Psychological impact of the pandemic (H1N1) 2009 on general hospital workers in Kobe

Impact of COVID-19-related experiences on health-related quality of life in cancer survivors in the United States

OBJECTIVE

Little evidence exists on the impact of the COVID-19 pandemic on cancer survivors, limiting recommendations to improve health-related quality of life (HRQoL) in this population. We describe survivors' pandemic experiences and examine associations between COVID-19-related exposures, psychosocial experiences, and HRQoL.

METHODS

Between May 2020-April 2021, survivors completed cross-sectional questionnaires capturing COVID-19-related exposures (e.g., exposure to virus, job loss); psychosocial experiences (i.e., COVID-19-related anxiety/depression, disruptions to health care and daily activities/social interactions, satisfaction with providers' response to COVID, financial hardship, perceived benefits of the pandemic, social support, and perceived stress management ability); and HRQoL.

RESULTS

Data were collected from N = 11,325 survivors in the United States. Participants were mostly female (58%), White (89%) and non-Hispanic (88%), and age 63 on average. Breast cancer was the most common diagnosis (23%). Eight percent of participants reported being exposed to COVID-19; 1% tested positive. About 6% of participants lost their jobs, while 24% lost household income. Nearly 30% avoided attending in-person oncology appointments because of the pandemic. Poorer HRQoL was associated with demographic (younger age; female; non-Hispanic White), clinical (Medicare; stage IV disease; hematologic/digestive/respiratory system cancer), and psychosocial factors (low perceived benefits and stress management ability; more disruption to health care and daily activities/social interactions; financial hardship).

CONCLUSIONS

COVID-19-related stressors were associated with various psychosocial experiences in cancer survivors, and these psychosocial experiences were associated with HRQoL above and beyond demographic and clinical factors.

Betrayal-Based Moral Injury and Mental Health Problems Among Healthcare and Hospital Workers Serving COVID-19 Patients

One factor potentially driving healthcare and hospital worker (HHW)'s declining mental health during the COVID-19 pandemic is feeling betrayed by institutional leaders, coworkers, and/or others' pandemic-related responses and behaviors. We investigated whether HHWs' betrayal-based moral injury was associated with greater mental distress and post-traumatic stress disorder (PTSD) symptoms related to COVID-19. We also examined if these associations varied between clinical and non-clinical staff. From July 2020 to January 2021, cross-sectional online survey data were collected from 1,066 HHWs serving COVID-19 patients in a large urban US healthcare system. We measured betrayal-based moral injury in three groups: institutional leaders, coworkers/colleagues, and people outside of healthcare. Multivariate logistic regression analyses were performed to investigate whether betrayal-based moral injury was associated with mental distress and PTSD symptoms. Approximately one-third of HHWs reported feeling betrayed by institutional leaders, and/or people outside healthcare. Clinical staff were more likely to report feelings of betrayal than non-clinical staff. For all respondents, 49.5% reported mental distress and 38.2% reported PTSD symptoms. Having any feelings of betrayal increased the odds of mental distress and PTSD symptoms by 2.9 and 3.3 times, respectively. These associations were not significantly different between clinical and non-clinical staff. As health systems seek to enhance support of HHWs, they need to carefully examine institutional structures, accountability, communication, and decision-making patterns that can result in staff feelings of betrayal. Building trust and repairing ruptures with HHWs could prevent potential mental health problems, increase retention, and reduce burnout, while likely improving patient care.

'We are all in the same boat': a qualitative cross-sectional analysis of COVID-19 pandemic imagery in scientific literature and its use for people working in the German healthcare sector

Background

The COVID-19 pandemic presents a significant challenge to professional responders in healthcare settings. This is reflected in the language used to describe the pandemic in the professional literature of the respective professions. The aim of this multidisciplinary study was to analyze the linguistic imagery in the relevant professional literature and to determine the identification of different professional groups with it and its emotional effects.

Method

A list of 14 typical, widespread and differing imageries for COVID-19 in form of single sentences (e.g., "Until the pandemic is over, we can only run on sight.") were presented to 1,795 healthcare professionals in an online survey. The imageries had been extracted from a qualitative search in more than 3,500 international professional journals in medicine, psychology and theology. Ratings of agreement with these imageries and feelings about them were subjected to factor analysis.

Results

Based on the list of imageries presented, it was possible to identify three factors for high/low agreement by experiences, and two factors for high/low induced feelings. Broad agreement emerged for imageries on "fight against the crisis" and "lessons learned from the crisis", while imageries on "acceptance of uncontrollability" tended to be rejected. Imageries of "challenges" tended to lead to a sense of empowerment among subjects, while imageries of "humility" tended to lead to a sense of helplessness.

Conclusion

Based on the qualitative and subsequential quantitative analysis, several factors for imageries for the COVID-19 pandemic were identified that have been used in the literature. Agreement with imageries is mixed, as is the assessment of how helpful they are.

Tracking Staff Mood and Concerns in a Pediatric Emergency Department During the COVID-19 Pandemic

INTRODUCTION

Few studies have monitored health care worker mood and job satisfaction changes longitudinally throughout an epidemic. The objective of this study was to track staff mood, job satisfaction, questions, and suggestions in a pediatric emergency department over 1 year during the coronavirus disease 2019 pandemic. We hypothesized that staff would experience heightened negative emotions earlier in the pandemic due to uncertainty around hospital protocols and the coronavirus disease 2019 disease process.

METHODS

A voluntary, cross sectional descriptive study using an anonymous electronic survey assessed job satisfaction and mood over 4 domains (sad-happy, angry-peaceful, exhausted-energized, fearful-confident) in pediatric emergency department staff members. Responses were reported with Likert scales and free-text fields.

RESULTS

Of 272 survey responses, most were from nurses and clinical technicians (N = 173, 63.6%), followed by physicians and physician assistants (N = 55, 20.2%) and nonmedical staff (N = 44, 16.2%). Department-wide values for the fearful-confident and angry-peaceful domains increased over time (P = .001 and P = .01, respectively), indicating an overall more confident and peaceful mood in department staff. Job satisfaction did not change over time or by staff role. Nurses and clinical technicians reported the most exhaustion (P = .002), and physicians and physician assistants reported the most fear (P = .03). We received a total of 71 comments, which we grouped into 4 themes: protocols and procedures, personnel, infection risk, and miscellaneous. Comments submitted early in the pandemic centered around intradepartmental protocols and procedures, with a peak in staffing comments 5 months into the pandemic.

DISCUSSION

An electronic survey monitoring mood, job satisfaction, and concerns in a pediatric emergency department identified mood changes in staff over the course of the coronavirus disease 2019 pandemic.

Development and initial psychometric evaluation of a COVID-related psychosocial experiences questionnaire for cancer survivors

BACKGROUND

Cancer survivors are at elevated risk of psychological problems related to COVID-19, yet no published measure adequately assesses their psychosocial experiences during the pandemic.

PURPOSE

Describe the development and factor structure of a comprehensive, self-report measure (COVID-19 Practical and Psychosocial Experiences questionnaire [COVID-PPE]) assessing the pandemic's impact on US cancer survivors.

METHODS

The sample (n = 10,584) was divided into three groups to assess COVID-PPE factor structure by conducting: (1) initial calibration/exploratory analysis of the factor structure of 37 items (n = 5070), (2) confirmatory factor analysis of the best-fitting model (36 items after item removal; n = 5140), and (3) post-hoc confirmatory analysis with an additional six items not collected in the first two groups (42 items; n = 374).

RESULTS

The final COVID-PPE was divided into two sets of subscales, conceptualized as Risk Factors and Protective Factors. The five Risk Factors subscales were labeled Anxiety Symptoms, Depression Symptoms, Health Care Disruptions, Disruptions to Daily Activities and Social Interactions, and Financial Hardship. The four Protective Factors subscales were labeled Perceived Benefits, Provider Satisfaction, Perceived Stress Management Skills, and Social Support. Internal consistency was acceptable for seven subscales (αs = 0.726-0.895; ωs = 0.802-0.895) but poor or questionable for the remaining two subscales (αs = 0.599-0.681; ωs = 0.586-0.692).

CONCLUSIONS

To our knowledge, this is the first published self-report measure comprehensively capturing psychosocial impact-both positive and negative-of the pandemic on cancer survivors. Future work should evaluate predictive utility of COVID-PPE subscales, particularly as the pandemic evolves, which may inform recommendations for cancer survivors and facilitate identification of survivors most in need of intervention.

The impact of pandemics on healthcare providers' workloads: A scoping review

AIMS

To review and synthesize available evidence exploring the impact of pandemics on direct healthcare providers' workloads in the acute care setting.

DESIGN

Scoping review.

DATA SOURCES

A review of English research articles published up to August 2022 that examined the impact of pandemics on healthcare providers' workloads was undertaken. Studies were identified by searching four electronic databases: Medline (EBSCO), CINAHL (EBSCO), Web of Science and PsychInfo (EBSCO). Fifty-five studies met the inclusion criteria.

REVIEW METHODS

The review followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses Scoping Review checklist.

RESULTS

Healthcare workers experience an increase in workload pressures during a pandemic. This included patients requiring more care, undertaking non-normal work activities, increase in work content including changes to documentation, increase in demand and skills required, an increase in overtime and hours of work per week and higher patient-to-nurse ratios. The review also highlighted changes to the work environment and worsened work environments, including staffing shortages.

CONCLUSION

Focused efforts from health organizations to prioritize supportive conditions, policies focused on improved work environments, staffing adequacy and fair and reasonable workloads will enhance retention of the current workforce and future planning for pandemics.

IMPACT

Understanding workload challenges faced by frontline health professionals during the pandemic can improve planning, including policies and procedures, and resource allocation for future pandemic or emergency situations. In addition, extended periods of high workloads can impact staff retention. As many countries return to life after COVID-19, it is important that healthcare organizations examine staff pressures and identify ways to support staff moving forward. This will be vital for the future sustainability of the workforce.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Parenting stress and associated factors in healthcare workers after the second wave of COVID-19 in India: a two-center cross-sectional study

Background

High parenting stress (PS) in members of the general population during the COVID-19 pandemic was exacerbated by work-, family-, and child-related factors. However, the negative effects of PS on the mental health and work participation of healthcare workers (HCWs) have received limited attention. This study aimed to examine the proportion of severe PS among HCWs and identify its contributory factors.

Methods

This cross-sectional survey was conducted in two COVID-19-care hospitals attached to medical colleges in India between November 1 and December 24, 2021, following the delta variant-driven second wave of COVID-19. The study recruited 662 HCW parent and child dyads (aged 1.5-18 years) and assessed workplace, family, and child-related characteristics. The Parenting Stress Scale (PSS) and Child Behavior Checklist (CBCL) were used to identify severe PS and child behavioral issues, respectively. Univariable and multivariable logistic regression analyzes were used to identify the significant and independent risk factors associated with severe PS, respectively.

Results

Equal proportions of medical and paramedical HCWs completed the survey [mean age: 36.96 ± 5.89; female: 466 (70%)]. The median PSS score of HCWs was 33 [interquartile range (IQR): 28-39], and 23% (155/662) of the HCW parents experienced severe PS. The independent predictors of severe PS included the female sex [adjusted odds ratio (aOR): 3.31; 95% confidence interval (CI): 1.74-6.29], HCWs with >15-day postings in COVID-19 care (aOR: 3.74; 95% CI: 1.53-9.16), having children with behavioral issues (aOR: 3.49; 95% CI: 1.29-9.48), HCWs at the Dehradun center (aOR: 2.25; 95% CI: 1.24-4.10), having an HCW spouse simultaneously working in COVID-19 care (aOR: 1.88; 95% CI: 1.01-3.49), and HCWs with joint families (aOR: 1.93; 95% CI: 1.17-3.18).

Conclusion

Overall, 23% of the cohort of HCWs continued to experience severe PS after the second COVID-19 wave driven by the delta variant in India. Routine screening of HCWs for PS using the PSS or similar measures, anticipatory guidance for parenting, and targeting at-risk HCWs with appropriate supportive measures may help reduce the incidence of severe PS and optimize the participation of HCWs in the fight against current and future pandemic-like situations.

The prevalence of effort-reward imbalance and its associations with working conditions, psychosocial resources and burden among health care workers during the COVID-19 pandemic: Results of the egePan-Voice study

OBJECTIVE

The association between a measure of effort-reward imbalance (ERI) and profession as well as gender in a sample of health care workers (HCW) during the first wave of the COVID-19 pandemic in Germany using the egePan-Voice study. In addition, we examined, which factors are associated with an effort-reward imbalance ratio (ERI ratio) >1.

METHODS

In a large sample of HCW (N = 6174) we assessed occupational stress with the short version of the effort-reward imbalance (ERI) questionnaire, working conditions, COVID-19-related problems and psychosocial resources (ENRICHD Social Support Inventory, ESSI; Sense of Coherence Scale, SOC-3 and optimism, SOP2).

RESULTS

The prevalence of a ERI ratio >1 among HCW was 50.9%. The prevalence's of an ERI ratio >1 were statistically significant different between gender as well as the occupational profession. The proportion of women (51.8%) with ERI ratio >1 was significantly higher than among men (47.8%). The highest ERI imbalance was found among nurses (62.8%), followed by medical technical assistants (MTA) (58.8%), while psychologists/psychotherapists revealed the lowest value (37.8%), followed by physicians (41.8%). In the total sample, most essential factors reported at this time for increased ERI ratio were: insufficient staff for the current work load, insufficient recovery, feeling insufficiently protected by measures taken by the hospital/the employer, high occupancy rate of the wards, insufficient trust in colleagues and being a nurse as compared with being a physician.

CONCLUSION

The findings indicate a high proportion of HCW with effort-reward imbalance and substantial profession-related differences. Preventive interventions should be offered to vulnerable groups among the HCW to decrease the imbalance measured by work stress.

Age and adult attachment style predict psychological distress in the Singapore general population during COVID-19

To date, there is increasing evidence to suggest that age and adult attachment styles, such as secure, anxious and avoidant attachment are predictive or protective for psychological distress. The study aimed to investigate the extent to which age and adult attachment style, measured by the Attachment Style Questionnaire, predicted psychological distress, measured by the Kessler 10 Psychological Distress Scale, in the Singapore general population during COVID-19. Ninety-nine residents of Singapore (44 females, 52 males, 3 prefer not to state their gender) aged between 18 and 66 completed an online survey, which collected information on age, adult attachment styles and levels of psychological distress. Multiple regression analysis was performed to study the influence of predictive factors on psychological distress. The study identified 20.2%, 13.1% and 14.1% of participants reporting psychological distress at the mild, moderate and severe levels, respectively. The study also reported that age and psychological distress were negatively correlated, and that psychological distress was negatively correlated with both anxious and avoidant attachment styles. It was concluded that age and adult attachment style significantly predicted psychological distress in the Singapore general population during COVID-19. Further studies exploring other variables and risk factors are required to further consolidate these results. At the global level, these findings may help countries predict residents' reactions to future outbreaks and help them prepare strategies and approaches to address these situations.

Mental Health: Pandemics, Epidemics and Tau Protein

Background

It is well established that a wide range of psychological disorders are influenced by the way people live, with lifestyle-related factors playing a substantial role. During the past decade, the effects of major disasters on mental health have drawn a lot of attention.

Aim

In this review, we compare clinical studies reporting a link between COVID-19 and other pandemics and mental health. Importantly, we also shed light on Tau protein and neurotransmitters as neurobiological factors that might explain this link.

Methods

A thorough PubMed search was done to gather and summarize published data on the COVID-19 pandemic's effect on mental health. Additionally, these studies were compared to previous research published on PubMed, triggering other pandemic and epidemic impacts on mental health.

Results

The COVID-19 epidemic has had the biggest impact on raising awareness about mental health. Moreover, the past century has seen an increase in the frequency of disease outbreaks like MERS-CoV, Ebola, and Influenza, which all had an impact on mental health. However, the exact role of these epidemics on mental health and brain functions is poorly understood.

Conclusion

Future research on the underlying pathways may yield essential information for the treatment and prevention of prospective mental diseases in light of the ongoing decline in mental health during the past 10 years.

High stress related to COVID-19 among health workers in the Plateau Central healthcare region (BURKINA FASO): a cross-sectional study

Background

The COVID-19 pandemic challenged the mental wellbeing of health workers. The objective of this study was to assess health workers' perceived stress during the response to COVID-19 in the Central Plateau region (Burkina Faso).

Methods

We conducted a cross-sectional study of health workers in the Central Plateau health region from September 20 to October 20, 2021. Agents' perceived stress was assessed by the Perceived Stress Scale (PSS-10). Factors associated with high stress (PSS-10 score ≥ 27) were identified by logistic regression.

Results

A total of 272 officers participated in the survey. The mean PSS-10 score was 29.3 points (standard deviation: 6.2). Three out of ten agents (68%) had a high level of stress. The main sources of stress were the risk of being exposed to contamination (70%) and being the source of contamination (78%). Working at the referral health center [adjusted odds ratio (aOR): 2.29; 95% confidence interval (95% CI): 1.19-4.41], the hospital as the main source of COVID-19 information (aOR: 1.17; 95% CI: 1.01-3.04), fear of COVID-19 patients being managed at one's center (aOR: 1.8; 95% CI: 1.06-3.07) were factors associated with high health worker stress levels during the first wave of COVID-19.

Conclusion

The COVID-19 pandemic caused high stress among health care workers in Burkina Faso. Psychological support for health center workers in responding to future epidemics would improve their mental health.

Motivation and hesitation of healthcare workers to work during the H1N1 influenza and COVID-19 pandemics: An exploratory single-centered repeated cross-sectional study

Aim

Pandemics of life-threatening viruses have detrimental impacts on the motivation of healthcare workers to work. However, no study has examined this impact during different pandemics with the same setting and design. This study aimed to reveal similarities and differences in factors associated with willingness and hesitation to work between two recent pandemics, H1N1 influenza and COVID-19, in the same hospital, using the same questionnaire.

Methods

Healthcare workers in one hospital in Japan completed a questionnaire on basic characteristics and stress-related questions during the H1N1 influenza (n = 1061) and the COVID-19 (n = 1111) pandemics. Logistic regressions were performed to ascertain the effect of personal characteristics and stress-related questions on the likelihood that employees showed strong or weak motivation or hesitation to work.

Results

The feeling of being protected by the hospital was the only factor that significantly decreased hesitation and increased motivation to work, and females felt significantly more hesitation to work than males did in both pandemics.

Conclusions

Hospital managers and government officers should focus on increasing organizational support and caring for female workers to maintain healthcare workers' motivation to work during future pandemics.

Characteristics of suicidal emergency room patients before and during the COVID-19 pandemic in Japan

AIM

Owing to the stress caused by the behavioral restrictions and lifestyle changes during the COVID-19 pandemic, suicide rates have increased in Japan, especially among young people. This study aimed to identify the differences in the characteristics of patients hospitalized for suicide attempts in the emergency room, requiring inpatient care before and during the pandemic over 2 years.

METHODS

This study was a retrospective analysis. Data were collected from the electronic medical records. A descriptive survey was conducted to examine changes in the pattern of suicide attempts during the COVID-19 outbreak. Two-sample independent t-tests, Chi-square tests, and Fisher's exact test were used for data analysis.

RESULTS

Two hundred one patients were included. No significant differences were found in the number of patients hospitalized for suicide attempts, average age, or sex ratio before and during the pandemic periods. Acute drug intoxication and overmedication in patients increased significantly during the pandemic. The self-inflicted means of injury with high fatality rates were similar during the two periods. The rate of physical complications significantly increased during the pandemic, while the proportion of unemployed individuals significantly decreased.

CONCLUSIONS

Despite studies predicting an increase in suicides based on past statistics of young people and of women, no significant changes were observed in this survey of the Hanshin-Awaji region, including Kobe. This may have been owing to the effect of suicide prevention measures and mental health measures implemented by the Japanese government after an increase in suicides and after past natural disasters.

Mental distress of physicians in the outpatient care throughout the COVID-19 pandemic: emotional and supportive human relations matter - Cross-sectional results of the VOICE-study

BACKGROUND

The aim of this cross-sectional study was to evaluate the course of self-reported mental distress and quality of life (QoL) of physicians, working in the outpatient care (POC). Outcomes were compared with a control group of physicians working in the inpatient care (PIC), throughout the Corona Virus Disease (COVID)-19 pandemic. The impact of risk and protective factors in terms of emotional and supportive human relations on mental distress and perceived QoL of POC were of primary interest.

METHODS

Within the largest prospective, multi-center survey on mental health of health care workers (HCW), conducted during the first (T1) and second (T2) wave of the COVID-19 pandemic in Europe, we investigated the course of current burden (CB), depression (Patient Health Questionnaire-2), anxiety (Generalized Anxiety Disorder-2) and QoL, cross-sectionally, in n = 848 POC (T1: n = 536, T2: n = 312). The primary outcomes were compared with an age- and gender-matchted control group of n = 458 PIC (T1: n = 262, T2: n = 196). COVID-19-, work-related, social risk and protective factors were examined.

RESULTS

At T1, POC showed no significant differences with respect to CB, depression, anxiety, and QoL, after Bonferroni correction. Whereas at T2, POC exhibited higher scores of CB (Cohen´s d/ Cd = .934, p < .001), depression (Cd = 1.648, p < 001), anxiety (Cd = 1.745, p < .001), work-family conflict (Cd = 4.170, p < .001) and lower QoL (Cd = .891, p = .002) compared with PIC. Nearly all assessed parameters of burden increased from T1 to T2 within the cohort of POC (e.g. depression: CD = 1.580, p < .001). Risk factors for mental distress of POC throughout the pandemic were: increased work-family conflict (CB: ß = .254, p < .001, 95% CI: .23, .28; PHQ-2: ß = .139, p = .011, 95% CI: .09, .19; GAD-2: ß = .207, p < .001, 95% CI: .16, .26), worrying about the patients´ security (CB: ß = .144, p = .007, 95% CI: .07, .22; PHQ-2: ß = .150, p = .006, 95% CI: .00, .30), fear of triage situations (GAD-2: ß = .132, p = .010, 95% CI: -.04, .31) and burden through restricted social contact in spare time (CB: ß = .146, p = .003, 95% CI: .07, .22; PHQ-2: ß = .187, p < .001, 95% CI: .03, .34; GAD-2: ß = .156, p = .003, 95% CI: -.01, .32). Protective factors for mental distress and QoL were the perceived protection by local authorities (CB: ß = -.302, p < .001, 95% CI: -.39, -.22; PHQ-2: ß = -.190, p < . 001, 95% CI: -.36, -.02; GAD-2: ß = -.211, p < .001, 95% CI: -.40, -.03; QoL: ß = .273, p < .001, 95% CI: .18, .36), trust in colleagues (PHQ-2: ß = -.181, p < .001, 95% CI: -.34, -.02; GAD-2: ß = -.199, p < .001, 95% CI: -.37, -.02; QoL: ß = .124, p = .017, 95% CI: .04, .21) and social support (PHQ-2: ß = -.180, p < .001, 95% CI: -.22, -.14; GAD-2: ß = -.127, p = .014, 95% CI: -.17, -.08; QoL: ß = .211, p < .001, 95% CI: .19, .23).

CONCLUSIONS

During the pandemic, the protective role of emotional and supportive human relations on the mental distress and quality of life of POC should be taken into account more thoroughly, both in practice and future research.

Intervention with EMDR on a sample of healthcare workers in the nephrology and dialysis service during the COVID-19 emergency: from immediate treatment effect to long-term maintenance

Background

During the COVID-19 pandemic, psychological support was provided to healthcare workers in Nephrology and Dialysis Operative Unit of the Azienda Ospedaliera Bassini using an EMDR group protocol to decrease posttraumatic stress symptoms in the medium and long term. The aim of this study was to demonstrate the effectiveness of EMDR treatment to reduce post-traumatic stress symptoms at the end of the first pandemic wave and its progress over time in the subsequent phases of the health emergency.

Methods

The sample of study consisted of 43 healthcare workers from the Nephrology and Dialysis Service who spontaneously decided to take part in the Brief EMDR treatment. Statistical analyses were carried out to compare the data collected with the IES-R, the Emotion Thermometer and the Post-Traumatic Growth Scale. The comparisons covered pre-treatment, post-treatment and follow-up.

Results

The results show a significant clinical improvement in reducing PTSD symptoms following the Brief EMDR group treatment. The comparison between PRE and POST treatment (DELTA1) regarding the scores from IES-R and Emotion Thermometer, highlighted the important statistically change that occurred in terms of symptomatology reduction (p < 0.001). By comparing POST and FU (DELTA2), it was observed that all variables except avoidance show a significant weakening of the effect with time (p < 0.001), but the magnitude of this effect is much smaller than the improvement found in DELTA1. DELTA 3 analysis finally made it possible to highlight how the treatment effect is maintained almost intact at follow-up. In fact, the maintenance of a better situation at follow-up was observed, in the course of re-traumatization linked to the new wave, compared to the initial data (p < 0.001).

Conclusion

The COVID-19 health emergency has significantly impacted hospital healthcare workers, leading to a high risk of developing PTSD symptoms. A psychological intervention aimed at the operators themselves is therefore of great importance.

The sustained psychological impact of coronavirus disease 2019 pandemic on hospital workers 2 years after the outbreak: a repeated cross-sectional study in Kobe

BACKGROUND

Healthcare workers who are exposed to coronavirus disease 2019 are psychologically distressed. This study aimed to evaluate the mental health outcomes of hospital workers 2 years after the outbreak of coronavirus disease 2019 and to identify changes in the stress of hospital workers and predicted risk factors.

METHODS

This survey was conducted 2 years after the initial evaluation performed under the first emergency declaration of the coronavirus disease 2019 pandemic among hospital workers at the same hospital in an ordinance-designated city in Japan from June to July 2022. Sociodemographic data, 19 stress-related question responses, the Impact of Event Scale-Revised, and the Maslach burnout inventory-general survey were collected. Multiple regression models were used to identify factors associated with each of the mental health outcomes 2 years after the coronavirus disease 2019 outbreak.

RESULTS

We received 719 valid responses. Between 2020 and 2022, hospital workers' anxiety about infection decreased, whereas their exhaustion and workload increased. Multiple regression analysis revealed that 2 years after the coronavirus disease 2019 outbreak, nurses and young people were at a higher risk of experiencing stress and burnout due to emotional exhaustion, respectively.

CONCLUSIONS

This is the first study to examine the long-term stress of hospital workers measured in Japan. Exhaustion and workload were worsened 2 years into the pandemic. Therefore, health and medical institutions should continuously monitor the physical and psychological health of staff members.

Effects of internal and external corporate social responsibility on employee job satisfaction during a pandemic: A medical device industry perspective

The outbreak of the COVID-19 pandemic has dramatically changed human lifestyles and contributed to the creation of a new normal in the business environment. This study examines the direct and indirect impacts of internal and external corporate social responsibility (CSR) practices on employee job satisfaction through organisational identification, conditional on employee age. A total of 236 valid responses were received from eight multinational medical device manufacturers in Malaysia. Partial least squares and PROCESS algorithms were employed to assess the hypothesised interactions between the predictors and criterion variables. The empirical results showed that internal CSR (i.e., CSR to employee) could significantly drive a greater sense of belonging and work satisfaction. Surprisingly, however, external CSR (i.e., CSR to community) negatively affects job fulfilment in the medical devices industry during the pandemic. Nevertheless, the findings also showed that ongoing CSR activities in the community could build organisational identification and subsequently improve job satisfaction. Conversely, CSR to environment did not statistically influence job satisfaction, either directly or indirectly. The mediating effects of organisational identification were not associated with employee age. This study provides a practical framework for effective CSR strategies amid the pandemic that can help organisations align with social responsibility, enhance their reputation, and contribute to society.

Psychological status of medical staff dedicated to nucleic acid collection in COVID-19 epidemic during closed-loop management: A cross-sectional study

Background

To investigate the depression, anxiety and somnipathy situation occurred in the nucleic acid collection staff during the closed-loop management period of COVID-19. And try to understand the influencing factors of related psychological status.

Methods

A cross-sectional study of 1,014 nucleic acid collection staff from seven Chinese hospitals was conducted. Various investigation methods were involved in the questionnaires to collect data, including 12-items self-made questionnaire survey of basic demographic information, 9-items patient health questionnaire depression scale (PHQ-9), 7-items generalized anxiety disorder scale (GAD-7) and Pittsburgh sleep quality index (PSQI). Data analysis was performed using SPSS version 26.0 and Excel software. Mann-Whitney U-test, Chi-square test, correlation analysis, mono-factor analysis and binary logistic regression were applied accordingly for further analysis.

Results

The positive rate of depression, anxiety and sleep disorder of 1,014 nucleic acid collectors under closed-loop management were 33.5, 27.2, and 50.1%, respectively. Depression was significantly positively correlated with anxiety and sleep (P &lt; 0.05). The scores of depression scale were positively correlated with the age and the fear for infection (r = 0.106, 0.218, both P &lt; 0.05); The scores of anxiety scale were also positively correlated with the age and the fear for infection (r = 0.124, 0.225, both P &lt; 0.05); The length of service, collection time and the degree of worry about infection and was positively correlated with the score of sleep scale (r = 0.077, 0.074, 0.195, both P &lt; 0.05); Education level had a significant negative association with PHQ-9, GAD-7 and PSQI (r = −0.167,−0.172, both P &lt; 0.05). Binary logistic regression analysis showed that age, technical title, education level, collection time, collection frequency, collection location, fear for infection and external environment were important influencing factors of depression, anxiety and sleep disorders.

Conclusion

The results of this study suggested that when carrying out nucleic acid collection mission, managers should intervene to optimize the collection location, control the duration of each collection mission, replace the collection staff in time and pay close attention to the psychological state of the collection staff.

[COVID-19 Pandemic: Psychosocial impact among healthcare professionals in Tunisia]

OBJECTIVE

To determine the psycho-affective impact of the Covid-19 pandemic on the mental health of health professionals in Tunisia and to estimate the associated factors.

METHODS

This is a multicenter, cross-sectional, descriptive and analytical study of health professionals carried out from May 2, 2020 to June 30, 2020 in Tunisia. Healthcare professionals included doctors, nurses, dentists and pharmacists. The participants answered a pre-established questionnaire using an electronic "Google Form". This questionnaire gathered demographic data and medical history. It included two psychometric scales, the GAD-7 (General Anxiety Disorder-7) and the PHQ-9 (Patient Health Questionnaire-9) to assess the prevalence and intensity of anxiety symptoms and depressive symptoms respectively.

RESULTS

The study included 203 healthcare professionals. The professionals had a mean age of 30.74±6.33years, 69.5 % were women, and the majority were doctors (77.8 %). Among professionals, 9.4 % were nurses, 7.4 % were dentists, and 5.4 % were pharmacists. A third of the participants 34.3 % worked in departments with Covid-19 patienfor having moderate to severe anxiety symptoms.

CONCLUSION

In order to ensure better patient care, early detection of psychiatric disorders and the implementation of specific strategies to ensure better mental health among healthcare professionals are priorities not only during the current pandemic but also in the event of a future similar pandemic.

The prevalence and associated factors of depression, anxiety, and PTSD among Moroccan medical doctors in the COVID-19 pandemic: a national study

COVID-19 pandemic is facing healthcare professionals with unprecedented challenges, which might alter their mental health. We targeted assessing depression, generalized anxiety, and post-traumatic stress disorder (PTSD) of Moroccan medical doctors during the COVID-19 pandemic; this would allow identifying the associated factors. A cross-sectional national study was carried out on 1267 exposed and unexposed public health medical doctors to COVID-19 patients. The study was conducted between May 15 and 15 June 2020. An anonymous self-administered questionnaire was completed online voluntarily and randomly. We used the Patient Health Questionnaire (PHQ-9), the Generalized Anxiety Disorder (GAD-7), and the PTSD Checklist for DSM‑5 (PCL-5) to assess depression, generalized anxiety, and PTSD, respectively. The respondents' rate was 63.3%. The mean age was 30.97 ± 6.65 years old, and 59.3% (N = 751) were females with a sex ratio M/F of 0.68. The sample included 43.0% (N = 545) of COVID-19 frontline doctors. Among all participants, 31.5% (N = 400) had depression, 29.2% (N = 370) had generalized anxiety, and 21.7% (N = 276) had PTSD. The average scores of the PHQ-9, the GAD-7, and the PCL-5 were 7.79 (± 5.54), 6.12 (±5.72), and 18.58 (±17.62), respectively. The multivariate logistic regression showed that working in primary and secondary hospitals, moderate and high-stress perceptions, a chronic physical illness, and a family history of psychiatric disorder were independently associated factors of depression, generalized anxiety, and PTSD. The females expressed significantly more anxiety. Doctors living in a family consisting of member with chronic disease showed a significantly higher risk of PTSD. The security sense of contamination risk and low threat perception of COVID-19 were significantly protective factors of depression, anxiety, and PTSD. Moroccan medical doctors are in psychological distress. It is essential to preserve medical doctors' mental well-being health for a better fight against the COVID-19 pandemic through effective and targeted health policies.

Quality of therapy and mental health among occupational therapists during the COVID-19 pandemic

Introduction

The coronavirus disease of 2019 (COVID-19) has had a severe psychological impact on occupational therapists. Clarifying the mental health status of occupational therapists and its relationship with therapy quality is essential for maintaining the quality of care and patients' quality of life. Therefore, the present study aimed to investigate whether and how mental health problems are related to the quality of occupational therapy.

Methods

A nationwide cross-sectional online survey was conducted during Japan's second national state of emergency (January 2021). A total of 4,418 registered occupational therapists who were members of the Japanese Association of Occupational Therapists participated in this study. After screening for the exclusion criteria, data from 1,966 participants were analyzed.

Results

Path analysis showed that insufficient information provision by the workplace and increased workload were associated with depression, anxiety, and insomnia. Specifically, depression was associated with decreased therapy quality. Furthermore, one's therapy quality showed a strong positive correlation with colleagues' therapy quality.

Discussion

These results demonstrated a direct link between therapists' mental health conditions and therapy quality and suggested that decreased therapy quality might occur at the institutional rather than individual level. A reassessment of the support system and prompt detection and support for professionals with psychological symptoms may be the key to enhancing therapy quality and patients' quality of life. The present results contribute to the understanding of these relationships, considering the current pandemic context for occupational therapists.

Prevalence of Perceived Stress, Anxiety, and Depression in HCW in Kosovo during the COVID-19 Pandemic: A Cross-Sectional Survey

A pandemic may have a negative impact on healthcare workers' (HCW) mental health. In this cross-sectional study, we assess the self-reported prevalence of stress, anxiety, and depression and identify their predictive factors among HCW in Kosovo. The online questionnaire collected data on socio-demographics (sex, age, occupation, education, workplace) and the presence and severity of depression, anxiety, and stress through the 21-item Depression, Anxiety, and Stress Scale (DASS-21) questionnaire. Descriptive statistics, t-test, and linear logistic regression were used to analyze the data. Of the 545 respondents, the majority were male (53.0%), under 60 years of age (94.7%), and married (81.7%). Most of them were physicians (78.2%), while the remaining were nurses, midwives, and other health professionals (22%). Prevalence rates for moderate to extremely high stress, anxiety, and depressive symptoms were 21.9%, 13.0%, and 13.9%, respectively. The nurses reported significantly higher mean scores for depression and anxiety than the physicians (p < 0.05). Being married, having poor health, not exercising, and reporting "burnout" from work significantly predicted higher levels of depressive, anxiety, and stress symptoms among health workers (p < 0.05). Most HCWs (71.6%) reported a mild, moderate, or severe mental health burden, and certain factors predicted higher levels of such burden.

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.

Workplace Wellbeing and Quality of Life Perceived by Portuguese Nurses during the COVID-19 Pandemic: The Role of Protective Factors and Stressors

During the COVID-19 pandemic, nurses were exposed to many stressors, which may have been associated with some mental health problems. However, most of the studies carried out on nurses' quality of life and workplace wellbeing during the COVID-19 pandemic took a pathogenic approach. Given that current scientific knowledge in this field presented too many gaps to properly inform preventive and therapeutic action, the aim of this study was to explore whether protective factors (resilience, perceived social support, and professional identification) and stressors (perceived stress and psychosocial risks in the workplace) influenced the quality of life and workplace wellbeing perceived by Portuguese nurses during the COVID-19 pandemic. Data for this cross-sectional study was collected through online self-administered questionnaires. Linear regression models were used to analyze the relationships between variables. Results showed that perceived stress, resilience and job satisfaction were associated with quality of life and workplace wellbeing among Portuguese nurses. The study's findings could serve to inform health policy and should draw the attention of nursing managers to the needs and difficulties reported by nurses, to the importance of providing them with emotional support, and to the relevance of promoting a good work environment.

Future public health emergencies and disasters: sustainability and insights into support programs for healthcare providers

BACKGROUND

The mental health of healthcare workers (HCWs) has been at the forefront throughout the COVID-19 pandemic. While workplace-based support programs have been developed in hospitals globally, few systematically collected data. While critical to their success, information on these programs and the experience of mental healthcare providers (MHP) who support colleagues is limited. The objective of this study was to explore the experiences of MHP caring for HCW colleagues within a novel workplace-based mental health support program during the COVID-19 pandemic, to provide insights on facilitators, areas for improvement and barriers to program sustainability.

METHODS

This qualitative study used semi-structured interviews conducted by videoconference between September 2020 to October 2021. UHN CARES (University Health Network Coping and Resilience for Employees and Staff) Program was developed during the first wave of the COVID-19 pandemic in March 2020. It supports over 21,000 staff members within the UHN, Canada's largest academic health research institution, in Toronto, Canada. Purposive sampling was used to select 10 of the 22 MHP in the UHN CARES Program (n = 10). Using a critical realism framework, key components required to sustain a successful workplace-based mental health support program for HCWs and balance the needs of MHP were determined.

RESULTS

Six psychiatrists and four psychologists (n = 10) with varying roles at UHN participated in 17 interviews, including seven repeat interviews exploring changes over time within the pandemic and program. Components which facilitated the success of the program included flexibility in scheduling, confidential health record storage, comprehensive administrative support, availability of resources and adaptive quality improvement approach. Recommendations for improvement included opportunities for peer supervision, triaging of cases, and managing HCW expectations. MHP found caring for HCWs to be meaningful and they utilized existing clinical skills during sessions. Challenges included working in a virtual setting, navigating boundaries when caring for colleagues, and managing the range of service users and their needs.

CONCLUSIONS

These findings suggest how support programs can be structured for HCWs, how to provide support, and how to sustain this support, allowing health systems to balance the needs of HCWs and MHPs in preparation for future public health emergencies.

Stress and the Psychological Impact of the COVID-19 Pandemic on Frontline Obstetrics and Gynecology Providers

OBJECTIVE

The coronavirus disease 2019 (COVID-19) pandemic rapidly overwhelmed global health care systems in 2020, with New York City (NYC) marking the first epicenter in the United States. High levels of stress amongst health care workers have been reported in pandemics, but less is known about stress amongst Obstetrics and Gynecology (OB/GYN) providers. We sought to describe levels of stress, anxiety, depression, and other aspects of mental health among OB/GYN health care workers during the first wave of the COVID-19 pandemic.

STUDY DESIGN

We conducted an anonymous cross-sectional electronic survey of a wide range of OB/GYN clinicians in a large NYC hospital system in the spring of 2020. We used both original survey questions and validated screening tools to assess stress, anxiety, depression, and burnout. We calculated median scores for these tools and compared median score between provider types. We also adapted questions on pandemic-related stressors from the MERS and SARS pandemics to fit the context of the COVID-19 pandemic and OB/GYN providers.

RESULTS

A total of 464 providers met study inclusion criteria, and 163 providers completed the survey (response rate = 35.1%). Approximately 35% of providers screened positive for anxiety and 21% for depression. Scores for depression, burnout, and fulfillment varied by provider type, with nurses scoring higher than physicians (p <0.05). The majority of respondents reported stress from pandemic and OB-specific stressors, including the possibility of transmitting COVID-19 to friends and family (83.9%, [95% confidence interval or CI 78.0-89.8%]), uncertainty regarding the pandemic's trajectory (91.3% [86.7-95.8%]), and frequent policy changes on labor and delivery (72.7% [65.1-80.3%]).

CONCLUSION

OB/GYN providers reported high levels of stress during the COVID-19 pandemic. The stress of caring for laboring patients during a pandemic may disproportionately affect nurses and trainees and highlights the need to provide interventions to ameliorate the negative impact of a pandemic on the mental health of our OB/GYN health care workers.

KEY POINTS

· COVID-19 led to stress amongst OB/GYN providers.. · Some stressors were unique to providing obstetric care.. · Nurses and trainees were more affected by this stress..

[egePan-VOICE study on the psychosocial burden of the Covid-19 pandemic among - medical technical assistants]

egePan-VOICE study on the psychosocial burden of the Covid-19 pandemic among - medical technical assistants Objectives: The Covid-19 pandemic is associated with increased demands on healthcare workers. A previously neglected occupational group is medical technical assistants (MTA). The aim is therefore to identify stress factors among MTA in Germany during the pandemic. Methods: A cross-sectional online survey of medical staff was conducted in spring 2020 (N = 8088). Results: N = 1483 records of MTA were analyzed. Retrospectively, the stress increased under the pandemic, and 60.1 % of MTA suffered from work stress (ERI). Staff shortages and extra work were associated with an increase in work stress. Problems of work-life balance and contact with contaminated material/infected persons favored stressful experiences. Conclusions: Some working conditions in the pandemic pose a potential health risk to MTA. It seems necessary to create improvements in the general conditions that enable healthily and effective work.

Rasch Modeling and Multilevel Confirmatory Factor Analysis for the Usability of the Impact of Event Scale-Revised (IES-R) during the COVID-19 Pandemic

BACKGROUND

Several instruments are currently used to assess Coronavirus Disease 2019 (COVID-19) -induced psychological distress, including the 22-item Impact of Event Scale-Revised (IES-R). The IES-R is a self-administered scale used to assess post-traumatic stress disorder (PTSD). The current study aimed to examine the construct validity of the IES-R, based on the Rasch model, with COVID-19-related data, as well as to test the multilevel construct validity of the IES-R within and among countries during the pandemic crisis.

METHODS

A multi-country web-based cross-sectional survey was conducted utilizing the 22-item IES-R. A total of 1020 participants enrolled in our survey, of whom 999 were included in the analyses. Data were analyzed using Rasch modeling and multilevel confirmatory factor analysis (MCFA).

RESULTS

The Rasch modeling results of the IES-R demonstrated that the IES-R is a satisfactory instrument with the five-point Likert scale, asserting that its 22 items are significant contributors to assessing PTSD as a unidimensional construct covered by the items of the IES-R. The MCFA confirmed that the 22-item IES-R, with its three factors, including intrusion, avoidance, and hyperarousal, demonstrates adequate construct validity at the within- and among-country levels. However, the results of the Akaike information criterion (AIC) model determined that the 16-item IES-R is better than the 22-item IES-R.

CONCLUSION

The results suggested that the 22-item IES-R is a reliable screening instrument for measuring PTSD related to the COVID-19 pandemic, and can be utilized to provide timely psychological health support, when needed, based on the screening results.

An international consensus for mitigation of the detrimental effects of the COVID-19 pandemic on laparoscopic training

AIM

Achieve an international consensus on how to recover lost training opportunities. The results of this study will help inform future EAES guidelines about the recovery of surgical training before and after the pandemic.

BACKGROUND

A global survey conducted by our team demonstrated significant disruption in surgical training during the COVID-19 pandemic. This was wide-spread and affected all healthcare systems (whether insurance based or funded by public funds) in all participating countries. Thematic analysis revealed the factors perceived by trainees as barriers to training and gave birth to four-point framework of recovery. These are recommendations that can be easily achieved in any country, with minimal resources. Their implementation, however, relies heavily on the active participation and leadership by trainers. Based on the results of the global trainee survey, the authors would like to conduct a Delphi-style survey, addressed to trainers on this occasion, to establish a pragmatic step-by-step approach to improve training during and after the pandemic.

METHODS

This will be a mixed qualitative and quantitative study. Semi-structured interviews will be performed with laparoscopic trainers. These will be transcribed and thematic analysis will be applied. A questionnaire will then be proposed; this will be based on both the results of the semi structured interviews and of the global trainee survey. The questionnaire will then be validated by the steering committee of this group (achieve consensus of >80%). After validation, the questionnaire will be disseminated to trainers across the globe. Participants will be asked to consent to participate in further cycles of the Delphi process until more than 80% agreement is achieved.

RESULTS

This study will result in a pragmatic framework for continuation of surgical training during and after the pandemic (with special focus on minimally invasive surgery training).

COVID-19 Outbreak: Understanding Moral-Distress Experiences Faced by Healthcare Workers in British Columbia, Canada

Pandemic-management plans shift the care model from patient-centred to public-centred and increase the risk of healthcare workers (HCWs) experiencing moral distress (MD). This study aimed to understand HCWs' MD experiences during the COVID-19 pandemic and to identify HCWs' preferred coping strategies. Based on a qualitative research methodology, three surveys were distributed at different stages of the pandemic response in British Columbia (BC), Canada. The thematic analysis of the data revealed common MD themes: concerns about ability to serve patients and about the risks intrinsic to the pandemic. Additionally, it revealed that COVID-19 fatigue and collateral impact of COVID-19 were important ethical challenges faced by the HCWs who completed the surveys. These experiences caused stress, anxiety, increased/decreased empathy, sleep disturbances, and feelings of helplessness. Respondents identified self-care and support provided by colleagues, family members, or friends as their main MD coping mechanisms. To a lesser extent, they also used formal sources of support provided by their employer and identified additional strategies they would like their employers to implement (e.g., improved access to mental health and wellness resources). These results may help inform pandemic policies for the future.

Psychological Distress in Healthcare Workers During the Covid-19 Pandemic: Development and Validation of the Italian Version of the Healthcare Workers Emergency Distress Questionnaire (HEDQ)

Objective

The COVID-19 pandemic has presented unprecedented challenges for health systems as it has proven to be an extraordinary emergency. Exposure to such chronic stress can have detrimental effects on the psychophysical well-being of healthcare workers, with possible manifestation of stress-related symptoms. The present study aimed to develop and validate the Healthcare Workers Emergency Distress Questionnaire (HEDQ), a self-report screening questionnaire with the purpose of identifying the healthcare workers at risk for psychological and moral distress, and PTSD-related symptoms during emergencies.

Method

The HEDQ was administered to 250 healthcare workers of the AULSS 3 Serenissima and 47 citizens from the general population in Venice (Italy) during the health emergency period (from April to June 2020). In the second administration (from August to September 2020), data were collected from 101 of the 250 healthcare workers who had participated in the first administration. To test for the convergent validity, the Depression Anxiety Stress Scale (DASS-21) was also administered.

Results

Exploratory and hierarchical confirmatory factor analyses validated the 21-item structure of the questionnaire. Internal consistency, and factorial and convergent validity were good. Moreover, the HEDQ discriminated between those who worked in COVID-19 hospital units and those who did not (including the general population), showing good known-group validity. The two-month temporal stability of the questionnaire was excellent. The HEDQ scale scores significantly decreased from the first to the second administration, thus supporting that the tool is a measure of acute stress in healthcare workers.

Conclusions

Our results provide support for the use of the HEDQ as a brief, multidimensional measure of emergency-related stress reactions in healthcare workers. Consequently, the HEDQ can be considered a useful instrument supporting clinical activity to identify those who may be more easily affected by stress reactions in the event of atypically high levels of risk exposure during crises.

"The emotions were like a roller-coaster": a qualitative analysis of e-diary data on healthcare worker resilience and adaptation during the COVID-19 outbreak in Singapore

BACKGROUND

Uncertainties related to COVID-19 have strained the mental health of healthcare workers (HCWs) worldwide. Gaining the ability to adapt and thrive under pressure will be key to addressing this. We explore what characterises risk, vulnerability and resilient responses of HCWs during the early stages of the outbreak in Singapore.

METHODS

We undertook qualitative theory-guided thematic analysis of e-diary entries from HCWs who navigated the outbreak from June-August 2020. Data were extracted from a subset of an online survey of n = 3616 participants collected across 9 institutions, including restructured hospitals, hospices and affiliated primary care partners.

RESULTS

N = 663 or 18% submitted qualitative journal entries included for analyses. All professional cadres, local as well as foreign HCWs participated. Themes are reported according to the Loads-Levers-Lifts model of resilience and highlighted in italics. The model assumes that resilience is a dynamic process. Key factors threatening mental health (loading) risk included a notable rise in anxiety, the effects of being separated from loved ones, and experiencing heightened emotions and emotional overload. Bad situations were made worse, prompting vulnerable outcomes when HCWs experienced stigma in the community and effects of "public paranoia"; or under conditions where HCWs ended up feeling like a prisoner with little control or choice when either confined to staff accommodation or placed on quarantine/Stay Home Notices. Those with strife in their place of residence also described already difficult situations at work being aggravated by home life. Protection (lifts) came from being able to muster a sense of optimism about the future or feeling grateful for the pace of life slowing down and having the space to reprioritise. In contrast, when risk factors were present, balancing these in the direction of resilient outcomes was achieved by choosing to re-direct stress into positive narratives, drawing on inner agency, uptake of therapeutic activities, social support as well as faith and prayer and drawing comfort from religious community among other factors.

CONCLUSION

The Loads-Levers-Lifts model is used to guide analysis to inform intervention designs. Levers promoting resilience through targeting therapies, workplace policies and awareness campaigns accounting for identified loads are proposed.

COVID-19 pandemisinin sağlık profesyonellerinin aile ve sosyal hayatlarına etkisi

Purpose: In this study, it was aimed to evaluate the impact of the novel coronavirus-2019 (COVID-19) on the family and social lives of frontline healthcare workers during the pandemic. Materials and Methods: A total of 136 frontline healthcare workers working in COVID-19 clinics and wards, intensive care units (ICUs), and emergency units were included. A questionnaire consisting of 19 questions was applied to all participants through face-to-face interviews. The demographic and occupational characteristics and family and social lives of the participants were documented. Results: While 95 (69.9%) of the participants experienced negative consequences in their family life, 91 (66.9%) of them were found to have negative consequences in their social life. 51 of the healthcare professionals (37.5%) used spirituality as a strategy to cope with negative thoughts and emotions. During the pandemic, a statistically significant relationship was found between frontline work and family life, especially for those with children. Conclusion: The family and social lives of healthcare professionals who care for patients with Covid are adversely affected.

Depression and Insomnia of Front-Line Medical Staff During the COVID-19 Outbreak in China: An On-Line Cross-Sectional Study

Purpose

During the COVID-19 outbreak, medical staff working in high-risk workplaces had a higher rate of epidemic infection. They also faced heavy workloads and pressure, which means they are more likely to suffer from psychological problems than others. To understand the mental health of medical staff during the epidemic, we explore the characteristics of medical staff susceptible to negative psychological emotions during the outbreak of public safety and health events. At the same time, we provide corresponding prevention and intervention measures to help them relieve negative emotions, this study compared the psychological symptoms of front-line and non-front-line medical staff, then explored its influencing factors.

Methods

This research investigated 5,924 medical staff in Guangdong, Beijing, Hubei, Hainan, Jiangxi, and Henan in China. The questionnaires were released online by Questionnaire Star, and levels of depression, anxiety, insomnia, and social support were measured by Patients' Health Questionnaire Depression Scale-9 item (PHQ-9), Generalized Anxiety Disorder 7-item Scale (GAD-7), Insomnia Severity Index (ISI) and Social Support Rating Scale (SSRS).

Results

The depressive, anxious, and insomniac scores of front-line medical staff during the COVID-19 epidemic period were higher than those of non-front-line with significant differences (P &lt; 0.001). In addition, front-line nurses went through the most serious psychological problems. Age, education, and anxiety level were the influencing factors of depression and insomnia in front-line medical staff. Among them, age was a protective factor for depression (OR = 0.71 &lt;1, P = 0.001 &lt;0.05, Beta = −0.34), while educational level was a risk factor for insomnia (OR = 1.27, P = 0.02 &lt;0.05, Beta = 0.24).

Conclusions

During the epidemic, front-line medical staff would experience more serious psychological problems, especially those who were younger, less experienced, and insufficiently educated. Attention should be paid to giving them psychological assistance and psychological interventions in the future.

"It's All COVID's Fault!": Symptoms of Distress among Workers in an Italian General Hospital during the Pandemic

BACKGROUND

Since the outbreak of the COVID-19 pandemic, healthcare workers (HCWs) have been faced with specific stressors endangering their physical and mental health and their functioning. This study aimed to assess the short-term psychological health of a sample of Italian HCWs and the related influencing factors. In particular, the study focused on the differences related to HCWs' gender and to having been directly in charge of COVID-19 patients or not.

METHODS

An online survey was administered to the whole staff of the Modena General University Hospital three months after the onset of the pandemic, in 2020. Demographic data and changes in working and living conditions related to COVID-19 were collected; mental health status was assessed by the Depression, Anxiety and Stress Scale (DASS-21) and the Impact of Event Scale-Revised (IES-R).

RESULTS

1172 out of 4788 members returned the survey (response rate = 24.5%), the male/female ratio was 30/70%. Clinically significant symptoms assessed according to the DASS-21 emerged among 21.0% of the respondents for depression, 22.5% for anxiety and 27.0% for stress. Symptoms suggestive of a traumatic reaction were reported by 19.0% of the sample. Symptoms of psychological distress were statistically associated with female gender, job role, ward, changes in lifestyle, whereas first-line work with COVID-19 patients was statistically associated with more stress symptoms. HCWs reported a significant level of psychological distress that could reach severe clinical significance and impact dramatically their quality of life and functioning.

CONCLUSIONS

Considering the persistence of the international emergency, effective strategies to anticipate, recognize and address distress in HCWs are essential, also because they may impact the organization and effectiveness of healthcare systems.

Psychological impact of the COVID-19 pandemic on hospital workers in Kobe: A cross-sectional survey

Aim

Many health-care workers exposed to coronavirus disease 2019 (COVID-19) are psychologically distressed. This study aimed to investigate the psychological impact of the COVID-19 pandemic on hospital workers under the emergency declaration in Japan.

Methods

This cross-sectional, survey-based study collected sociodemographic data and responses to 19 stress-related questions and the Impact of Event Scale-Revised (IES-R), which measures post-traumatic stress disorder (PTSD) symptoms, from all 3217 staff members at Kobe City Medical Center General Hospital from April 16, 2020 to June 8, 2020. Exploratory factor analysis was applied to the 19 stress-related questions. Multiple regression models were used to evaluate the association of personal characteristics with each score of the four factors and the IES-R.

Results

We received 951 valid responses; 640 of these were by females, and 311 were by respondents aged in their 20s. Nurses accounted for the largest percentage of the job category. Women, those aged in their 30s-50s, nurses, and frontline workers had a high risk of experiencing stress. The prevalence of stress (IES-R ≥ 25) was 16.7%. The psychological impact was significantly greater for those aged in their 30s-50s and those who were not medical doctors.

Conclusions

This is the first study to examine the stress of hospital workers, as measured by the IES-R, under the emergency declaration in Japan. It showed that women, those aged in their 30s-50s, nurses, and frontline workers have a high risk of experiencing stress. Health and medical institutions should pay particular attention to the physical and psychological health of these staff members.

Pandemics and the Impact on Physician Mental Health: A Systematic Review

Physician mental health is a major area of concern with physician burnout on the rise, while at the same time pandemics are becoming more frequent and serious in nature. This combination of physician burnout and pandemics has the potential for serious negative implications for physicians, patients, and health care organizations. Thus, we conduct a systematic review that examines the effect of pandemics on physician mental health using the burnout cascade as a framework. We identified 30 quantitative studies for inclusion. We find that Stages 4 and 5 of the burnout cascade are particularly troublesome with physicians experiencing high levels of anxiety and depression. Furthermore, we find in the degradation phase that physicians experience stigma which may intensify other negative effects. Physicians who are women, younger, and have less training are more susceptible to the negative effects of pandemics. We discuss overall implications and recommendations for future research.

Do digital competencies and social support boost work engagement during the COVID-19 pandemic?

In today's world of work, the need for digital communication and collaboration competencies became even more prevalent during the ongoing COVID-19 pandemic. Yet, research and practice are lacking solid measurement instruments assessing digital communication and collaboration competencies of workers so far. Furthermore, it is yet unknown if digital communication and collaboration competencies and other so far known resources indeed act as drivers of work engagement during the pandemic. Based on the Job Demands-Resources (JD-R) model and the conservation of resources theory, we hypothesized that personal (digital communication and collaboration competencies) and job (social support) resources positively influence each other over time, also boosting work engagement. In a cross-lagged study design during the pandemic, we investigated our hypotheses in a sample of German workers (N = 231). Against our expectations, we did not find support for effects from personal or job resources on work engagement over time or effects of the resources influencing each other. Instead, we found high stabilities of digital communication and collaboration competencies and work engagement. Our results provide important insights into the motivational process of individuals working during a pandemic. The theoretical and practical implications for the JD-R model in times of crisis are discussed.

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.

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.

Psychological symptoms and related risk factors among healthcare workers and medical students during the early phase of the COVID-19 pandemic in Japan

Aim

The aim of this study was to investigate the mental health status of healthcare workers and medical students during the early phase of the COVID-19 pandemic.

Methods

An online questionnaire was administered to 637 students and 3189 healthcare workers from May to July, 2020. The patient healthcare questionnaire-9 (PHQ-9) and state anxiety (A-State) of the state-trait anxiety inventory-form (STAI) were used to assess depression and anxiety symptoms, respectively. Individuals were categorized into severe (15 or higher) depression and severe (50-51 or higher) anxiety groups.

Results

Healthcare workers and those taking care of COVID-19 patients had a higher risk of severe depression (PHQ-9 scores >15) than other comparison groups. Students and men also had a higher risk of severe anxiety (STAI > 50-51). Multivariable logistic regression analysis showed that healthcare workers had a fivefold higher risk of developing severe depression symptoms (adjusted odds ratio [OR] = 4.99, confidence interval [CI] 2.24-5.97, P-value < 0.001) and those taking care of COVID-19 patients had 2.8-fold higher risk of developing severe depression symptoms (OR 2.75, CI 1.36-5.53, P-value = 0.005).

Conclusion

Both medical students and healthcare workers have been experiencing depression and anxiety symptoms during the first wave of the pandemic. Our findings showed a high rate of severe anxiety symptoms in medical students and a high rate of severe depression symptoms in healthcare workers. Those who treated COVID-19 patients were at greater risk of developing major depressive disorder than those who treated non-COVID-19 patients.

Prevalence of psychological outcomes and its associated factors in healthcare personnel working during COVID-19 outbreak in India

BACKGROUND

Care of COVID-19 patients has been shown to affect the mental health of healthcare personnel (HCP), however, there is little data reflecting psychological health of HCP in India.

AIMS

The present study was undertaken to assess the prevalence of psychological outcomes and its association with various sociodemographic and occupational factors among the HCP in India.

METHODOLOGY

A cross-sectional, online survey, using snowball sampling method was conducted between June 1, 2020, and June 22, 2020. The HCP working in COVID-19 designated hospitals across India were invited to participate. Patient Health Questionnaire-4 and 19-item stress-related questionnaire were used to evaluate symptoms of overall anxiety, depression, COVID-19 infection specific anxiety, exhaustion, and workload.

RESULTS

In this cross-sectional study with 2334 HCP from 27 states and 7 union territories of India; 17.9% of participants had depression, 18.7% had overall anxiety, 26.5% had exhaustion, 30.3% reported heavy workload, and 25.4% had COVID-19 infection-specific anxiety, respectively. The HCP working in states with higher caseload was a common risk factor for overall anxiety (odds ratio [OR], 1.7; P < 0.001), depression (OR, 1.6; P < 0.001), COVID-19 infection-specific anxiety (OR, 2.5; P < 0.001), exhaustion (OR, 3.1; P < 0.001), and heavy workload (OR, 2.6; P < 0.001). Nurses were more at risk for depression (OR, 2.2; P < 0.001), anxiety specific to COVID-19 infection (OR, 1.3; P = 0.034), and heavy workload (OR, 2.9; P < 0.001); while doctors were more at risk for overall anxiety (OR, 2.0; P = 0.001) and exhaustion (OR, 3.1; P < 0.001).

CONCLUSIONS

Frontline workers, specifically nurses and doctors, and those working in states with high COVID-19 caseload are more at risk for adverse psychological outcomes. The relatively less prevalence compared with other countries, is perhaps a reflection of measures undertaken, including early lockdown, ensuring better all-round preparedness and social norms.

The impact of the COVID-19 pandemic on the mental health of medical staff considering the interplay of pandemic burden and psychosocial resources-A rapid systematic review

BACKGROUND

In times of the global corona pandemic health care workers (HCWs) fight the disease at the frontline of healthcare services and are confronted with an exacerbated load of pandemic burden. Psychosocial resources are thought to buffer adverse effects of pandemic stressors on mental health. This rapid review summarizes evidence on the specific interplay of pandemic burden and psychosocial resources with regard to the mental health of HCWs during the COVID-19 pandemic. The goal was to derive potential starting points for supportive interventions.

METHODS

We conducted a rapid systematic review following the recommendations of the Cochrane Rapid Reviews Methods Group. We searched 7 databases in February 2021 and included peer-reviewed quantitative studies, that reported related data on pandemic stressors, psychosocial resources, and mental health of HCWs.

RESULTS

46 reports were finally included in the review and reported data on all three outcomes at hand. Most studies (n = 41) applied a cross-sectional design. Our results suggest that there are several statistically significant pandemic risk factors for mental health problems in HCWs such as high risk and fear of infection, while resilience, active and emotion-focused coping strategies as well as social support can be considered beneficial when protecting different aspects of mental health in HCWs during the COVID-19 pandemic. Evidence for patterns of interaction between outcomes were found in the context of coping style when facing specific pandemic stressors.

CONCLUSIONS

Our results indicate that several psychosocial resources may play an important role in buffering adverse effects of pandemic burden on the mental health of HCWs in the context of the COVID-19 pandemic. Nevertheless, causal interpretations of mentioned associations are inadequate due to the overall low study quality and the dominance of cross-sectional study designs. Prospective longitudinal studies are required to elucidate the missing links.

Interventional Response of Hospital and Health Services to the Mental Health Effects of Viral Outbreaks on Health Professionals

The aim of this integrative review was to examine the impact of past viral epidemics on staff mental health interventional responses, with a specific focus on healthcare provider response in the context of the COVID-19 pandemic. Following PRISMA methodology, databases were searched for relevant articles. A total of 55 articles with a range of methodologies (e.g., commentary papers, cohort studies, qualitative studies) were included to ensure broad coverage of this rapidly emerging research area. The literature showed that many healthcare providers implemented a variety of wellbeing initiatives to support their staff during a viral outbreak. Most of these interventions, however, were not formally evaluated. Interventions included leadership/team support; online psychoeducational resources and updated information on the pandemic; respite spaces; peer support outreach; staff resilience training; telephone hotline support; staff support groups; and individual counseling. Staff were generally supportive of the initiatives offered by hospital and health services, with certain interventions being more appreciated (e.g., staff respite areas). Rapid, locally, and culturally appropriate workplace-based responses may counter the negative mental health impact on staff; but a stepped response is required for a smaller number of staff at risk of mental illness, or those with pre-existing mental illness. Systematic Review Registration: Unique Identifier: CRD42020222761.

The Perceived Risk of Being Infected with COVID-19 at Work, Communication, and Employee Health: A Longitudinal Application of the Job Demands–Resources Model

The perceived risk of being infected at work (PRIW) with COVID-19 represents a potential risk factor for workers during the current COVID-19 pandemic. In line with the job demands–resources (JD-R) model in the context of safety at work, in this longitudinal study we propose that PRIW can be conceptualized as a job demand (JD), whereas communication (i.e., the exchange of good-quality information across team members) can be conceived of as a job resource (JR). Accordingly, we hypothesize that PRIW at Time 1 (T1) would positively predict psychophysical strain at Time 2 (i.e., four months later), and that communication at T1 would negatively predict psychophysical strain at T2. Overall, 297 workers participated in the study. The hypothesized relationships were tested using multiple regression analysis. The results support our predictions: PRIW positively predicted psychophysical strain over time, whereas communication negatively predicted psychophysical strain over time. The results did not change after controlling for age, gender, and type of contract. Overall, this study suggests that PRIW and communication might be conceived of as a risk and a protective factor for work-related stress, respectively. Hence, to promote more sustainable working conditions, interventions should help organizations to promote an adequate balance between JDs and JRs related to COVID-19.

A cross-sectional study of the psychological status of 33,706 hospital workers at the late stage of the COVID-19 outbreak

BACKGROUND

Hospital workers have been under intense psychological pressure since the COVID-19 outbreak. We analyzed the psychological status of hospital staff in the late period of the COVID-19 to provide a basis for the construction of global health care after the COVID-19 outbreak.

METHODS

We used online surveys to assess participants' self-reported symptoms at the late stage of the outbreak. This study collected data on sociodemographic characteristics, epidemic-related factors, psychological status (PHQ-9, GAD-7, and PHQ-15), psychological assistance needs, perceived stress and support, PTSD symptoms (PCL-C) and suicidal and self-injurious ideation (SSI). Participants were hospital workers in all positions from 46 hospitals. Chi-square tests to compare the scales and logistic regression analysis were used to identify risk factors for PTSD and SSI.

RESULTS

Among the 33,706 participants, the prevalences of depression, anxiety, somatic symptoms, PTSD symptoms, and SSI were 35.8%, 24.4%, 49.7%, 5.0%, and 1.3%, respectively. Logistic regression analysis showed that work in a general ward, attention to the epidemic, high education, work in non-first-line departments, insufficient social support, and anxiety and somatization symptoms were influencing factors of PTSD (P<0.05). The independent risk factors for SSI were female gender; psychological assistance needs; contact with severe COVID-19 patients; high stress at work; single or divorced marital status; insufficient social support; and depression, anxiety or PTSD symptoms (P<0.05).

LIMITATIONS

This cross-sectional study could not reveal causality, and voluntary participation may have led to selection bias. The longer longitudinal studies are needed to determine the long-term psychological impact.

CONCLUSION

This COVID-19 pandemic had a sustained, strong psychological impact on hospital workers, and hospital workers with PTSD symptoms were a high-risk group for SSI in the later period of the epidemic. Continuous attention and positive psychological intervention are of great significance for specific populations.

COVID-19 pandemic: the impact on Canada’s intensive care units

The COVID-19 pandemic has exposed the precarious demand-capacity balance in Canadian hospitals, including critical care where there is an urgent need for trained health care professionals to dramatically increase ICU capacity.

The impact of the pandemic on ICUs varied significantly across the country with provinces that implemented public health measures later and relaxed them sooner being impacted more severely. Pediatric ICUs routinely admitted adult patients. Non-ICU areas were converted to ICUs and staff were redeployed from other essential service areas. Faced with a lack of critical care capacity, triage plans for ICU admission were developed and nearly implemented in some provinces.

Twenty eight percent of patients in Canadian ICUs who required mechanical ventilation died. Surviving patients have required prolonged ICU admission, hospitalization and extensive ongoing rehabilitation. Family members of patients were not permitted to visit, resulting in additional psychological stresses to patients, families, and healthcare teams. ICU professionals also experienced extreme psychological stresses from caring for such large numbers of critically ill patients, often in sub-standard conditions. This resulted in large numbers of health workers leaving their professions.

This pandemic is not yet over, and it is likely that new pandemics will follow. A review and recommendations for the future are provided.

What Can We Learn From the Past? Pandemic Health Care Workers' Fears, Concerns, and Needs: A Review

BACKGROUND

Health care workers (HCWs) have been engaged in fighting dangerous epidemics for hundreds of years, more recently in severe acute respiratory syndrome, H1N1, Middle East respiratory syndrome, and now coronavirus disease 2019. A consistent feature of epidemic disease results is that health care systems and HCWs are placed under immense strain.

METHODS

A focused narrative review was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to examine the main concerns and anxieties faced by HCWs during recent epidemics and to determine the supports deemed most important to those HCWs to keep them at the frontline. PubMed, Web of Science, and the Cochrane Library were searched in March 2020 using terms "Healthcare" OR "Medical" AND "Staff" OR "Workers" OR "Front line" AND "Concerns" OR "Anxiety" OR "Stress" AND "Pandemic" Or "Epidemic."

RESULTS

Twenty-five studies that reported the concerns and expectations of an estimated 13,793 HCWs in 10 countries (Canada, China, Greece, Hong Kong, Japan, Liberia, Netherlands, Saudi Arabia, Singapore and Taiwan) during pandemic situations were identified. Health care workers identified personal and family safety, appreciation, and the provision of personal protective equipment and adequate rest as primary concerns. Informal psychological supports were favored over formal employment-based group interventions.

DISCUSSION

Despite being hailed by the media as heroes, HCWs face social stigmatization and experienced high levels of anxiety and fear regarding personal safety and the health of their colleagues and family. Health care workers are more likely to seek peer-to-peer psychological support but also benefit from knowing that formal psychological supports are available to them.

Mental Health Differences in Healthcare Workers Exposed to Different Risks During the Coronavirus Disease 2019 Pandemic

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic has caused a significant impact on the physical and mental health of healthcare workers. This study assessed the psychological status of healthcare workers who were exposed to different risk-levels in China and explored the factors that affected their mental health.

METHODS

Demographic, occupational characteristics, and mental health measurements were collected from 810 workers in 41 hospitals in China, through online questionnaires from February 11 to March 3, 2020. The degree of symptoms for fatigue, anxiety, and insomnia were assessed using the Chinese versions of the Fatigue Severity Scale, 7-item Generalized Anxiety Disorder Scale, and Insomnia Severity Index, respectively. Binary logistic regression analysis was performed to identify factors associated with mental health symptoms.

RESULTS

All 810 participants completed the relevant questionnaires without missing data. The prevalence of fatigue, anxiety, and insomnia symptoms was 74.3, 73.7, and 61.7%, respectively. Nurses, women, and workers exposed to high-risk areas were more likely to report mental health problems (P < 0.05). After controlling for confounders, exposure to high-risk areas was independently associated with increased symptoms of fatigue, anxiety, and insomnia (fatigue among high-risk areas: OR, 3.87; 95% CI, 2.26-6.61; P < 0.001; anxiety among high-risk areas: OR, 2.66; 95% CI, 1.58-4.51; P < 0.001; insomnia among high-risk areas: OR, 2.83; 95% CI, 1.68-4.79, P < 0.001).

CONCLUSION

The study demonstrated significant differences in psychological symptoms among healthcare workers exposed to different levels of risk, and those in high-risk areas were more vulnerable to experiencing mental health symptoms. These findings emphasize the importance of giving due attention to healthcare workers, especially women, nurses, and those working in high-risk settings during the COVID-19 pandemic.

Stressors, self-reported overall health, potential protective factors and the workplace well-being of nurses during the COVID-19 pandemic in Switzerland: a longitudinal mixed-methods study protocol

INTRODUCTION

The COVID-19 pandemic was making a huge impact on Europe's healthcare systems in the spring of 2020, and most predictive models concurred that pandemic waves were in the offing. Most studies adopted a pathogenic approach to the subject; few used a salutogenic approach. These showed, however, that nurses can retain their health despite a pandemic by mobilising generalised resistance resources. Our study aims to understand how nurses working in Switzerland's hospitals protected their health and workplace well-being during the COVID-19 pandemic by investigating the moderating effects of the health resources they mobilised against the stressors inherent to the situation. The study aims to explore and describe the stressors and the resources nurses used to remain healthy during the COVID-19 pandemic.

METHOD AND ANALYSIS

We will use a concurrent mixed-methods panel design with qualitative analyses ancillary to quantitative analyses. Quantitative data will be collected using electronic questionnaires at four time points over 2 years. Qualitative data will be collected using focus groups. Nurses from Switzerland's two main linguistic regions who had direct, indirect or no contact with patients with COVID-19 will be invited to participate. The a priori sample size will be at least 3631 participants at T0 and 1852 at T4. Longitudinal structural equation modelling and knowledge mapping will be used to analyse quantitative and qualitative data, respectively. The results derived from the two data types will then be compared and discussed using a side-by-side approach to determine whether they agree or disagree and how they complement each other to achieve our aims.

ETHICS AND DISSEMINATION

Nurses will receive an electronic informed consent form. The data collected will be stored on a secure server at the authors' institution. This research project was approved by the Human Research Ethics Committee of the Canton of Vaud (2020-02845).