder increased by five times at RII (p = 0.02). In RI anxiety was most prevalent in middle-aged females. In RII depression was most prevalent in physicians with no children. Most coping was adaptive (90%) and included Behavioural, Relational, Cognitive, Spiritual, and Interventional strategies. After one-year, Spiritual coping decreased, while Interventional coping increased by eight times (p = 0.01). Despite efforts to employ adaptive coping, physicians' rates of psychological and physical health difficulties remained high or worsened over one year, offering insight into the protracted health care crisis, and the need for solutions. Our observation of physicians' needs for additional supports, camaraderie and appreciation as well as the shift in coping strategies as the pandemic progressed, offer targets for interventions meant to promote recovery.
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Affiliation(s)
- G Camelia Adams
- Department of Psychiatry, College of Medicine, University of Saskatchewan, 103 Hospital Drive, Saskatoon, SK, S7N 0W8, Canada
| | - Thuy Le
- Department of Psychiatry, College of Medicine, University of Saskatchewan, 103 Hospital Drive, Saskatoon, SK, S7N 0W8, Canada
| | - Mariam Alaverdashvili
- Department of Psychiatry, College of Medicine, University of Saskatchewan, 103 Hospital Drive, Saskatoon, SK, S7N 0W8, Canada
| | - Stephen Adams
- Department of Psychiatry, College of Medicine, University of Saskatchewan, 103 Hospital Drive, Saskatoon, SK, S7N 0W8, Canada
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Bondjers K, Lingaas I, Stensland S, Atar D, Zwart JA, Wøien H, Dyb G. "I've kept going" - a multisite repeated cross-sectional study of healthcare workers' pride in personal performance during the COVID-19 pandemic. BMC Health Serv Res 2023; 23:322. [PMID: 37004056 PMCID: PMC10066023 DOI: 10.1186/s12913-023-09246-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 03/06/2023] [Indexed: 04/03/2023] Open
Abstract
BACKGROUND For healthcare workers, working through a pandemic may include both challenges, such as coping with increased demands and a lack of control, and rewards, such as experiencing a sense of achievement and meaningfulness. In this study, we explore the accomplishments healthcare workers themselves are proud of achieving at work, in order to elucidate the positive aspects of working through a pandemic. METHODS In June 2020 (T1), December 2020 (T2), and May 2021 (T3), healthcare workers (n = 1,996) at four Norwegian hospitals participated in a web-based survey assessing job strain, psychological health, and support during the pandemic. The survey included the open-ended question "During the past two weeks, what have you been feeling proud of achieving at work?". Responses (1,046) to this item were analyzed using conventional content analysis, which resulted in 13 subthemes under 6 themes. RESULTS For some, pride was found in their professional identity and dedication to their work. Others took pride in specific achievements, such as juggling their own needs (e.g., health, private life) with those of the workplace, contributing to cohesion and collaboration, their ability to learn and adjust, in being a useful resource at work, and in their efforts towards developing the organization and workplace. IMPLICATIONS The current findings shed light on what healthcare workers feel proud of achieving in their day-to-day work. Assessment of these factors provides insight on both positive and negative aspects of working clinically during a pandemic, and highlights specific targets for building sustainable and rewarding work environments for healthcare workers.
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Affiliation(s)
- Kristina Bondjers
- Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway.
| | - Ingebjørg Lingaas
- Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
| | - Synne Stensland
- Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
- Research and Communication Unit for Musculoskeletal Health (FORMI), Oslo University Hospital, Oslo, Norway
| | - Dan Atar
- Department of Cardiology, Oslo University Hospital Ulleval, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - John-Anker Zwart
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Research and Innovation, Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
| | - Hilde Wøien
- Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
| | - Grete Dyb
- Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Adams GC, Reboe-Benjamin M, Alaverdashvili M, Le T, Adams S. Doctors' Professional and Personal Reflections: A Qualitative Exploration of Physicians' Views and Coping during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5259. [PMID: 37047874 PMCID: PMC10094024 DOI: 10.3390/ijerph20075259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 03/15/2023] [Accepted: 03/16/2023] [Indexed: 06/19/2023]
Abstract
Numerous studies have examined the risks for anxiety and depression experienced by physicians during the COVID-19 pandemic. Still, qualitative studies investigating physicians' views, and their discovered strengths, are lacking. Our research fills this gap by exploring professional and personal reflections developed by physicians from various specialties during the pandemic. Semi-structured interviews were conducted with physicians practicing in the province of Saskatchewan, Canada, during November 2020-July 2021. Thematic analysis identified core themes and subthemes. Seventeen physicians, including nine males and eight females, from eleven specialties completed the interviews. The pandemic brought to the forefront life's temporality and a new appreciation for life, work, and each other. Most physicians found strength in values, such as gratitude, solidarity, and faith in human potential, to anchor them professionally and personally. A new need for personal fulfilment and hybrid care emerged. Negative feelings of anger, fear, uncertainty, and frustration were due to overwhelming pressures, while feelings of injustice and betrayal were caused by human or system failures. The physicians' appreciation for life and family and their faith in humanity and science were the primary coping strategies used to build adaptation and overcome negative emotions. These reflections are summarized, and implications for prevention and resilience are discussed.
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Lee BEC, Ling M, Boyd L, Olsson C, Sheen J. The prevalence of probable mental health disorders among hospital healthcare workers during COVID-19: A systematic review and meta-analysis. J Affect Disord 2023; 330:329-345. [PMID: 36931567 PMCID: PMC10017178 DOI: 10.1016/j.jad.2023.03.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 02/24/2023] [Accepted: 03/06/2023] [Indexed: 03/17/2023]
Abstract
OBJECTIVES The mental health impacts of the COVID-19 pandemic continue to be documented worldwide with systematic reviews playing a pivotal role. Here we present updated findings from our systematic review and meta-analysis on the mental health impacts among hospital healthcare workers during COVID-19. METHODS We searched MEDLINE, CINAHL, PsycINFO, Embase and Web Of Science Core Collection between 1st January 2000 to 17th February 2022 for studies using validated methods and reporting on the prevalence of diagnosed or probable mental health disorders in hospital healthcare workers during the COVID-19 pandemic. A meta-analysis of proportions and odds ratio was performed using a random effects model. Heterogeneity was investigated using test of subgroup differences and 95 % prediction intervals. RESULTS The meta-analysis included 401 studies, representing 458,754 participants across 58 countries. Pooled prevalence of depression was 28.5 % (95 % CI: 26.3-30.7), anxiety was 28.7 % (95 % CI: 26.5-31.0), PTSD was 25.5 % (95 % CI: 22.5-28.5), alcohol and substance use disorder was 25.3 % (95 % CI: 13.3-39.6) and insomnia was 24.4 % (95 % CI: 19.4-29.9). Prevalence rates were stratified by physicians, nurses, allied health, support staff and healthcare students, which varied considerably. There were significantly higher odds of probable mental health disorders in women, those working in high-risk units and those providing direct care. LIMITATIONS Majority of studies used self-report measures which reflected probable mental health disorders rather than actual diagnosis. CONCLUSIONS These updated findings have enhanced our understanding of at-risk groups working in hospitals. Targeted support and research towards these differences in mental health risks are recommended to mitigate any long-term consequences.
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Affiliation(s)
| | - Mathew Ling
- School of Psychology, Deakin University, Burwood, VIC, Australia; Neami National, Preston, VIC, Australia
| | | | - Craig Olsson
- School of Psychology, Deakin University, Burwood, VIC, Australia
| | - Jade Sheen
- School of Psychology, Deakin University, Burwood, VIC, Australia
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The global evolution of mental health problems during the COVID-19 pandemic: A systematic review and meta-analysis of longitudinal studies. J Affect Disord 2022; 315:70-95. [PMID: 35842064 PMCID: PMC9278995 DOI: 10.1016/j.jad.2022.07.011] [Citation(s) in RCA: 75] [Impact Index Per Article: 37.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 06/17/2022] [Accepted: 07/07/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND The COVID-19 pandemic impacted mental health, but the global evolution of mental health problems during the pandemic is unknown. We conducted a systematic review and meta-analysis of longitudinal studies to evaluate the global evolution of mental health problems during the pandemic. METHODS To conduct this systematic review, we searched for published articles from APA PsycInfo (Ovid), CINAHL (EBSCOhost), Embase (Ovid), MEDLINE (Ovid), and Web of Science. Longitudinal (at least 2 waves during the COVID-19 pandemic) and peer-reviewed articles on mental health problems conducted as from 2020 and after were included in the current study. Of 394 eligible full texts, 64 articles were included in the analysis. We computed random effects, standardized mean differences, and log odds ratio (LOR) with 95 % CIs. The meta-analysis protocol was registered with PROSPERO (CRD42021273624). RESULTS Results showed that anxiety (LOR = -0.33; 95 % CI, -0.54, -0.12) and depression symptoms (LOR = -0.12; 95 % CI, -0.21, -0.04) decreased from baseline to follow up. However, other mental health problems showed no change. Higher prevalence rates (40.9 %; 95 % CI, 16.1 %-65.8 %) of psychological distress were found in months after July 2020, respectively, while there were no significant month differences for the prevalence of other mental health problems. Higher means of anxiety (d = 3.63, 95 % CI, 1.66, 5.61), depression (d = 3.93; 95 % CI, 1.68, 6.17), and loneliness (d = 5.96; 95 % CI, 3.22, 8.70) were observed in May 2020. Higher prevalence of anxiety, depression, and PTSD and higher means of anxiety, depression and loneliness were observed in North America. The prevalence of psychological distress and insomnia was higher in Latin America and Europe, respectively. LIMITATIONS There is a lack of longitudinal studies in some parts of the world, such as Africa, the Caribbean, India, the Middle East, in Latin America, and Asia. CONCLUSIONS Results indicated that anxiety and depression symptoms decreased during the COVID-19 pandemic while other mental health problems showed no statistical change. The findings reveal that mental health problems peaked in April and May 2020. Prevalence of mental health problems remains high during the pandemic and mental health prevention, promotion and intervention programs should be implemented to mitigate the consequences of the COVID-19 pandemic on the global population.
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Alanazi TNM, McKenna L, Buck M, Alharbi RJ. Reported effects of the COVID-19 pandemic on the psychological status of emergency healthcare workers: A scoping review. Australas Emerg Care 2022; 25:197-212. [PMID: 34802977 PMCID: PMC8585598 DOI: 10.1016/j.auec.2021.10.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 09/29/2021] [Accepted: 10/27/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND While literature on psychological consequences among frontline healthcare workers (HCWs) flourishes, understanding the psychological burden on this group is particularly crucial, as their exposure to COVID-19 makes them especially at high risk. We explored what is known about psychological effects of the COVID-19 pandemic on emergency HCWs. METHODS We used a scoping review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. RESULTS The search identified 5432 articles, from which a total of 21 were included in the final review. Anxiety, burnout, depression, inadequate sleep, post-traumatic stress disorder (PTSD) symptoms, distress/stress and secondary trauma, were all reportedly experienced by emergency HCWs. Anxiety, burnout, depression and stress levels were higher among physicians and nurses compared to others. Post-traumatic stress disorder symptoms were higher among reserve medics, while Red Cross volunteers developed similar reactions of psychological stress and secondary trauma to other healthcare workers. Male HCWs reported more post-traumatic stress disorder symptoms than females, while stress was higher among females than male HCWs. CONCLUSIONS Emergency HCWs providing care during the COVID-19 pandemic are at risk from specific psychological impacts, including anxiety, burnout, depression, inadequate sleep, PTSD symptoms, psychological distress/stress and secondary trauma, and stress TWEETABLE ABSTRACT: Emergency healthcare workers are at direct risk of psychological impacts from the COVID-19 pandemic.
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Affiliation(s)
- Tariq Noman M Alanazi
- School of Nursing & Midwifery, LaTrobe University, Kingsbury Drive, Bundoora, VIC 3086, Australia; General Directorate of Health Affairs, The Northern Border Region, Ministry of Health, Ar'Ar 73311, Saudi Arabia.
| | - Lisa McKenna
- School of Nursing & Midwifery, LaTrobe University, Kingsbury Drive, Bundoora, VIC 3086, Australia.
| | - Miranda Buck
- School of Nursing & Midwifery, LaTrobe University, Kingsbury Drive, Bundoora, VIC 3086, Australia.
| | - Rayan Jafnan Alharbi
- School of Nursing & Midwifery, LaTrobe University, Kingsbury Drive, Bundoora, VIC 3086, Australia; Department of Emergency Medical Service, Jazan University, Jazan 45142, Saudi Arabia.
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Li J, Zhao N, Zhang H, Yang H, Yang J. Roles and Challenges for Village Doctors in COVID-19 Pandemic Prevention and Control in Rural Beijing, China: A Qualitative Study. Front Public Health 2022; 10:888374. [PMID: 35844871 PMCID: PMC9277090 DOI: 10.3389/fpubh.2022.888374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 06/06/2022] [Indexed: 11/29/2022] Open
Abstract
Objectives Rural areas in China are more vulnerable to COVID-19 pandemic than urban areas, due to their far fewer health care resources. Village doctors, as rural grassroots health workers in China, have been actively engaged in the pandemic prevention and control. This study aims to describe the roles of village doctors in rural China, and the challenges they have faced during the prevention and control of the COVID-19 pandemic. Setting This study was conducted in three towns in Huairou District, Beijing, China. Design We carried out semi-structured interviews with 75 key informants. All the interviews were audio-recorded and transcribed verbatim. We employed thematic analysis to define themes and sub-themes from the qualitative data. Results We reported four themes. First, the village doctor guided the village committee to carry out decontamination, monitored home-isolated residents, and disseminated knowledge on prevention of the COVID-19 pandemic during the rural pandemic prevention and control. Second, they took pandemic prevention measures in village clinics, distributed pandemic prevention materials, and undertook pre-screening triage. Third, village doctors provided basic medical care, including treatment of common diseases as well as the purchase and delivery of medicines to villagers. Fourth, village doctors faced difficulties and challenges, such as inadequate medical skills, aging staff structure, and lack of pandemic prevention materials. Conclusions Despite many difficulties and challenges, village doctors have actively participated in rural pandemic prevention and control, and made outstanding contributions to curbing spread of COVID-19 pandemic in rural areas. Village doctors provide basic health care while participating in various non-medical tasks.
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Affiliation(s)
- Jin Li
- School of Public Health, Capital Medical University, Beijing, China
| | - Ning Zhao
- School of Public Health, Capital Medical University, Beijing, China
| | - Haiyan Zhang
- Department of Health Education, Beijing Huairou Hospital of University of Chinese Academy of Sciences, Beijing, China
| | - Hui Yang
- Beijing Key Laboratory for Pediatric Diseases of Otolaryngology Head and Neck Surgery, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Jia Yang
- School of Public Health, Capital Medical University, Beijing, China
- *Correspondence: Jia Yang
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Shaukat N, Ali DM, Barolia R, Hisam B, Hassan S, Afzal B, Khan AS, Angez M, Razzak J. Documenting response to COVID-individual and systems successes and challenges: a longitudinal qualitative study. BMC Health Serv Res 2022; 22:656. [PMID: 35578197 PMCID: PMC9109738 DOI: 10.1186/s12913-022-08053-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 05/05/2022] [Indexed: 11/10/2022] Open
Abstract
Background This study aimed to document the evolution of perceptions of frontline healthcare workers (FHCW) regarding their well-being and the quality of health systems' response to the COVID-19 pandemic over four months in Pakistan. Methods We conducted this prospective longitudinal qualitative study during the four months (June–September 2020) coinciding with the peak and trough of the first wave of Pakistan's COVID-19 pandemic. We approached frontline healthcare workers (physicians and nurses) working in emergency departments (ED) in two hospitals using the WhatsApp group of the Pakistan Society of Emergency Physicians (PSEM). Participants were asked to self-record their perception of their wellness and their level of satisfaction with the quality of their hospitals' response to the pandemic. We transcribed, translated, and analysed manually using MAXQDA 2020 software and conducted the thematic analysis to identify themes and sub-themes. Results We invited approximately 200 FHCWs associated with PSEM to participate in the study. Of the 61 who agreed to participate, 27 completed the study. A total of 149 audio recordings were received and transcribed. Three themes and eight sub-themes have emerged from the data. The themes were individual-level challenges, health system-level challenges, and hope for the future. Sub-themes for individual-level challenges were: fear of getting or transmitting infection, feeling demotivated and unappreciated, disappointment due to people’s lack of compliance with COVID-19 protocols, physical exhaustion, and fatigue. For the healthcare system, sub-themes were: Infrastructure, logistics, management, and communications response of the hospital/healthcare system and financial stressors. For sub-themes under hope for the future were the improved disease knowledge and vaccine development. The overall perceptions and experiences of FHCWs evolved from fear, grief, and negativity to hope and positivity as the curve of COVID-19 went down. Conclusion This study shows that the individuals and systems were not prepared to deal with the challenges of the COVID-19 pandemic. The findings highlight the challenges faced by individuals and health systems during the wake of the Covid-19 pandemic. The healthcare workers were emotionally and physically taxed, while the health systems were overwhelmed by COVID-19. The overall perceptions of FHCWs evolved with time and became negative to positive as the curve of COVID-19 went down during the first wave of COVID-19 in Pakistan.
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Affiliation(s)
- Natasha Shaukat
- Department of Community Health Sciences, Aga Khan University, Stadium Road, P.O. Box-3500, Karachi, 74800, Pakistan. .,Centre of Excellence for Trauma and Emergencies, Aga Khan University, Karachi, Pakistan.
| | - Daniyal Mansoor Ali
- Centre of Excellence for Trauma and Emergencies, Aga Khan University, Karachi, Pakistan
| | - Rubina Barolia
- School of Nursing and Midwifery, Aga Khan University, Karachi, Pakistan
| | - Butool Hisam
- Centre of Excellence for Trauma and Emergencies, Aga Khan University, Karachi, Pakistan
| | - Sheza Hassan
- Aga Khan University Medical College, Karachi, Pakistan
| | - Badar Afzal
- Department of Emergency Medicine, Aga Khan University, Karachi, Pakistan
| | - Abdus Salam Khan
- Department of Emergency Medicine, Shifa International Hospital, Islamabad, Pakistan
| | - Meher Angez
- Aga Khan University Medical College, Karachi, Pakistan
| | - Junaid Razzak
- Centre of Excellence for Trauma and Emergencies, Aga Khan University, Karachi, Pakistan.,Department of Emergency Medicine, Weill Cornell Medical Center, Newyork, USA
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Blanchard J, Li Y, Bentley SK, Lall MD, Messman AM, Liu YT, Diercks DB, Merritt‐Recchia R, Sorge R, Warchol JM, Greene C, Griffith J, Manfredi RA, McCarthy M. The perceived work environment and well-being: A survey of emergency health care workers during the COVID-19 pandemic. Acad Emerg Med 2022; 29:851-861. [PMID: 35531649 PMCID: PMC9347760 DOI: 10.1111/acem.14519] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 04/26/2022] [Accepted: 05/05/2022] [Indexed: 12/21/2022]
Abstract
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.
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Affiliation(s)
- Janice Blanchard
- Department of Emergency Medicine George Washington University School of Medicine and Health Sciences Washington District of Columbia USA
| | - Yixuan Li
- Department of Health Policy, Milken Institute School of Public Health George Washington University Washington District of Columbia USA
| | - Suzanne K. Bentley
- Departments of Emergency Medicine & Medical Education Icahn School of Medicine at Mount Sinai, New York City Health+Hospitals/Elmhurst New York New York USA
| | - Michelle D. Lall
- Department of Emergency Medicine Emory University School of Medicine Atlanta Georgia USA
| | - Anne M. Messman
- Department of Emergency Medicine Wayne State University School of Medicine, University Health Center–6G Detroit Michigan USA
| | - Yiju Teresa Liu
- Department of Emergency Medicine David Geffen School of Medicine at UCLA, Harbor–UCLA Medical Center Torrance California USA
| | | | - Rory Merritt‐Recchia
- Department of Emergency Medicine Alpert Medical School of Brown University Providence Rhode Island USA
| | - Randy Sorge
- Department of Emergency Medicine Louisiana State University Spirit of Charity Emergency Medicine Residency Program New Orleans Louisiana USA
| | - Jordan M. Warchol
- Department of Emergency Medicine University of Nebraska Medical Center Omaha Nebraska USA
| | - Christopher Greene
- Department of Emergency Medicine University of Alabama at Birmingham Birmingham Alabama USA
| | - James Griffith
- Department of Psychiatry George Washington University School of Medicine and Health Sciences Washington District of Columbia USA
| | - Rita A. Manfredi
- Department of Emergency Medicine George Washington University School of Medicine and Health Sciences Washington District of Columbia USA
| | - Melissa McCarthy
- Departments of Health Policy and Emergency Medicine, Milken Institute School of Public Health George Washington University Washington District of Columbia USA
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Lewis-de Los Angeles CP, Lewis-de Los Angeles W, Kamath S, Heinly A, Elliott S, Daniels TE, Watts DJ. Differences in Work-Life Experiences of Physicians by Parenting Status, Gender, and Training Level During the COVID-19 Pandemic. RHODE ISLAND MEDICAL JOURNAL (2013) 2022; 105:63-67. [PMID: 35476741 PMCID: PMC11215836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND The COVID-19 pandemic has presented new challenges for physicians, and physician-parents specifically. Few studies have focused on work-life changes in this population. The present study investigated work-life changes in a group of physicians during the first six months of the COVID-19 pandemic. METHODS A survey was distributed electronically to physicians affiliated with a U.S. medical school inquiring about experiences during the first six months of the COVID-19 pandemic (March 2020 to September 2020). RESULTS In logistic regression models adjusted for age, significantly more female physician- parents reported increased burnout, increased time with kids, and increased fear of going to work compared to male physician-parents. Around 1 in 2 attendings reported burnout, regardless of parenting status. CONCLUSION While high rates of burnout were found across all groups in this study, differences were found by gender and parenting status. Further research is needed to understand burnout during the COVID-19 pandemic and to support physician-parents.
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Affiliation(s)
- C Paula Lewis-de Los Angeles
- Department of Pediatrics, Hasbro Children's Hospital, Alpert Medical School of Brown University; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI
| | | | - Shuba Kamath
- Department of Pediatrics, Hasbro Children's Hospital, Alpert Medical School of Brown University, Providence, RI
| | - Allison Heinly
- Department of Pediatrics, Hasbro Children's Hospital, Alpert Medical School of Brown University, Providence, RI
| | | | - Teresa E Daniels
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI
| | - D J Watts
- Department of Pediatrics, Hasbro Children's Hospital, Alpert Medical School of Brown University, Providence, RI
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Healthcare Worker Mental Health After the Initial Peak of the COVID-19 Pandemic: a US Medical Center Cross-Sectional Survey. J Gen Intern Med 2022; 37:1169-1176. [PMID: 34993856 PMCID: PMC8734540 DOI: 10.1007/s11606-021-07251-0] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 10/27/2021] [Indexed: 12/22/2022]
Abstract
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.
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Blanchard J, Messman AM, Bentley SK, Lall MD, Liu YT, Merritt R, Sorge R, Warchol JM, Greene C, Diercks DB, Griffith J, Manfredi RA, McCarthy M, McCarthy M. In their own words: Experiences of emergency health care workers during the COVID-19 pandemic. Acad Emerg Med 2022; 29:974-986. [PMID: 35332615 PMCID: PMC9111302 DOI: 10.1111/acem.14490] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 03/03/2022] [Accepted: 03/19/2022] [Indexed: 12/23/2022]
Abstract
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.
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Affiliation(s)
- Janice Blanchard
- George Washington University School of Medicine and Health Sciences Washington District of Columbia USA
| | - Anne M. Messman
- Wayne State University School of Medicine Detroit Michigan USA
| | - Suzanne K. Bentley
- Icahn SOM at Mount Sinai, New York City Health + Hospitals/Elmhurst New York New York USA
| | | | - Yiju Teresa Liu
- David Geffen School of Medicine at UCLA, Harbor‐UCLA Medical Center Torrance California USA
| | - Rory Merritt
- Alpert Medical School of Brown University Providence Rhode Island USA
| | - Randy Sorge
- Louisiana State University Spirit of Charity Emergency Medicine Residency Program New Orleans Louisiana USA
| | | | | | | | - James Griffith
- George Washington University School of Medicine and Health Sciences Washington District of Columbia USA
| | - Rita A. Manfredi
- George Washington University School of Medicine and Health Sciences Washington District of Columbia USA
| | - Melissa McCarthy
- George Washington University, Milken Institute of Public Health Washington District of Columbia USA
| | - Melissa McCarthy
- Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, USA.,Department of Health Policy, George Washington University, Milken Institute of Public Health, 950 New Hampshire Ave, NW, Washington, DC, USA
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Melnikow J, Padovani A, Miller M. Frontline physician burnout during the COVID-19 pandemic: national survey findings. BMC Health Serv Res 2022; 22:365. [PMID: 35303889 PMCID: PMC8933125 DOI: 10.1186/s12913-022-07728-6] [Citation(s) in RCA: 48] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 02/28/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Physician burnout and wellbeing are an ongoing concern. Limited research has reported on the impact of the COVID 19 pandemic on burnout over time among U.S. physicians. METHODS We surveyed U.S. frontline physicians at two time points (wave one in May-June 2020 and wave two in Dec 2020-Jan 2021) using a validated burnout measure. The survey was emailed to a national stratified random sample of family physicians, internists, hospitalists, intensivists, emergency medicine physicians, and infectious disease physicians. Burnout was assessed with the Professional Fulfillment Index Burnout Composite scale (PFI-BC). Responses were weighted to account for sample design and non-response bias. Random effects and quantile regression analyses were used to estimate change in conditional mean and median PFI-BC scores, adjusting for physician, geographic, and pandemic covariates. RESULTS In the random effects regression, conditional mean burnout scores increased in the second wave among all respondents (difference 0.15 (CI: 0.24, 0.57)) and among respondents to both waves (balanced panel) (difference 0.21 (CI: - 0.42, 0.84)). Conditional burnout scores increased in wave 2 among all specialties except for Emergency medicine, with the largest increases among Hospitalists, 0.28 points (CI: - 0.19,0.76) among all respondents and 0.36 (CI: - 0.39,1.11) in the balanced panel, and primary care physicians, 0.21 (CI: - 0.23,0.66) among all respondents and 0.31 (CI: - 0.38,1.00) in the balanced panel. The conditional mean PFI-BC score among hospitalists increased from 1.10 (CI: 0.73,1.46) to 1.38 (CI: 1.02,1.74) in wave 2 in all respondents and from 1.49 (CI: 0.69,2.29) to 1.85 (CI: 1.24,2.46) in the balanced panel, near or above the 1.4 threshold indicating burnout. Findings from quantile regression were consistent with those from random effects. CONCLUSIONS Rates of physician burnout during the first year of the pandemic increased over time among four of five frontline specialties, with greatest increases among hospitalist and primary care respondents. Our findings, while not statistically significant, were consistent with worsening burnout; both the random effects and quantile regressions produced similar point estimates. Impacts of the ongoing pandemic on physician burnout warrant further research.
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Affiliation(s)
- Joy Melnikow
- Center for Healthcare Policy and Research, Department of Family and Community Medicine, University of California, Davis, USA. .,, Sacramento, California, USA.
| | - Andrew Padovani
- Center for Healthcare Policy and Research, Department of Family and Community Medicine, University of California, Davis, USA
| | - Marykate Miller
- Center for Healthcare Policy and Research, University of California, Davis, USA
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19
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Levine H, Baranchuk N, Li T, Garra G, Nagarajan MS, Garg N. An emergency medicine physician well-being study focusing on gender differences and years of practice during the COVID-19 pandemic. Am J Emerg Med 2022; 55:84-88. [PMID: 35287093 PMCID: PMC8891117 DOI: 10.1016/j.ajem.2022.02.055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 02/22/2022] [Accepted: 02/26/2022] [Indexed: 12/20/2022] Open
Affiliation(s)
- Heidi Levine
- South Shore University Hospital, Department of Emergency Medicine, 301 East Main Street, Bay Shore, New York 11706, United States of America.
| | - Nadia Baranchuk
- South Shore University Hospital, Department of Emergency Medicine, 301 East Main Street, Bay Shore, New York 11706, United States of America.
| | - Timmy Li
- North Shore University Hospital/Northwell Health Zucker School of Medicine, 300 Community Drive, Manhasset, NY 11030, United States of America.
| | - Gabrielle Garra
- South Shore University Hospital, Department of Emergency Medicine, 301 East Main Street, Bay Shore, New York 11706, United States of America
| | - Mohanapriya Sayeen Nagarajan
- South Shore University Hospital, Department of Emergency Medicine, 301 East Main Street, Bay Shore, New York 11706, United States of America.
| | - Nidhi Garg
- South Shore University Hospital, Department of Emergency Medicine, 301 East Main Street, Bay Shore, New York 11706, United States of America.
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Prevalence, Incidence, and Factors Associated with Posttraumatic Stress at Three-Month Follow-Up among New York City Healthcare Workers after the First Wave of the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:ijerph19010262. [PMID: 35010524 PMCID: PMC8750525 DOI: 10.3390/ijerph19010262] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 12/21/2021] [Accepted: 12/23/2021] [Indexed: 12/17/2022]
Abstract
Background: Prevalence, incidence, and factors associated with posttraumatic stress disorder (PTSD) symptoms at follow-up among healthcare workers after the first wave of the COVID-19 pandemic are unknown. Methods: A web survey invitation was sent to healthcare worker listservs at a NYC medical center (April, 2020). The Primary Care (PC)-PTSD questionnaire was used to screen for PTSD symptoms at baseline and then every 2 weeks for 10 weeks. Incidence and prevalence of PTSD symptoms were determined at each time point. Multivariable generalized estimating equation models were performed to investigate the factors associated with a positive PC-PTSD screen at follow-up. Results: Median age (interquartile range) of N = 230 participants was 36 (31–48) years; 79.6% were women; 82.6% worked in COVID-19-focused settings. The prevalence of PTSD symptoms decreased from 55.2% at baseline to 25.0% at 10 weeks (p < 0.001). Among participants who had a baseline negative screen for PTSD symptoms, the incidence of PTSD at 10 weeks was 12.2% (p-trend 0.034). In multivariable-adjusted analyses, being a nurse (odds ratio [OR]: 1.70, 95% confidence interval [CI]: 1.06–2.71), female (OR: 3.00, 95% CI: 1.59, 5.72), and working in a COVID-19-focused location (OR: 1.51, 95% CI: 1.02, 2.21) were associated with increased odds of PTSD symptoms at 10-weeks. Conclusions: PTSD symptoms improved over 3 months following the first wave of the COVID-19 pandemic. However, one out of four NYC healthcare workers still had an increased risk for PTSD at 10-weeks. Screening healthcare workers for PTSD symptoms should be considered during the COVID-19 pandemic.
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21
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Yeo IH, Kim YJ, Kim JK, Lee DE, Choe JY, Kim CH, Park JB, Seo KS, Park SY, Lee SH, Cho JK, Lee SH. Impact of the COVID-19 Pandemic on Emergency Department Workload and Emergency Care Workers’ Psychosocial Stress in the Outbreak Area. Medicina (B Aires) 2021; 57:medicina57111274. [PMID: 34833491 PMCID: PMC8618446 DOI: 10.3390/medicina57111274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/14/2021] [Accepted: 11/16/2021] [Indexed: 11/18/2022] Open
Abstract
Background and Objectives: Due to the unexpected spread of coronavirus disease 2019 (COVID-19), there was a serious crisis of emergency medical system collapse. Healthcare workers working in the emergency department were faced with psychosocial stress and workload changes. Materials and Methods: This was a cross-sectional survey of healthcare workers in the emergency department in Daegu and Gyeongbuk, Korea, from November 16 to 25, 2020. In the survey, we assessed the general characteristics of the respondents; changes in the working conditions before and after the COVID-19 pandemic; and resulting post-traumatic stress disorder, depression and anxiety statuses using 49 questions. Results: A total of 529 responses were collected, and 520 responses were included for the final analyses. Changes in working conditions and other factors due to COVID-19 varied by emergency department level, region and disease group. Working hours, intensity, role changes, depression and anxiety scores were higher in the higher level emergency department. Isolation ward insufficiency and the risk of infection felt by healthcare workers tended to increase in the lower level emergency department. Treatment and transfer delay were higher in the fever and respiratory disease groups (M = 3.58, SD = 1.18; M = 4.08, SD = 0.95), respectively. In all the disease groups, both treatment and transfer were delayed more in Gyeongbuk than in Daegu. Conclusions: Different goals should be pursued by the levels and region of the emergency department to overcome the effects of the COVID-19 pandemic and promote optimal care.
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Affiliation(s)
- In-Hwan Yeo
- Department of Emergency Medicine, School of Medicine, Kyungpook National University, Daegu 41944, Korea; (I.-H.Y.); (Y.-J.K.); (D.-E.L.); (J.-Y.C.); (C.-H.K.); (J.-B.P.); (K.-S.S.)
| | - Yun-Jeong Kim
- Department of Emergency Medicine, School of Medicine, Kyungpook National University, Daegu 41944, Korea; (I.-H.Y.); (Y.-J.K.); (D.-E.L.); (J.-Y.C.); (C.-H.K.); (J.-B.P.); (K.-S.S.)
| | - Jong-Kun Kim
- Department of Emergency Medicine, School of Medicine, Kyungpook National University, Daegu 41944, Korea; (I.-H.Y.); (Y.-J.K.); (D.-E.L.); (J.-Y.C.); (C.-H.K.); (J.-B.P.); (K.-S.S.)
- Correspondence: ; Tel.: +82-53-200-6400
| | - Dong-Eun Lee
- Department of Emergency Medicine, School of Medicine, Kyungpook National University, Daegu 41944, Korea; (I.-H.Y.); (Y.-J.K.); (D.-E.L.); (J.-Y.C.); (C.-H.K.); (J.-B.P.); (K.-S.S.)
| | - Jae-Young Choe
- Department of Emergency Medicine, School of Medicine, Kyungpook National University, Daegu 41944, Korea; (I.-H.Y.); (Y.-J.K.); (D.-E.L.); (J.-Y.C.); (C.-H.K.); (J.-B.P.); (K.-S.S.)
| | - Chang-Ho Kim
- Department of Emergency Medicine, School of Medicine, Kyungpook National University, Daegu 41944, Korea; (I.-H.Y.); (Y.-J.K.); (D.-E.L.); (J.-Y.C.); (C.-H.K.); (J.-B.P.); (K.-S.S.)
| | - Jung-Bae Park
- Department of Emergency Medicine, School of Medicine, Kyungpook National University, Daegu 41944, Korea; (I.-H.Y.); (Y.-J.K.); (D.-E.L.); (J.-Y.C.); (C.-H.K.); (J.-B.P.); (K.-S.S.)
| | - Kang-Suk Seo
- Department of Emergency Medicine, School of Medicine, Kyungpook National University, Daegu 41944, Korea; (I.-H.Y.); (Y.-J.K.); (D.-E.L.); (J.-Y.C.); (C.-H.K.); (J.-B.P.); (K.-S.S.)
| | - Sin-Yul Park
- Department of Emergency Medicine, College of Medicine, Yeungnam University, Daegu 42415, Korea;
| | - Suk-Hee Lee
- Department of Emergency Medicine, Daegu Catholic University, Daegu 42472, Korea;
| | - Jae-Kyung Cho
- Department of Emergency Medicine, Daegu Fatima Hospital, Daegu 41199, Korea;
| | - Sang-Hun Lee
- Department of Emergency Medicine, Keimyung University Dongsan Hospital, Daegu 42601, Korea;
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22
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Kodumayil SA, Kodumayil A, Thomas SA, Pathan SA, Bhutta ZA, Qureshi I, Azad A, Harris TR, Thomas SH. Q-DEPICT: Qatar Determining Emergency Physician Incidence of COVID-Positive Testing. Qatar Med J 2021; 2021:44. [PMID: 34660215 PMCID: PMC8501270 DOI: 10.5339/qmj.2021.44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 08/15/2021] [Indexed: 11/05/2022] Open
Abstract
Despite protective measures such as personal protective equipment (PPE) and a COVID airway management program (CAMP), some emergency physicians will inevitably test positive for COVID. We aim to develop a model predicting weekly numbers of emergency physician COVID converters to aid operations planning. The data were obtained from the electronic medical record (EMR) used throughout the national healthcare system. Hamad Medical Corporation's internal emergency medicine workforce data were used as a source of information on emergency physician COVID conversion and numbers of emergency physicians completing CAMP training. The study period included the spring and summer months of 2020 and started on March 7 and ran for 21 whole weeks through July 31. Data were extracted from the system's EMR database into a spreadsheet (Excel, Microsoft, Redmond, USA). The statistical software used for all analyses and plots was Stata (version 16.1 MP, StataCorp, College Station, USA). All data definitions were made a priori. A total of 35 of 250 emergency physicians (14.0%, 95% CI 9.9%–19.9%) converted to a positive real-time reverse transcriptase-polymerase chain reaction (PCR) during the study's 21-week period. Of these. only two were hospitalized for having respiratory-only disease, and none required respiratory support. Both were discharged within a week of admission. The weekly number of newly COVID-positive emergency physicians was zero and was seen in eight of 21 (38.1%) weeks. The peak weekly counts of six emergency physicians with new COVID-positive were seen in week 14. The mean weekly number of newly COVID-positive emergency physicians was 1.7 ± 1.9, and the median was 1 (IQR, 0 to 3). This study demonstrates that in the State of Qatar's Emergency Department (ED) system, knowing only four parameters allows the reliable prediction of the number of emergency physicians likely to convert COVID PCR tests within the next week. The results also suggest that attention to the details of minimizing endotracheal intubation (ETI) risk can eliminate the expected finding of the association between ETI numbers and emergency physician COVID numbers.
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Affiliation(s)
| | - Ashid Kodumayil
- Department of Emergency Medicine, Hamad General Hospital, Doha 3050, Qatar E-mail:
| | - Sarah A Thomas
- BSc Candidate in Medical Biosciences, Faculty of Medicine, Imperial College London, UK
| | | | | | - Isma Qureshi
- Department of Emergency Medicine, Hamad General Hospital, Doha 3050, Qatar E-mail:
| | - Aftab Azad
- Department of Emergency Medicine, Hamad General Hospital, Doha 3050, Qatar E-mail:
| | - Tim R Harris
- Department of Emergency Medicine, Hamad General Hospital, Doha 3050, Qatar E-mail: .,Blizard Institute, Barts and The London School of Medicine, Queen Mary Univ. of London, UK
| | - Stephen H Thomas
- Department of Emergency Medicine, Hamad General Hospital, Doha 3050, Qatar E-mail: .,Blizard Institute, Barts and The London School of Medicine, Queen Mary Univ. of London, UK
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23
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Magnavita N, Soave PM, Antonelli M. A One-Year Prospective Study of Work-Related Mental Health in the Intensivists of a COVID-19 Hub Hospital. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:9888. [PMID: 34574811 PMCID: PMC8466101 DOI: 10.3390/ijerph18189888] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 09/13/2021] [Accepted: 09/19/2021] [Indexed: 12/23/2022]
Abstract
The COVID-19 pandemic has severely tested the physical and mental health of health care workers (HCWs). The various stages of the epidemic have posed different problems; consequently, only a prospective study can effectively describe the changes in the workers' health. This repeated cross-sectional study is based on a one-year investigation (spring 2020 to spring 2021) of intensive care physicians in one of the two COVID-19 hub hospitals in Central Italy and aims to study the evolution of the mental health status of intensivists during the pandemic. Changes in their work activity due to the pandemic were studied anonymously together with their perception of organisational justice, occupational stress, sleep quality, anxiety, depression, burnout, job satisfaction, happiness, and intention to quit. In May-June 2021, one year after the baseline, doctors reported an increased workload, isolation at work and in their social life, a lack of time for physical activity and meditation, and compassion fatigue. Stress was inversely associated with the perception of justice in safety procedures and directly correlated with work isolation. Occupational stress was significantly associated with anxiety, depression, burnout, dissatisfaction, and their intention to quit. Procedural justice was significantly associated with happiness. Doctors believed vaccinations would help control the problem; however, this positive attitude had not yet resulted in improved mental health. Doctors reported high levels of distress (73%), sleep problems (28%), anxiety (25%), and depression (64%). Interventions to correct the situation are urgently needed.
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Affiliation(s)
- Nicola Magnavita
- Postgraduate School of Occupational Medicine, Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
- Department of Woman/Child & Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Paolo Maurizio Soave
- Postgraduate School of Occupational Medicine, Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
- Department of Emergency, Anesthesiology and Resuscitation Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy;
| | - Massimo Antonelli
- Department of Emergency, Anesthesiology and Resuscitation Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy;
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24
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Magnavita N, Soave PM, Antonelli M. Prolonged Stress Causes Depression in Frontline Workers Facing the COVID-19 Pandemic-A Repeated Cross-Sectional Study in a COVID-19 Hub-Hospital in Central Italy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:7316. [PMID: 34299767 PMCID: PMC8304927 DOI: 10.3390/ijerph18147316] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 07/07/2021] [Indexed: 12/13/2022]
Abstract
The COVID-19 pandemic has severely tested the mental health of frontline health care workers. A repeated cross-sectional study can provide information on how their mental health evolved during the various phases of the pandemic. The intensivists of a COVID-19 hub hospital in Rome were investigated with a baseline survey during the first wave of the pandemic in April 2020, and they were contacted again in December 2020, during the second wave. Of the 205 eligible workers, 152 responded to an online questionnaire designed to measure procedural justice, occupational stress (effort/reward imbalance), sleep quality, anxiety, depression, burnout, job satisfaction, happiness, and turnover intention. Workers reported a further increase in workload and compassion fatigue, which had already risen during the first wave, and a marked reduction in the time devoted to meditation and mental activities. A low level of confidence in the adequacy of safety procedures and the need to work in isolation, together with an increased workload and lack of time for meditation, were the most significant predictors of occupational stress in a stepwise linear regression model. Occupational stress was, in turn, a significant predictor of insomnia, anxiety, low job satisfaction, burnout, and intention to leave the hospital. The number of workers manifesting symptoms of depression increased significantly to exceed 60%. Action to prevent occupational risks and enhance individual resilience cannot be postponed.
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Affiliation(s)
- Nicola Magnavita
- Postgraduate School of Occupational Medicine, Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
- Department of Woman/Child & Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Paolo Maurizio Soave
- Postgraduate School of Occupational Medicine, Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
- Department of Emergency, Anesthesiology and Resuscitation Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy;
| | - Massimo Antonelli
- Department of Emergency, Anesthesiology and Resuscitation Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy;
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