Interventions to support the mental health and well-being of front-line healthcare workers in hospitals during pandemics: an evidence review and synthesis

Development, implementation and usefulness of an intervention to support psychological resilience during the COVID-19 pandemic: a study from a Swedish hospital based on interviews, documents and a survey

OBJECTIVES

A range of interventions to support psychological resilience among healthcare workers were provided in hospitals during the COVID-19 pandemic. Most research has focused on the content and experience of these interventions, but less is known about their implementation. The aim of this study was to increase understanding of the development, implementation and perceived usefulness of an intervention to support psychological resilience among healthcare workers at a Swedish hospital during the pandemic.

DESIGN

This study employs interviews and documents to explore the development and implementation of support activities and a survey to assess the usefulness of the activities (on a scale from 1 to 5). Qualitative content analysis was used to analyse the interview data and documents. Descriptive statistics were used to analyse the survey data.

SETTINGS

A tertiary hospital in the outskirts of Region Stockholm.

PARTICIPANTS

Eight individual interviews were conducted with actors involved in developing the intervention. 286 healthcare workers answered the survey.

RESULTS

Support activities were developed and implemented by an internal multidisciplinary group who continuously identified and adapted activities to the needs of staff. The strategy of involving existing resources to jointly develop and continuously adapt staff support activities was beneficial for the implementation and longevity of the intervention. Scheduling difficulties were one of the challenges. The mean ratings of the activities ranged from 2.27 for one-on-one counselling to 3.25 for physical activity. Licensed practical nurses generally valued the activities higher than other professional groups.

CONCLUSIONS

The provision of activities to support psychological resilience in a crisis is facilitated by the ability of an organisation to use current resources in the face of a crisis, which is a sign of organisational resilience. Leaders who act quickly and create the conditions to test and learn under uncertainty can contribute to developing effective responses to a crisis.

Promoting workplace retention during global crises: An international survey of the preventive role of psychological support among victims of social discrimination in long-term care facilities

This international cross-sectional survey examined the potential role of organizational psychological support in mitigating the association between experiencing social discrimination against long-term care (LTC) facilities' healthcare professionals (HCPs) and their intention to stay in the current workplace during the COVID-19 pandemic. Participants included a convenience sample of 2,143 HCPs (nurses [21.5 %], nurse aids or residential care workers [40.1 %], social workers [12.1 %], and others [26.4 %]) working at 223 LTC facilities in 13 countries/regions. About 37.5 % of the participants reported experiencing social discrimination, and the percentage ranged from 15.3 % to 77.9 % across countries/regions. Controlling for socio-demographic and work-related variables, experiencing social discrimination was significantly associated with a lower intention to stay, whereas receiving psychological support showed a statistically significant positive association (p-value=0.015 and <0.001, respectively). The interaction term between social discrimination and psychological support showed a statistically significant positive association with the intention to stay, indicating a moderating role of the psychological support.

Culture, conditions and care support mental health of healthcare workers during crises

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic has presented immense challenges to health systems worldwide and significantly impacted the mental health of frontline healthcare workers.

AIMS

This study drew on the experiences of frontline healthcare workers to examine organizational strategies needed to support the mental health and well-being of healthcare workers during times of crisis.

METHODS

Semi-structured focus groups or individual interviews were conducted with healthcare workers to examine their perspectives on organizational strategies for enhancing staff mental health and well-being during crises. Data were analysed thematically. Following this, evidence for the identified strategies was reviewed to assess alignment with participant views and recommendations.

RESULTS

Thirty-two healthcare workers from diverse disciplines (10 allied health, 11 nursing, 11 medical) participated in the study. Data analysis identified three broad themes contributing to supporting mental health and well-being. These themes can be encapsulated as the 'Three Cs'-culture (building an organizational culture that prioritizes mental health); conditions (implementing proactive organizational strategies during crises) and care (ensuring fit-for-purpose strategies to support mental health and well-being).

CONCLUSIONS

Study findings underscore the necessity of an integrated and systemic organizational approach to address mental health and well-being in the healthcare workplace. This approach must be long term with the components of the 'Three Cs', particularly cultural change and conditions, viewed as a part of a suite of strategies to ensure crisis preparedness. It is imperative that organizations collaborate with their staff, providing support and fostering a safe and inclusive work environment that ultimately benefits patients, their care and staff well-being.

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

Introduction

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

Objectives

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

Materials and methods

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

Results

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

Conclusion

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

Alexithymia, Burnout, and Hopelessness in a Large Sample of Healthcare Workers during the Third Wave of COVID-19 in Italy

In the present study, we aimed to assess the frequency of and the relationships between alexithymia, burnout, and hopelessness in a large sample of healthcare workers (HCWs) during the third wave of COVID-19 in Italy. Alexithymia was evaluated by the Italian version of the 20-item Toronto Alexithymia Scale (TAS-20) and its subscales Difficulty in Identifying Feelings (DIF), Difficulty in Describing Feelings (DDF), and Externally Oriented Thinking (EOT), burnout was measured with the scales emotional exhaustion (EE), depersonalisation (DP), and personal accomplishment (PA) of the Maslach Burnout Test (MBI), hopelessness was measured using the Beck Hopelessness Scale (BHS), and irritability (IRR), depression (DEP), and anxiety (ANX) were evaluated with the Italian version of the Irritability' Depression' Anxiety Scale (IDA). This cross-sectional study recruited a sample of 1445 HCWs from a large urban healthcare facility in Italy from 1 May to 31 June 2021. The comparison between individuals that were positive (n = 214, 14.8%) or not for alexithymia (n = 1231, 85.2%), controlling for age, gender, and working seniority, revealed that positive subjects showed higher scores on BHS, EE, DP IRR, DEP, ANX, DIF, DDF, and EOT and lower on PA than the not positive ones (p < 0.001). In the linear regression model, higher working seniority as well as higher EE, IRR, DEP, ANX, and DDF scores and lower PA were associated with higher hopelessness. In conclusion, increased hopelessness was associated with higher burnout and alexithymia. Comprehensive strategies should be implemented to support HCWs' mental health and mitigate the negative consequences of alexithymia, burnout, and hopelessness.

Canadian healthcare workers' mental health and health behaviours during the COVID-19 pandemic: results from nine representative samples between April 2020 and February 2022

OBJECTIVE

In the context of COVID-19, Canadian healthcare workers (HCWs) worked long hours, both to respond to the pandemic and to compensate for colleagues who were not able to work due to infection and burnout. This may have had detrimental effects on HCWs' mental health, as well as engagement in health-promoting behaviours. This study aimed to identify changes in mental health outcomes and health behaviours experienced by Canadian HCWs throughout the COVID-19 pandemic.

METHODS

Nine representative samples (Ntotal = 1615 HCWs) completed the iCARE survey using an online polling firm between April 2020 (Time 1) and February 2022 (Time 9). Participants were asked about the psychological effects of COVID-19 (e.g., feeling anxious) and about changes in their health behaviours (e.g., alcohol use, physical activity).

RESULTS

A majority of the HCWs identified as female (65%), were younger than 44 years old (66%), and had a university degree (55%). Female HCWs were more likely than male HCWs to report feeling anxious (OR = 2.68 [1.75, 4.12]), depressed (OR = 1.63 [1.02, 2.59]), and irritable (OR = 1.61 [1.08, 2.40]) throughout the first two years of the pandemic. Female HCWs were more likely than their male counterparts to report eating more unhealthy diets (OR = 1.54 [1.02, 2.31]). Significant differences were also revealed by age, education level, income, parental status, health status, and over time.

CONCLUSION

Results demonstrate that the impacts of COVID-19 on HCWs' mental health and health behaviours were significant, and varied by sociodemographic characteristics (e.g., sex, age, income).

Psychological symptoms and correlates of Chinese healthcare professionals in the intensive care unit before and after the COVID-19 outbreak: A comparison of two cross-sectional studies

BACKGROUND

The outbreak of COVID-19 disarranged lives across mainland China. No study has examined changes in psychological symptoms of healthcare professionals in the intensive care unit (ICU) before and after the outbreak of COVID-19. The aim of this study was to estimate changes in psychological symptoms of ICU healthcare professionals before and after the COVID-19 outbreak, and to analyze factors related to psychological symptoms.

METHODS

Two waves' administrations were implemented between December 13 and December 14, 2018, and between April 5 and April 7, 2020, respectively. The symptom checklist-90 (SCL-90) were used to evaluate psychological symptoms. Multiple logistical regression was used to reveal the risk of psychological symptoms.

RESULTS

A total of 3902 and 3908 ICU healthcare professionals took part in the first and second surveys. The mean total score of the SCL-90 was 179.27 (70.02) at wave 1 and 147.75 (58.40) at wave 2, respectively. The proportion of psychological symptoms was 55.6 % (95%CI = 54.0-57.1) at wave 1. But rates of psychological symptoms decreased to 36.6 % (95%CI = 35.1-38.2) at wave 2. ICU healthcare professionals with western economic belt and 6-10 years of work were more likely to develop psychological symptoms, while ICU healthcare professionals with the later survey and doctoral degree were less likely to develop psychological symptoms.

CONCLUSION

Although COVID-19 period benefited psychological symptoms of ICU healthcare professionals, psychological symptoms still had a related high prevalence. Regular screening and appropriate interventions should still be implemented to decrease the risk for psychological symptoms among Chinese ICU healthcare professionals.

Psychosoziale Belastung und psychosoziale Unterstützung für Fachkräfte im Gesundheitswesen während der COVID-19-Pandemie

Hintergrund

Ausgangspunkt der Studie ist die hohe psychosoziale Belastung von Fachkräften im Gesundheitswesen bei gleichzeitig geringer Inanspruchnahme eines Beratungs- und Unterstützungsangebots für Mitarbeiter*innen einer Universitätsklinik während der COVID-19-Pandemie.

Ziel der Arbeit

Die vorliegende Studie untersucht den Grad des psychosozialen Belastungserlebens von Fachkräften im Gesundheitswesen (n = 859) einer Universitätsklinik sowie Kenntnis, Inanspruchnahme und Bewertung innerbetrieblicher psychosozialer Versorgungsstrukturen.

Material und Methoden

Im Rahmen einer Online-Befragung (21.07.–19.10.2021) wurden die subjektiv empfundene Belastung durch die COVID-19-Pandemie, Depressivität (PHQ-8) des Personals sowie Kenntnis, Inanspruchnahme und Bewertung möglicher Versorgungsangebote der Universitätsklinik erhoben. Zusätzlich wurden qualitative Daten zu Informationsquelle, -vermittlung sowie Art der Kontaktaufnahme der innerbetrieblichen Versorgungsstrukturen erhoben.

Ergebnisse

Trotz hoher psychosozialer Belastung und überwiegender Kenntnis der Existenz innerbetrieblicher psychosozialer Versorgungsangebote ist deren Inanspruchnahme bei Fachkräften im Gesundheitswesen gering. Insbesondere der Kontakt zu Patient*innen stellte einen Risikofaktor für das psychosoziale Belastungserleben dar. Die qualitative Analyse zeigt, dass die Mitarbeiter*innen mehr über E‑Mails und Newsletters informiert werden möchten sowie eine übersichtliche Darstellung der Angebote vermissen.

Diskussion

Eine Überarbeitung der Angebotsdarstellung und Kontaktwege gemäß den Wünschen des Personals könnte die Inanspruchnahme innerbetrieblicher Angebote verbessern.

Increasing access to mental health supports for healthcare workers during the COVID-19 pandemic and beyond through a novel coaching program

The COVID-19 pandemic led to heightened anxiety, distress, and burnout among healthcare workers and faculty in academic medicine. Penn Medicine launched Coping First Aid (CFA) in March 2020 in response to the pandemic. Informed by Psychological First Aid principles and therapeutic micro skills, CFA was designed as a tele-mental healthcare service for health system employees and their families delivered by trained lay volunteer coaches under the supervision of licensed mental health clinicians. We present an overview of the model, feasibility and utilization data, and preliminary implementation and effectiveness outcomes based on cross sectional coach (n = 22) and client (n = 57) self-report surveys with a subset of program users in the first year. A total of 44 individuals completed training and were certified to coach. Over the first 24 months of the program, 513 sessions occurred with 273 clients (119 sessions were no-shows or canceled). Follow-up appointments were recommended in 52.6% (n = 270) of sessions and 21.2% (n = 109) of clients were referred for professional mental health care. Client survey respondents reported CFA was helpful; 60% were very or extremely satisfied, and 74% indicated they would recommend the program. Our preliminary findings suggest that CFA was feasible to implement and most clients found the service beneficial. CFA provides a model for rapidly developing and scaling mental health supports during and beyond the pandemic.