A Study of Basic Needs and Psychological Wellbeing of Medical Workers in the Fever Clinic of a Tertiary General Hospital in Beijing during the COVID-19 Outbreak

Efficacy of the my health too online cognitive behavioral therapy program for healthcare workers during the COVID-19 pandemic: A randomized controlled trial

Background

Healthcare workers' mental health has been impacted by the COVID-19 pandemic, emphasizing the need for mental health interventions in this population. Online cognitive behavioral therapy (CBT) is efficient to reduce stress and may reach numerous professionals. We developed "MyHealthToo", an online CBT program to help reduce stress among healthcare workers during the COVID-19 pandemic.

Objective

The aim of our study is to investigate the efficacy of an online CBT program on stress and mental health conditions among healthcare workers during a health crisis.

Methods

We performed a multicentric randomized controlled trial among 155 participants allocated either to the experimental or active control group (bibliotherapy). The primary outcome was the decrease of perceived stress scores (PSS-10) post-treatment. Secondary outcomes included depression, insomnia and PTSD symptoms along with self-reported resilience and ruminations. Assessments were scheduled pretreatment, mid-treatment (4 weeks), post-treatment (8 weeks), and at 1-month and 4-months follow-up.

Results

For both interventions, mean changes on the PSS-10 were significant post-therapy (W8), as at 1-month (W12) and 4-months (W24) follow-ups. The between-group comparison showed no difference at any time point (ps > 0.88). Work-related ruminations significantly decreased in the experimental group with a significant between-group difference at W8 (Δ = -1.83 [-3.57; -0.09], p = 0.04). Posttraumatic stress symptoms significantly decreased in the experimental group with a significant between-group difference at W12 (Δ = -1.41 [-2.68; -0.14], p = 0.03). The decrease in work-related ruminations at W8 mediated the decrease in posttraumatic stress symptoms at W12 (p = 0.048).

Conclusion

The "MyHealthToo" online CBT intervention may help reduce ruminations about work and posttraumatic stress symptoms among healthcare workers during a major health crisis. Work-related ruminations may represent a relevant target of online interventions to improve mental health among healthcare workers.

Signs of front-line healthcare professionals' information anxiety during the COVID-19 pandemic: Grounded theory study in a Wuhan hospital

AIM

Being front-line healthcare professionals is associated with possible severe information anxiety during the COVID-19 pandemic. Investigating signs of information anxiety is the first and key step of its targeted medical intervention. This study aims to explore the signs of front-line healthcare professionals' information anxiety during the COVID-19 pandemic.

DESIGN

This study is qualitative research. Grounded theory was used to classify information anxiety signs of front-line healthcare professionals.

METHODS

Twenty-four front-line healthcare professionals from a general hospital with over 5000 beds in Wuhan were recruited to participate in semi-structured interviews. According to the frequency and frequency variation of signs appearing in interviews, the trends of signs during the virus encounter, lockdown, flattening and second wave were compared. Based on the interviews, those signs that were conceptually related to each other were extracted to construct a conceptual model.

RESULTS

Psychological signs (emotion, worry, doubt, caution, hope), physical signs (insomnia, inattention, memory loss, appetite decreased) and behavioural signs (panic buying of goods, be at a loss, pay attention to relevant information, change habits) could be generalized from 13 subcategories of information anxiety signs. Psychological signs were the most in every period of the pandemic. Furthermore, psychological signs decreased significantly during lockdown, while behavioural and physical signs increased. Finally, severe psychological and behavioural signs were associated with physical signs.

Impact of the COVID-19-pandemic and perception of self-efficacy on the mental health of out-of-hospital emergency healthcare professionals by modality of care

OBJECTIVE

To analyse the influence of the COVID-19 pandemic and the perception of self-efficacy on the health professionals of the Spanish out-of-hospital emergency services.

DESIGN

Observational, cross-sectional and descriptive with a survey methodology of 1710 participants from Spain (1 February-30 April, 2021).

METHODS

The mental health of healthcare workers was assesed in terms of stress, anxiety and depression, as well as their self-efficacy. Linear and logistic regression models were fitted to predict these variables. A moderation analysis was conducted to determine the effect of self-efficacy on mental health.

RESULTS

The means of the sample for stress, anxiety, depression and self-efficacy were 20.60, 15.74, 13.07 and 70.87, respectively. In the regression models, being a woman was the most significant factor for severe mental health impairment. Female gender was also a relevant factor for self-efficacy. Self-efficacy had a direct effect on the mental health for working in patient care.

CONCLUSIONS

Healthcare workers showed moderate stress, severe anxiety, mild depression and good self-efficacy. Direct patient care was associated with more stress and severe anxiety. Age, female gender, job changes and job adjustment were associated with levels of stress, anxiety and depression. Self-efficacy is a determining factor of mental health in the direct care modality.

IMPLICATIONS

The mental health of healthcare workers has been of great importance in the aftermath of the pandemic, but out-of-hospital emergency workers have been neglected in research. The levels of stress, anxiety and depression during the pandemic justify the creation of prevention and early diagnosis programmes, as they are essential in a health disaster. Surprisingly, their high level of perceived self-efficacy directly impact on the mental health of patient helthcare workers, so improving it will reduce the psychological risk.

REPORTING METHOD

We have followed the STROBE guidelines. It has been partially funded by the Asistencia Sanitanitaria Interprovincial de Seguros - ASISA Foundation (Spain). PATIENT OR PUBLIC CONTRIBUTION: 'No patient or public involvement'.

Work Experience of Intensive Care Nurses during the Period of the Pandemic: A Qualitative Study

This study was conducted to describe the working experiences, feelings, and thoughts of nurses working in the intensive care unit (ICU) during the COVID-19 pandemic from their perspective. Empirical phenomenological approach, one of the qualitative study methods, was used to obtain detailed descriptions of the experiences of nurses working in the ICU during the COVID-19 outbreak in providing patient care. The research design is an in-depth interview technique. The Colaizzi method was used in the analysis of the interviews. The data obtained from the research were categorized in six main themes. These themes are as follows: backbone of the health system-nursing, professional achievements, difficulties encountered, support needs and expectations, changes in emotions, and private life. In the process of fighting the pandemic, ICU nurses undertook important responsibilities, quickly adapted to the crisis, and displayed a strong stance, thus carrying a huge burden within the healthcare system.

COVID-19 "Nightmare": Perceived Stress, Emotional Distress, and Burnout Syndrome among Medical Staff after One Year of the COVID-19 Pandemic

(1) After one year of treating patients with SARS-CoV-2 infection, physical exhaustion is added to emotional stress and burnout syndrome. (2) By applying specific questionnaires, we evaluated healthcare workers who handled patients infected with SARS-CoV-2in terms of disease perception, perceived stress, emotional distress, and burnout syndrome after one year of the COVID-19 pandemic and compared them with staff who did not handle infected patients. (3) A total of 165 persons were evaluated, with 79 working in the COVID-19 department and 86 working in the non-COVID-19 department. No statistically significant differences were found in the perceived stress scores, emotional distress (functional or dysfunctional), and disease perception among the COVID-19 and non-COVID-19 groups. Also, we did not find any differences between the COVID-19 and non-COVID-19 departments concerning their total Maslach scores-50 in the COVID-19 department and 51 in the non-COVID-19 department, p = 0480-so a moderate level of burnout in the two groups. The only statistical difference was in the Maslach depersonalization scores, which were higher among COVID-19 workers (p = 0.024). (4) In our center, there was no statistically significant difference in perceived stress or emotional distress. The level of burnout syndrome seems to be the same among the two groups, regardless if they worked withCOVID-19-infected patients or not.

Factors Associated with Burnout in Medical Staff: A Look Back at the Role of the COVID-19 Pandemic

Despite the significant consequences for medical practice and public health, burnout in healthcare workers remains underestimated. Pandemic periods have increased the reactivity to stress by favoring some changes whose influence are still felt.

PURPOSE

This study aims to identify opportune factors during pandemic periods that predispose medical personnel to burnout and the differences between medical staff which worked with COVID-19 patients and those who did not work with COVID-19 patients.

MATERIAL AND METHODS

This is a prospective study on 199 subjects, medical staff and auxiliary staff from national health units, COVID-19 and non-COVID-19, who answered questions using the Google Forms platform about the level of stress related to the workplace and the changes produced there. All statistical analyses were conducted using IBM SPSS Statistics (Version 28).

RESULTS

The limited equipment and disinfectant solutions from the lack of medical resources category, the fear of contracting or transmitting the infection from the fears in relation to the COVID-19 pandemic category and the lack of personal and system-level experience in combating the infection due to the lack of information on and experience with COVID-19 were the most predisposing factors for burnout. No significant differences were recorded between those on the front line and the other healthcare representatives.

CONCLUSIONS

The results of this study identify the stressors generated in the pandemic context with prognostic value in the development of burnout among medical personnel. At the same time, our data draw attention to the cynicism or false-optimism stage of burnout, which can mask a real decline.

Psychometric properties and psychological correlates of the COVID-19 Anxiety Syndrome Scale: A comprehensive systematic review and meta-analysis

Coronavirus disease-19 (COVID-19) has led to the demise of millions of people worldwide; additionally, it has resulted in a significant economic and mental health burden. Since the onset of the COVID-19 pandemic, various measures have been constructed to evaluate pandemic-related fear and anxiety. The COVID-19 Anxiety Syndrome Scale (C-19ASS) is a promising measure that assesses coping strategies (e.g., avoidance, checking, worrying and threat monitoring), termed 'COVID-19 Anxiety Syndrome', in response to COVID-19 fear and anxiety. The measure has been broadly welcomed, leading to its use in Brazil (Portuguese), China, Greece, Indonesia, the Philippines, Iran (Farsi), Italy, Saudi Arabia (Arabic), Turkey, the United Kingdom and the United States. To gain a better understanding of the relevance of the COVID-19 Anxiety Syndrome, we conducted a systematic review and meta-analysis to explore the psychological correlates and psychometric properties of the C-19ASS. Through the analysis of a total of 17,789 individuals (age range 19-70; female = 33%-85%), the C-19ASS demonstrated a consistent factor structure, measurement invariance across gender and acceptable reliabilities. Furthermore, a significant association with COVID-19 anxiety, depressive symptoms, generalized anxiety, health anxiety, psychological distress and functional impairment (work and social adjustment) during the COVID-19 pandemic was observed. When considering the Big Five personality traits, the C-19ASS and its subscales were only significantly and negatively associated with extraversion; only the total score on the measure was associated with neuroticism. The observed effect sizes ranged from very small to medium. Given that all included studies (K = 24) were cross-sectional, and due to the nature of the COVID-19 Anxiety Syndrome, which may well persist after the pandemic ends, it is recommended to continue screening society for the persistence of this syndrome.

Mental health experiences of HIV/TB healthcare workers during the COVID-19 pandemic - lessons for provider well-being and support from a qualitative study in seven South African provinces

BACKGROUND

COVID-19 has substantially reshaped health service delivery. Healthcare workers have had to serve more clients, work longer shifts, and operate in conditions of uncertainty. They have experienced multiple stressors related to the additional 'labour of care', including managing the frustration of inadequate therapeutic or symptom relief options, witnessing clients dying, and having to give this news to clients' family members. Ongoing psychological distress among healthcare workers can severely undermine performance, decision-making and well-being. We sought to understand the impact of the COVID-19 pandemic on the mental health experiences of healthcare workers delivering HIV and TB services in South Africa.

METHODS

We used a pragmatic and exploratory design to understand HCWs' mental health experiences with in-depth qualitative data. We implemented the study in ten high HIV/TB burden districts across seven of South Africa's nine provinces among healthcare workers employed by USAID-funded implementing partners. We conducted in-depth interviews (virtual) with 92 healthcare workers across 10 cadres.

RESULTS

Healthcare workers reported experiencing a range of extreme and rapidly fluctuating emotions because of COVID-19 that negatively impacted on their well-being. Among these, many healthcare workers report experienced a great deal of guilt at their inability to continue to provide quality care to their clients. In addition, a constant and pervasive fear of contracting COVID-19. Healthcare workers' stress coping mechanisms were limited to begin with, and often further interrupted by COVID-19 and non-pharmaceutical response measures e.g., 'lockdowns'. Healthcare workers reported a need for greater support for managing the everyday burden of work - not only when experiencing a mental well-being 'episode'. Further, that whenever they were exposed to stressor events, e.g., supporting a child living with HIV who reports sexual abuse to the healthcare worker, that this this would trigger additional support interventions and not rely on the healthcare worker seeking this out. Further, that supervisors spend more effort demonstrating appreciation toward staff.

CONCLUSIONS

The COVID-19 epidemic has added significant mental health burden for healthcare workers in South Africa. Addressing this requires broad and cross-cutting strengthening of everyday support for healthcare workers and centring staff's mental well-being as core to delivering quality health services.

Mental health complaints among healthcare workers engaged in the care of COVID-19 patients: A prospective cohort study from Japan

Background

Healthcare workers (HCWs) caring for patients with coronavirus disease-2019 (COVID-19) can experience physical and mental health burdens. It is imperative that hospitals reduce such burdens on frontline HCWs, protect them, and support their healthcare. This study aimed to investigate the association between occupation and the manifestation of physical or psychological symptoms among HCWs during the current COVID-19 pandemic.

Methods

A twice-weekly survey using questionnaires targeting HCWs who care for COVID-19 patients was performed at Osaka Metropolitan University Hospital (tertiary hospital). The demographic characteristics of the participants, exposure level, and physical and psychological complaints were evaluated.

Results

Seventy-one HCWs participated in this study, of whom 27 (38.0%) were doctors, 25 (35.2%) were nurses, and 19 (26.8%) were technicians. Among the HCWs, the proportions of those who experienced any physical or psychological symptoms were 28.2% and 31.0%, respectively. The frequency of depression and anxiety was obviously higher among the nurses than that among the doctors (both p < 0.01). Multivariate analysis revealed that being a nurse (odds ratio 4.90; p = 0.04) and having physical complaints (odds ratio 4.66; p = 0.02) might be independent predictors of the manifestation of psychological symptoms.

Conclusion

Our results indicate that the follow-up of HCWs experiencing physical symptoms, especially nurses engaged in the care of COVID-19 patients, may require more careful management to improve the psychological outcomes. We believe that this study is the first step toward establishing a psychological health management strategy for HCWs caring for COVID-19 patients.

Use it or lose it? Identifying reasons for the low use of psychosocial support by hospital staff

BACKGROUND

Psychosocial support programs are a way for hospitals to support the mental health of their staff. However, while support is needed, utilization of support by hospital staff remains low. This study aims to identify reasons for non-use and elements that are important to consider when offering psychosocial support.

METHODS

This mixed-method, multiple case study used survey data and in-depth interviews to assess the extent of psychosocial support use, reasons for non-use and perceived important elements regarding the offering of psychosocial support among Dutch hospital staff. The study focused on a time of especially high need, namely the COVID-19 pandemic. Descriptive statistics were used to assess frequency of use among 1514 staff. The constant comparative method was used to analyze answers provided to two open-ended survey questions (n = 274 respondents) and in-depth interviews (n = 37 interviewees).

RESULTS

The use of psychosocial support decreased from 8.4% in December 2020 to 3.6% by September 2021. We identified four main reasons for non-use of support: deeming support unnecessary, deeming support unsuitable, being unaware of the availability, or feeling undeserving of support. Furthermore, we uncovered four important elements: offer support structurally after the crisis, adjust support to diverse needs, ensure accessibility and awareness, and an active role for supervisors.

CONCLUSIONS

Our results show that the low use of psychosocial support by hospital staff is shaped by individual, organizational, and support-specific factors. These factors can be targeted to increase use of psychosocial support, whereby it is important to also focus on the wider hospital workforce in addition to frontline staff.

Comparing SARS-CoV-2 neutralizing antibody levels in convalescent unvaccinated, convalescent vaccinated, and naive vaccinated subjects

Background

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in December 2019 and spread rapidly. The purpose of this study was to compare neutralizing antibodies (NAbs) following the original booster vaccine in convalescent and naive vaccinated individuals and in a third comparison group consisting of unvaccinated convalescent plasma donors.

Methods

We assessed NAbs before and 2 months after a booster vaccine in 68 adults who had completed the initial vaccine series for SARS-CoV-2. Of these subjects, 58 had no history of prior infection (naïve vaccinated group) and 10 had been infected with SARS-COV-2 prior to the completing the first vaccine series (convalescent vaccinated group). A third comparison group included unvaccinated convalescent plasma donors (n = 55) from an earlier study with NAbs assessed approximately 2 months after a positive test for SARS-CoV-2.

Results

Prior to the booster, convalescent vaccinated subjects had higher NAbs compared to naive vaccinated subjects (p = 0.02). Two months following the booster, NAbs increased in both vaccinated groups. The naive vaccinated group increased more than the convalescent vaccinated group (p = 0.02). NAbs in the naive vaccinated group were almost four times higher than NAbs in the 55 unvaccinated subjects, while the convalescent vaccinated group had levels 2.5 times higher p < 0.01.

Conclusion

NAbs in both vaccinated/boosted groups were significantly higher than in the convalescent unvaccinated group (p < 0.01). Our data indicates that subjects with a single infection with SARS-CoV-2 did not have the same levels of neutralizing antibodies that we observed in subjects who were either in the convalescent vaccinated or the naive vaccinated groups.

Effectiveness of psychological first aid in infectious disease pandemics: An overview of systematic reviews

There is insufficient research on the usefulness of psychological interventions, such as psychological first aid (PFA), during outbreaks. We searched for and critically appraised systematic reviews that examined the effectiveness of PFA during infectious disease outbreaks, such as the novel coronavirus disease (COVID-19). Systematic reviews that examined the efficacy of PFA in the severe acute respiratory syndrome, Middle East respiratory syndrome coronavirus, Ebola virus disease, and COVID-19 outbreaks were searched through PubMed on February 19, 2021. The three included systematic reviews were critically appraised and assessed using AMSTAR-2. One review's overall confidence in its findings was evaluated as "high," which suggested that PFA training had a favorable effect on healthcare personnel. Furthermore, the review also demonstrated that PFA was commonly used during outbreaks and could be delivered through multiple methods, such as a phone or video call. Although it was anticipated that PFA would improve subjective well-being, reports showed no evidence of reduced depression or insomnia. Future studies should examine additional numbers of PFA recipients and conduct quasi-experimental studies to better understand the effectiveness of PFA. Evidence on its effectiveness in infectious disease outbreaks is still lacking, along with research and evaluation methods. Quasi-experimental studies, such as comparisons with other psychological interventions, are required to better understand the effectiveness of PFA.

Patterns of work-related stress and their predictors among emergency department nurses and emergency medical services staff in a time of crisis: a latent profile analysis

BACKGROUND

Previous studies have shown that a disease outbreak may cause high stress among healthcare workers. However, the vast majority of those studies applied a variable-centered approach, in which relationships between the variables are believed to be identical across the studied population. The main purpose of this study was to identify latent profiles of healthcare workers with similar combinations of levels of various work-related stressors during the coronavirus disease 2019 (COVID-19) pandemic and to examine their predictors.

METHODS

A cross-sectional paper-and-pencil study was conducted among a convenience sample of 297 emergency department (ED) nurses and 219 emergency medical services (EMS) staff members working in 10 hospital EDs and 52 EMS centers in Ardabil province, Iran. Data were collected using the Health and Safety Executive Management Standards Indicator Tool (HSE-MS IT).

RESULTS

Using the latent profile analysis (LPA), five work-related stress profiles were identified: "high stress with a good understanding of one's job role" (11.1%), "moderate stress" (41.9%), "relatively high stress with average demands and a very low understanding of one's job role" (23.8%), "low stress" (18.0%), and "generally low stress but with very high job demands and relational conflicts" (5.2%). Age, marital status, service location, workplace, and the number of overtime hours significantly predicted profile membership.

CONCLUSION

The results of the study suggest the importance of incorporating various sources of stress and using the person-centered approach when investigating the work-related stress of healthcare workers during disease outbreaks. Identifying sociodemographic and work-related predictors of profile membership may be useful for preparing interventions that will be better suited to healthcare workers' needs.

State and Federal Legislators’ Responses on Social Media to the Mental Health and Burnout of Health Care Workers Throughout the COVID-19 Pandemic: Natural Language Processing and Sentiment Analysis

Background

Burnout and the mental health burden of the COVID-19 pandemic have disproportionately impacted health care workers. The links between state policies, federal regulations, COVID-19 case counts, strains on health care systems, and the mental health of health care workers continue to evolve. The language used by state and federal legislators in public-facing venues such as social media is important, as it impacts public opinion and behavior, and it also reflects current policy-leader opinions and planned legislation.

Objective

The objective of this study was to examine legislators’ social media content on Twitter and Facebook throughout the COVID-19 pandemic to thematically characterize policy makers’ attitudes and perspectives related to mental health and burnout in the health care workforce.

Methods

Legislators’ social media posts about mental health and burnout in the health care workforce were collected from January 2020 to November 2021 using Quorum, a digital database of policy-related documents. The total number of relevant social media posts per state legislator per calendar month was calculated and compared with COVID-19 case volume. Differences between themes expressed in Democratic and Republican posts were estimated using the Pearson chi-square test. Words within social media posts most associated with each political party were determined. Machine-learning was used to evaluate naturally occurring themes in the burnout- and mental health–related social media posts.

Results

A total of 4165 social media posts (1400 tweets and 2765 Facebook posts) were generated by 2047 unique state and federal legislators and 38 government entities. The majority of posts (n=2319, 55.68%) were generated by Democrats, followed by Republicans (n=1600, 40.34%). Among both parties, the volume of burnout-related posts was greatest during the initial COVID-19 surge. However, there was significant variation in the themes expressed by the 2 major political parties. Themes most correlated with Democratic posts were (1) frontline care and burnout, (2) vaccines, (3) COVID-19 outbreaks, and (4) mental health services. Themes most correlated with Republican social media posts were (1) legislation, (2) call for local action, (3) government support, and (4) health care worker testing and mental health.

Conclusions

State and federal legislators use social media to share opinions and thoughts on key topics, including burnout and mental health strain among health care workers. Variations in the volume of posts indicated that a focus on burnout and the mental health of the health care workforce existed early in the pandemic but has waned. Significant differences emerged in the content posted by the 2 major US political parties, underscoring how each prioritized different aspects of the crisis.

The COVID-19 pandemic and mental health outcomes - A cross-sectional study among health care workers in Coastal South India

Background: Frontline health care workers (HCWs) are at increased risk of developing unfavourable mental health outcomes and burnout, especially during the COVID-19 pandemic. Recognizing the early warning signs of mental distress is very important to ensure the provision of quality patient care. Methods: In this facility-based cross-sectional study, HCWs of the teaching hospitals affiliated to Kasturba Medical College, Mangalore were assessed regarding their mental health status using a semi-structured questionnaire. All doctors and nurses who were willing to participate from these teaching hospitals were included in the study. Data was collected over a period of four months (1 st March -30 th June 2021) till the required sample size was reached and analysed using IBM SPSS and expressed using mean (standard deviation), median (interquartile range), and proportions. Univariate analysis was done to identify the factors associated with mental health outcomes among the HCWs and the corresponding unadjusted odds ratio and 95% confidence interval were reported. Results: A total of 245 HCWs [52.2% (n=128) doctors and 47.8% (n=117) nurses] were included in our study. The proportion of participants with depressive symptoms, anxiety, and insomnia assessed using PHQ-9, GAD-7, and ISI-7 scales were 49% (n=119), 38% (n=93), and 42% (n=102) respectively. Depression, anxiety, and insomnia were more likely to be experienced by HCWs aged > 27 years, females, and involved in COVID-19 patient care. (p>0.05) Conclusions:  Our findings that 38% of the examined HCWs had clinically relevant anxiety symptoms and 49% had clinically relevant depression symptoms draws attention to the importance of systematically tracking the mental health of HCWs during this ongoing pandemic. HCWs should monitor their stress reactions and seek appropriate help both on a personal and professional level. Appropriate workplace interventions including psychological support should be provided to HCWs, to ensure provision of uncompromised quality patient care.

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.

Burnout and coping strategies among resident physicians at an Indonesian tertiary referral hospital during COVID-19 pandemic

BACKGROUND

The COVID-19 pandemic has increased the burden on resident physicians. They may use different coping strategies to manage those burdens, which partly determine their mental health outcomes, including burnout syndrome. This study explores the relationship between coping strategies and burnout among resident physicians during the COVID-19 pandemic in an Indonesian tertiary referral hospital.

METHODS

This online cross-sectional study was conducted from June to August 2020, involving nine residency programs in the Faculty of Medicine Universitas Indonesia-Cipto Mangunkusumo Hospital. Burnout syndrome was assessed using Maslach Burnout Inventory, while Brief COPE measured coping strategies.

RESULTS

A total of 388 residents participated in this study. High emotional exhaustion (EE), depersonalization (DP), and low personal accomplishment (PA) were found in 15.5%, 5.2%, and 39.2%, respectively. Residents more often use adaptive than maladaptive coping strategies. Higher PA was correlated to residents using problem-focused (r = 0.299; p < 0.001) and emotion-focused (r = 0.397; p < 0.001). Meanwhile, dysfunctional coping strategies are moderately correlated with EE (r = 0,518; p <0,001) and DP (r = 0,507; p<0,001).

CONCLUSION

The use of dysfunctional coping strategies is linked to higher emotional exhaustion and depersonalization aspect of burnout. However, a higher sense of personal accomplishment is linked to problem-focused and emotion-focused strategies. Appropriate identification and intervention of residents with dysfunctional coping strategies may be beneficial in reducing burnout risk.

The COVID-19 Pandemic Between Bio-Ethics, Bio-Law and Bio-Politics: A Case Study on The Italian Experience of The DuPre Commission

The aim of this qualitative study was to consider the question of whether the Italian political management of the pandemic respected the European bio-ethical and bio-juridical approaches in light of the principles of autonomy, dignity, integrity and vulnerability. As no specific consolidated literature exists on the subject, the Italian situation was taken into consideration, specifically the work of a spontaneous commission (DuPre) that collected the reflections of academics and researchers interested in discussing political decisions for the management of the emergency, which was the coronavirus disease (COVID-19) pandemic. The analysis took into account the contributions of scholars during two conferences (without proceedings), which were transcribed and examined. From the texts processed with a thematic analysis, three main themes emerged: ‘pandemic as a state of exception, sovereignty and crisis of democracy’, ‘the value of doubt and refutation’ and ‘elimination of informed consent between persuasion and blackmail’. In this paper, the final bio-political considerations on the European approach and the management of the COVID-19 pandemic in Italy are presented.

On the Frontlines: The Impact of the COVID-19 Pandemic on Social Workers' Well-Being

The crisis created by the spread of COVID-19 brought increasing needs and referrals to social welfare services in many countries. However, at the same time, social services suffered from staff cutbacks and service closures, resulting in significant workload increases to address the hardships associated with the pandemic. This article investigates the impact of the COVID-19 pandemic on Israeli social workers' well-being, using a mixed-methods design with a sample of 2,542 licensed social workers. Findings show that over 70 percent of social workers suffered from at least one health problem related to their work. Path analysis findings indicated that social workers who experienced greater service restrictions reported a greater decrease in job satisfaction and experienced higher levels of stress and work-related problems. Machine learning emotion-detection analysis revealed that the pandemic affected their lives, causing feelings of fear, frustration, and sadness. This article demonstrates how social workers whose work was characterized by greater service restrictions were less satisfied with their jobs, more stressed, and experienced greater job-related health problems, and concludes with a discussion of the implications for social work practice in times of crisis.

Experiences of Operating Room Nurses During the COVID-19 Pandemic: A Qualitative Study

PURPOSE

The study was conducted to examine the experiences of operating room nurses during the COVID-19 pandemic.

DESIGN

This study was designed as a phenomenological qualitative research method.

METHODS

This study was conducted with 10 volunteer operating room nurses who met the criteria for participation in the study between February 2021 and March 2021 in a public hospital. Data were collected using a personal information form and a semi-structured interview from using the in-depth interview technique. Two researchers and one expert created the themes and codes using the thematic analysis method.

FINDINGS

As a result of the analysis, four themes and 29 codes were identified. The following codes were created for the theme "Changing systems and practices in the operating room": Personal protective equipment and sterility, workload/time, lack of communication between patient and nurse, decrease in the number of cases, change in the use of emergencies and elective procedures, flexible working methods. On the theme of the impact of the pandemic, anxiety/anxiety, psychological distress, difficulty with personal protective equipment, lack of nurses, longing/distance from family, sleep disturbances, family problems, and difficulty working in another department were noted. On the theme of coping strategies for the pandemic, the codes found were; communication with family, breathing/sporting exercises, spirituality, regular/healthy diet, online shopping, watching TV series/movies, and acceptance of the process. On the theme of "learning from the pandemic," the codes of the importance of life/health, the importance of family, worthlessness of the caring profession, financial injustice, gaining work experience, the importance of personal protection, lack of union support, and job satisfaction were produced.

CONCLUSIONS

The study found that the nursing in the operating room has changed due to the COVID-19 pandemic, that nurses have experienced many positive/negative impacts, and that they have gained many benefits from the pandemic through various coping methods.

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

OBJECTIVE

Pandemics negatively impact healthcare workers' (HCW's) mental health and well-being causing additional feelings of anxiety, depression, moral distress and post-traumatic stress. A comprehensive review and evidence synthesis of HCW's mental health and well-being interventions through pandemics reporting mental health outcomes was conducted addressing two questions: (1) What mental health support interventions have been reported in recent pandemics, and have they been effective in improving the mental health and well-being of HCWs? (2) Have any mobile apps been designed and implemented to support HCWs' mental health and well-being during pandemics?

DESIGN

A narrative evidence synthesis was conducted using Cochrane criteria for synthesising and presenting findings when systematic review and pooling data for statistical analysis are not suitable due to the heterogeneity of the studies.

DATA SOURCES

Evidence summary resources, bibliographic databases, grey literature sources, clinical trial registries and protocol registries were searched.

ELIGIBILITY CRITERIA

Subject heading terms and keywords covering three key concepts were searched: SARS-CoV-2 coronavirus (or similar infectious diseases) epidemics, health workforce and mental health support interventions. Searches were limited to English-language items published from 1 January 2000 to 14 June 2022. No publication-type limit was used.

DATA EXTRACTION AND SYNTHESIS

Two authors determined eligibility and extracted data from identified manuscripts. Data was synthesised into tables and refined by coauthors.

RESULTS

2694 studies were identified and 27 papers were included. Interventions were directed at individuals and/or organisations and most were COVID-19 focused. Interventions had some positive impacts on HCW's mental health and well-being, but variable study quality, low sample sizes and lack of control conditions were limitations. Two mobile apps were identified with mixed outcomes.

CONCLUSION

HCW interventions were rapidly designed and implemented with few comprehensively described or evaluated. Tailored interventions that respond to HCWs' needs using experience co-design for mental health and well-being are required with process and outcome evaluation.

Socio-Occupational and Health Conditions in Intensive Care Unit (ICU) Professionals during the COVID-19 Pandemic in Spain

Objective: The aim of this research is to analyze the socio-occupational and health conditions of Intensive Care Units (ICU) health professionals during the COVID-19 pandemic in Spain. In addition, with regard to the working conditions (availability of personal protective equipment—PPE, workload and patient/professional ratio), this research aims to analyze the possible differences depending on the Spanish region that was sampled and their professional category, as well as their relationship with the characteristic symptoms of COVID-19 (myalgias and respiratory distress). Method: A cross-sectional study performed with an online questionnaire, which was spread throughout all of the Spanish autonomous communities/regions. Results: The sample consisted of 461 ICU professionals in Spain, of whom, 94% reported an increase in their workload, and 43% reported a patient/professional ratio that was higher than it usually is. The median professional experience in the ICU was 9.73 years, with 47% of them having less than 5 years of experience in it. About 80% had undergone some diagnostic tests. There is a significant difference in ‘Serology (+)’ in terms of sex, with males having a serology (+) in 26% of the cases and females having it in 13% of the cases (p = 0.011). Most of the professionals (80%) were concerned about a possible infection, and up to 96% were worried about infecting their family members. The most common COVID-19 symptom was a headache, with there being a higher incidence of this in women. Significant differences were observed with respect to the availability of appropriate PPE depending on the Spanish region (i.e., Cataluña had best rate of PPE availability) (p = 0.005). The higher incidence of myalgias and respiratory distress were associated with a lower availability of PPE and a higher patient/professional ratio. Conclusions: The ICU staff reported an increase in their workload, with an increase in the amount of staff who had less experience. A high percentage of them have suffered symptoms, although the proportion of positive tests was low. The most characteristic symptoms of COVID-19 seem to be related to the working conditions. The results show the socio-occupational and health conditions of Spanish ICU professionals during the pandemic and point to the need to establish occupational risk-prevention measures.

Workplace factors can predict the stress levels of healthcare workers during the COVID-19 pandemic: First interim results of a multicenter follow-up study

Background

Research is lacking on the long-term influence of workplace factors on the mental health of health care workers during the COVID-19 pandemic.

Methods

We distributed two online surveys to health care workers between May and October 2020 (T1) and between February and April 2021 (T2). Perceived stress, coronavirus-related risks, and workplace factors were measured via self-report questionnaires at both time points. We conducted hierarchical linear regression to investigate the predictive factors for high stress.

Results

A total of 2,110 participants from seven countries and 4,240 participants from nine countries were enrolled at T1 and T2, respectively. Among them, 612 participated in both surveys. We called this cohort T1 + T2. High stress was reported in 53.8 and 61.6% of participants at T1 and T2, respectively. In cohort T1 + T2, compared with the baseline, the level of stress rose significantly (6.0 ± 2.9 vs. 6.4 ± 3.1), as did health/safety in the workplace (3.9 ± 0.8 vs. 4.2 ± 0.7). Unfortunately, we did not detect any significant difference concerning support in the workplace. Among all factors at baseline, being older than 35 [β (95% CI) = -0.92 (-1.45, -0.40)], support [-0.80 (-1.29, -0.32)], and health/safety in the workplace [-0.33 (-0.65, -0.01)] were independent protective factors, while a positive history of mental disorders [0.81 (0.26, 1.37)] and rejection in private life [0.86 (0.48, 1.25)] were risk factors for high stress at T2.

Conclusion

To relieve the high stress of health care workers, organizational-level approaches should be implemented, especially measures designed to enhance support, health/safety in the workplace, and to reduce the rejection of the public.

Changes over time in anxiety, depression, and stress symptoms among healthcare workers in French emergency departments during the first COVID-19 outbreak

STUDY OBJECTIVE

Assess the changes in anxiety, depression, and stress levels over time and identify risk factors among healthcare workers in French emergency departments (EDs) during the first COVID-19 outbreak.

METHOD

A prospective, multicenter study was conducted in 4 EDs and an emergency medical service (SAMU). During 3 months, participants completed fortnightly questionnaires to assess anxiety, depression, and stress using the Hospital Anxiety and Depression and the Chamoux-Simard scale. The changes in anxiety, depression, and stress levels over time were modelled by a linear mixed model including a period effect and a continuous time effect within periods.

RESULTS

A total of 211 respondents (43.5 %) completed the survey at inclusion. There was a decrease in mean anxiety (from 7.33 to 5.05, p < 0.001), mean depression (from 4.16 to 3.05, p = 0.009), mean stress at work (from 41.2 to 30.2, p = 0.008), and mean stress at home (from 33.0 to 26.0, p = 0.031) at the beginning of each period. The mean anxiety level was higher for administrative staff (+0.53) and lower for paramedics (-0.61, p = 0.047) compared to physicians. The anxiety level increased with the number of day and night shifts (0.13/day, p < 0.001, 0.12/night, p = 0.025) as did stress at work (1.6/day, p < 0.001, 1.1/night, p = 0.007). Reassigned healthcare workers were at higher risk of stress particularly compared to SAMU workers (stress at work: p = 0.015, at home: p = 0.021, in life in general: p = 0.018).

CONCLUSION

Although anxiety, depression, and stress decreased over time, anxiety was higher among physicians and administrative staff. Reassignment and working hours were identified as potential risk factors for mental health distress in EDs.

[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.

Post-traumatic stress disorder among healthcare workers during the COVID-19 pandemic in Italy: Effectiveness of an eye movement desensitization and reprocessing intervention protocol

Aim

The Coronavirus 2019 (COVID-19) pandemic represents one of the most catastrophic events of recent times. Due to the hospitals’ emergency situation, the population of healthcare workers was the most affected. Healthcare workers who were exposed to COVID-19 patients are most likely to develop psychological distress and post-traumatic stress disorder (PTSD). The present study aimed at investigating PTSD in a sample of Italian healthcare workers during this outbreak and to evaluate the effectiveness of the Eye Movement Desensitization and Reprocessing (EMDR) Therapy with this population.

Methods

A total of 744 healthcare workers were included. 587 healthcare workers were treated with EMDR, while the other 157 were not treated. Participants were asked to provide sociodemographic information; the post-traumatic symptomatology was evaluated through Impact of Event Scale-Revised (IES-R) and to investigate the level of intensity of emotional activation was used The Emotion Thermometer (THERMO) at two time points (pre-post treatment).

Results

The results obtained between EMDR treatment and non-EMDR treatment were evaluated on only 2 hospitals. Treatment group n = 68 vs. waitlist non-treatment group n = 157. All scores pre- and post-EMDR decreased significantly (p < 0.001) showing an evident effect of EMDR. The differences between pre- and post-treatment of the IES-R scores of subjects in which EMDR was performed as compared to the scores pre- and post-12 weeks of waiting list subjects in which it was not performed were significantly different (p < 0.001).

Limitation

The emergency situation did not provide an opportunity to explore further aspects that would have been important for research. One limitation is the use and analysis of only two standardized tests. In addition, other psychopathologies were not investigated as outcome measures. A limitation is the comparison of subjects treated online and de visu. Although the protocol used was the same, the mode of intervention may have influenced the results. In addition, the effectiveness of EMDR treatment was only evaluated at two time points (pre-post) with no possibility of follow-up and the lack of a control group.

Discussion/conclusion

The findings of the present study suggest that healthcare workers were at high risk of developing PTSD when confronted with COVID-19 outbreak and suggest the importance of psychological support during this humanitarian emergency.

Dispositional Resilience as Mediator in Psychological Stress on Healthcare Workers: A Multi-Group Analysis of Frontline and Non-Frontline Workers

The experiences of healthcare workers (HCWs) during COVID-19 have been characterized by psychological symptoms such as stress, anxiety and depression, compassion fatigue and post-traumatic stress, which are long-lasting. The general picture of HCWs, especially frontline workers, is that of a physically and psychologically exhausted group. The aim of the study was to examine the potential mediating role of dispositional resilience in the impact of depression, anxiety and stress on professional quality of life among HCWs during the pandemic period. We also investigated possible differences between the frontline and non-frontline HCWs. The study enrolled 487 participants from public Italian hospitals. The variables of stress and anxiety predicted all factors related to professional quality of life, against depression which positively predicted only burnout and secondary traumatic Stress. Resilience was an important mediator in all these paths and the multigroup analysis suggested statistically significant differences between frontline and non-frontline HCWs. Results emphasised the importance of caring and concern for frontline HCWs to improve their quality of life, satisfaction and have positive impacts on the quality of service and care provided. There is a need to reflect on the necessity to develop projects and protocols that address health emergencies in advance.

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

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

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

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

Mental health symptoms during the COVID-19 pandemic in developing countries: A systematic review and meta-analysis

Background

This systematic review aims to 1) summarize the prevalence of anxiety, depression, distress, insomnia, and PTSD in the adult population during the first year of the COVID pandemic in developing countries and 2) uncover and highlight the uneven distribution of research on mental health in all developing countries across regions.

Methods

Several literature databases were systemically searched for meta-analyses published by September 22, 2021, on the prevalence rates of mental health symptoms in developing countries worldwide. We meta-analysed the raw data of the individual empirical results from the previous meta-analysis papers in developing countries in different regions.

Results

The prevalence rates of mental health symptoms were summarized based on 341 empirical studies with a total of 1 704 072 participants from 40 out of 167 developing countries in Africa, Asia (East, Southeast, South, and West), Europe, and Latin America. Comparatively, Africa (39%) and West Asia (35%) had the worse overall mental health symptoms, followed by Latin America (32%). The prevalence rates of overall mental health symptoms of medical students (38%), general adult students (30%), and frontline health care workers (HCWs) (27%) were higher than those of general HCWs (25%) and general populations (23%). Among five mental health symptoms, distress (29%) and depression (27%) were the most prevalent. Interestingly, people in the least developing countries suffered less than those in emergent and other developing countries. The various instruments employed lead to result heterogeneity, demonstrating the importance of using the well-established instruments with the standard cut-off points (eg, GAD-7, GAD-2, and DASS-21 for anxiety, PHQ-9 and DASS-21 for depression, and ISI for insomnia).

Conclusions

The research effort on mental health in developing countries during COVID-19 has been highly uneven in the scope of countries and mental health outcomes. This meta-analysis, the largest on this topic to date, shows that the mental health symptoms are highly prevalent yet differ across regions. The accumulated systematic evidence from this study can help enable the prioritization of mental health assistance efforts to allocate attention and resources across countries and regions.

The Impact of the COVID-19 Pandemic on the Psychological Well-being of Healthcare Workers in Obstetrics and Gynaecology: An Observational Study at an Apex Institute

Background and objective

The coronavirus disease 2019 (COVID-19) pandemic has affected the health, social, and economic sectors all over the world. With a view to assessing the impact of COVID-19 on the mental health of healthcare workers (HCWs), we conducted a study to find out the incidence and severity of depression, anxiety, and post-traumatic stress disorder (PTSD) among HCWs.

Material and methods

This was an observational cross-sectional study conducted in the Department of Obstetrics and Gynaecology in collaboration with the Department of Psychiatry at AIIMS, New Delhi from March 2021 to June 2021. One hundred HCWs working in the Department of Obstetrics and Gynaecology were surveyed using a set of semi-structured interview schedules and structured questionnaires distributed via email or manually. The structured questionnaire included the demographic profile; other baseline information; the 42-item Depression, Anxiety, and Stress Scale (DASS-42); and the Impact of Event Scale-Revised (IES-R) instrument. Data analysis was carried out using the statistical package STATA version 14.0 (StataCorp LLC, College Station, TX).

Results

A total of 100 HCWs participated in the study, out of which 39 (39%), 45 (45%), and 16 (16%) were doctors, nursing staff, and supporting staff, respectively. Overall, 92 (92%) of the participants were women, and the mean age of the participants was 29.87 ±4.85 years. Out of the 100 participants, 17 (17%), 25 (25%), 13 (13%), and two (2%) participants had depression, anxiety, stress, and PTSD, respectively. Occupation-wise, among the nursing staff, doctors, and supporting staff, the incidence of depression was 24.4%, 15.4%, 0.0%, respectively; the anxiety rate was 33.3%, 25.6%, and 0.0%, respectively; and the rate of stress was 17.8%, 12.8%, and 0.0%, respectively. The IES-R score was significantly higher among unmarried as compared to married participants (2.70 ±7.935 vs. 1.60 ±3.583, p=0.000). Participants living in joint families had a higher DASS-42 score (DASS-D: 4.00 ±5.299 vs. 3.77 ±7.727, p=0.889; DASS-A: 4.31 ±4.398 vs. 4.12 ±7.496, p=0.905; DASS-S: 4.08 ±4.816 vs. 3.88 ±7.567, p=0.016) and lower IES-R score (1.31 ±4.922 vs. 2.66 ±9.947, p=0.752) as compared to those living in nuclear families. Depression (4.86 ±8.165 vs. 2.00 ±4.388, p=0.054), anxiety (5.31 ±7.538 vs. 2.14 ±4.704, p=0.024), stress (5.20 ±7.651 vs. 1.67 ±4.733, p=0.014) and PTSD (3.61 ±10.900 vs. 1.44 ±2.634, p=0.245) were all higher among HCWs having exposure to COVID-19 more than 10 hours per week compared to participants with an exposure of less than 10 hours per week. The participants having psychiatric illness in the family showed significantly higher mean values for DASS-42 (DASS-D: 20.00 ±26.870 vs. 3.50 ±6.264, p=0.001; DASS-A: 18.50 ±20.506 vs. 3.88 ±6.215, p=0.002; DASS-S: 18.00 ±21.213 vs. 3.64 ±6.346, p=0.003) as compared to those without any psychiatric illness in the family.

Conclusion

Based on our findings, occupational and environmental factors at the workplace play a key role in mental health outcomes, and COVID-19 has had a significant impact on the mental health of HCWs. Furthermore, we have also observed that effective planning can significantly reduce mental stress.

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

BACKGROUND

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

OBJECTIVE

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

DESIGN

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

PARTICIPANTS

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

MAIN MEASURES

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

KEY RESULTS

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

CONCLUSIONS

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

A scoping review of COVID-19-related stress coping resources among nurses

Objective

The entire mental health hazard among the nurses dealing with COVID-19 is just the tip of the iceberg. The goal of this study was to find acceptable and adaptive coping techniques for nurses in order to keep the healthcare system resilient during and after the COVID-19 pandemic.

Method

The scoping review search took place from January 2020 to May 2021 published articles, and the results were saved in Endnote software. For data synthesis and review, the Joanna Briggs Institute manual and PRISMA-ScR principles were followed. Following backward and forward screening to exclude redundant, irrelevant, and ineligible studies, 13 studies (3,613 nurses) were finally selected for this review.

Results

The majorities of participants in these studies were female and had children, and worked in departments of critical care, emergency, and fever clinics. Safety concerns for family or colleagues, as well as a lack of safe working environment, were the primary causes of the mental illness. Professional responsibility attitude, COVID-19 training, workplace safety, team spirit, and a few relaxation activities such as deep breathing, reading books, watching movies, and praying, on the other hand, were found to be beneficial for stress coping among nurses.

Conclusion

Mentally fit nurses are more capable and flexible in the face of any life-threatening outbreak, even if it is very contagious. Several coping strategies were found to be effective for nurses during the COVID-19 pandemic, whereas problem-specific intervention trials might yield even better results. We should not delay specific mental health interventions to keep them viable and more efficient during a pandemic battlefield, whereas Post-Traumatic Stress Disorder and suicide rates can destroy the entire health care system.

Coronavirus disease 2019 and radiation oncology-survey on the impact of the severe acute respiratory syndrome coronavirus 2 pandemic on health care professionals in radiation oncology

Background

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has changed the lives of most humans worldwide. The aim of this study was to evaluate the impact of the SARS-CoV‑2 pandemic on health care professionals (HCPs) in radiation oncology facilities.

Methods

We distributed an online survey to HCPs in radiation oncology (physicians, medical physics experts, radiology assistants/radiation therapists, nurses, and administrative personnel). The survey was completed by 334 participants between May 23 and June 9, 2020.

Results

In 66.2% of the cases, HCPs reported a shortage of protective clothing. The protective measures were regarded as very reasonable by 47.4%, while 0.8% regarded them as not reasonable (rather reasonable: 44.0%; less reasonable 7.8%). 29.0% of the participants had children who needed care. The most frequently used care options were public emergency childcare (36.1%) and private childcare (e.g. relatives/friends). HCPs reported about additional work burden (fully agreed: 27.2%, rather agreed: 34.4%, less agreed: 28.2%, not agreed: 10.2%), and reduced work satisfaction (fully agreed: 11.7%, rather agreed: 29.6%, less agreed: 39.8%, not agreed: 18.9%). 12.9% and 29.0% of the participants were fully or rather mentally strained (less mentally strained: 44.0%, not mentally strained: 14.1%).

Conclusion

We must learn from this pandemic how to prepare for further outbreaks and similar conditions. This includes the vast availability of protective clothing and efficient tracing of infection chains among the HCPs, but also secured childcare programs and experienced mental health support are crucial. Further, work satisfaction and appreciation by employers is essential.

Supplementary Information

The online version of this article (10.1007/s00066-022-01903-8) contains supplementary material, which is available to authorized users.

"Well, I Signed Up to Be a Soldier; I Have Been Trained and Equipped Well": Exploring Healthcare Workers' Experiences during COVID-19 Organizational Changes in Singapore, from the First Wave to the Path towards Endemicity

(1) Background: As COVID-19 transmission continues despite vaccination programs, healthcare workers (HCWs) face an ongoing pandemic response. We explore the effects of this on (1) Heartware, by which we refer to morale and commitment of HCWs; and identify how to improve (2) Hardware, or ways of enabling operational safety and functioning. (2) Methods: Qualitative e-diary entries were shared by HCWs during the early phases of the outbreak in Singapore from June to August 2020. Data were collected via an online survey of n = 3616 HCWs of all cadres. Nine institutions—restructured hospitals (n = 5), affiliated primary partners (n = 2) and hospices (n = 2)—participated. Applied thematic analysis was undertaken and organized according to Heartware and Hardware. Major themes are in italics (3) Results: n = 663 (18%) HCWs submitted a qualitative entry. Dominant themes undermining (1) Heartware consisted of burnout from being overworked and emotional exhaustion and at times feeling a lack of appreciation or support at work. The most common themes overriding morale breakers were a stoic acceptance to fight, adjust and hold the line, coupled with motivation from engaging leadership and supportive colleagues. The biggest barrier in (2) Hardware analysis related to sub-optimal segregation strategies within wards and designing better protocols for case detection, triage, and admissions criteria. Overall, the most cited enabler was the timely and well-planned provision of Personal Protective Equipment (PPE) for front-liners, though scope for scale-up was called for by those not considered frontline. Analysis maps internal organizational functioning to wider external public and policy-related narratives. (4) Conclusions: COVID-19 surges are becoming endemic rather than exceptional events. System elasticity needs to build on known pillars coupling improving safety and care delivery with improving HCW morale. Accordingly, a model capturing such facets of Adaptive Pandemic Response derived from our data analyses is described. HCW burnout must be urgently addressed, and health systems moved away from reactive “wartime” response configurations.

Healthcare Professionals, Post-traumatic Stress Disorder, and COVID-19: A Review of the Literature

The recent COVID-19 pandemic impacted healthcare professionals psychologically. They were unprepared to handle such a powerful and unknown virus. Consequently, they had to face situations of extreme distress, developing vicarious traumatization and post-traumatic stress disorder (PTSD). The first one is associated with the "cost of caring" for others and affected persons who constantly are exposed to other sufferings. PTSD is a psychiatric disorder that could affect people who have experienced or witnessed a traumatic event. Post-traumatic stress disorder (PTSD) and correlated symptoms might impact the lives of healthcare professionals at the personal, professional, and relational levels. Furthermore, the pandemic could decrease the empathy of healthcare professionals, influencing their relationship with patients. This review aimed to describe the incidence of PTSD among HPs during the COVID-19 pandemic. We focused on the following aspects: (a) PTSD symptoms and correlated psychological issues, (b) repercussions at working and personal levels, (c) change in empathetic involvement of healthcare professionals.

Assessment of Resident Burnout After Formalization of Wellness Program

INTRODUCTION

Burnout has reached epidemic levels among resident physicians. Characterized by emotional exhaustion (EE), depersonalization, and feelings of inefficacy, burnout negatively affects patient outcomes, increases costs, and decreases physician quality of life. These negative outcomes catalyze leaders in graduate medical education to address burnout and reverse its trends. The primary aim of this project is to design a residency Wellness Program utilizing the facets of physician wellness, assess levels of burnout among resident physicians, and determine the program's effects on burnout.

MATERIALS AND METHODS

A Wellness Program was formalized at a Midwestern, military-civilian Obstetrics and Gynecology residency program for the 2019-2020 academic year. Resident wellness and perceptions were assessed at three time points (0, 6, and 12 months) through surveys consisting of free response, yes-no questions, and the Maslach Burnout Inventory Scales.

RESULTS

On average, 17 of 24 residents completed all three survey assessments. Perception of the residency program prioritization of wellness increased significantly from 52.9% to 94.4% (P = .007). Residents consistently demonstrated burnout throughout the year with low levels of EE, high levels of depersonalization, and moderate levels of personal achievement. Residents were consistently satisfied with their personal wellness (80%-92.9%) during the program. Residents wanted to see physical activity incorporated into the program.

CONCLUSIONS

This study assessed burnout during a formalization of a Wellness Program and insight on resident perceptions and wellness requests. Military medicine, graduate medical education, and other residency programs can utilize this research to better develop and study the implementation of wellness initiatives aimed at reducing burn out.

Association of Self-Leadership With Acute Stress Responses and Acute Stress Disorders in Chinese Medics During the COVID-19 Pandemic: A Cross-Sectional Study

BACKGROUND

The outbreak of the highly infectious coronavirus disease 2019 (COVID-19) renders a huge physical and psychological risk to the public, especially to the medics. Additionally, self-leadership has proven to improve self-efficacy and mediate tension, such as nervousness and depression. Therefore, a cross-sectional survey was conducted to explore the association of self-leadership with acute stress responses (ASRs) and acute stress disorders (ASDs) in medics during the COVID-19 epidemic.

METHODS

Self-reported online questionnaires were administered, and 627 participants were finally included. The data were analyzed using the univariate analysis and the logistical regression model to identify whether self-leadership and sociodemographic and epidemic characteristics were associated with mental health, including ASRs and ASDs.

RESULTS

Initially, 790 medics responded. Of these, 627 remained after excluding for invalid questionnaires and those with a substantial amount of missing data. Therefore, the participation validity rate was 79.37%. Frontline medical staff (β = 0.338; p < 0.001), possibility of infection among people around the medic being mild (β = 0.141; p < 0.001), subjective estimation of epidemic duration being 3-6 months (β = 0.074; p < 0.05), self-sets (β = -0.022; p < 0.001), self-punishment (β = 0.229; p < 0.001), belief hypothesis and evaluation (β = -0.147; p < 0.05), and successful foresight (β = 0.105; p < 0.05) were statistically significant with ASRs. Marital status [adjusted odds ratio (AOR) =1.813; 95% CI (1.141, 2.881); p = 0.012], being a frontline worker [AOR = 25.760; 95% CI (14.220, 46.667); p < 0.001], visiting Hubei in the previous 14 days [AOR = 3.656; 95% CI (1.500, 8.911); p = 0.004], self-punishment [AOR = 1.352; 95% CI (1.180, 1.548); p < 0.001], and self-dialogue [AOR = 1.256; 95% CI (11.063, 1.483); p = 0.007] were the risk factors for ASD. Conversely, having frontline medical staff in one's family [AOR = 0.523; 95% CI (0.297, 0.923); p = 0.025], self-sets [AOR = 0.814; 95% CI (0.715, 0.826); p = 0.002], and belief hypothesis and evaluation [AOR = 0.796; 95% CI (0.672, 0.943); p = 0.038] were the protective factors.

CONCLUSION

The special working environment of the COVID-19 epidemic resulted in ASR and ASD. Notably, findings revealed a positive association between ASR symptoms and frontline medical staff, the subjective estimation of epidemic duration, self-punishment, and successful foresight. Nevertheless, marital status, having visited Hubei in the previous 14 days, and self-dialogue were the risk factors accounting for ASD symptoms. Surprisingly, having frontline medical staff in one's family, self-sets, and belief hypothesis and evaluation had potential benefits for ASD symptoms.

The psychological impact of COVID-19 on Chinese healthcare workers: a systematic review and meta-analysis

PURPOSE

This study aimed at investigating five dimensions of the psychological impact (post-traumatic stress symptoms (PTSS), anxiety, depression, sleep disturbance or profession-related burnout) of COVID-19 on healthcare workers (HCW) in China.

METHODS

Studies that evaluated at least one of the five target dimensions of the psychological impact of COVID-19 on HCW in China were included. Studies with no data of our interest were excluded. Relevant Databases were searched from inception up to June 10, 2020. Preprint articles were also included. The methodological quality was assessed using the checklist recommended by AHRQ. Both the rate of prevalence and the severity of symptoms were pooled. The protocol was registered in PROSPERO (CRD42020197126) on July 09, 2020.

RESULTS

We included 44 studies with a total of 65,706 HCW participants. Pooled prevalence rates of moderate to severe PTSS, anxiety, depression, and sleep disturbances were 27% (95% CI 16%-38%), 17% (13-21%), 15% (13-16%), and 15% (7-23%), respectively; while the prevalence of mild to severe level of PTSS, anxiety, and depression was estimated as 31% (25-37%), 37% (32-42%) and 39% (25-52%). Due to the lack of data, no analysis of profession-related burnout was pooled. Subgroup analyses indicated higher prevalence of moderate to severe psychological impact in frontline HCW, female HCW, nurses, and HCW in Wuhan.

CONCLUSION

About a third of HCW in China showed at least one dimension of psychological symptoms during the COVID-19 pandemic, whereas the prevalence of moderate and severe syndromes was relatively low. Studies on profession-related burnout, long-term impact, and the post-stress growth are still needed.

Nurses' mental health from early COVID-19 pandemic to vaccination

AIMS

The influence of the COVID-19 vaccine and the evolution of the pandemic over time on nurses' mental health have not been thoroughly examined. This study aimed to explore the changes in nurses' mental health from the early pandemic to the early vaccination period over a 1-year time span and examine vaccination and coping mechanisms as predictors of nurses' poor mental health and burnout.

METHODS

Three cross-sectional surveys were conducted: Early-pandemic (n = 320), pre-vaccination (n = 228), and early-vaccination cohorts (n = 292).

FINDINGS

About 72% of nurses in the early-vaccination cohort were fully vaccinated with two doses of mRNA COVID-19 vaccines. There were significant decreases in moderate/severe anxiety and moderate/severe depression for the early-vaccination cohort compared to the other cohorts. In multivariate analyses, vaccination had almost three-fold higher odds of moderate/severe anxiety (Odds Ratio [OR] = 2.87; 95% Confidence Interval [CI] = 1.28-6.44). High resilience, family functioning, and spirituality were associated with two- to five-fold lower odds of poor mental health and burnout.

CONCLUSIONS

Although nurses in the early-vaccination cohort had lower anxiety and depression than earlier cohorts, COVID-19 vaccination had minimal associations with nurses' mental health. Coping mechanisms and organizational support appear to be important predictors of nurses' poor mental health and burnout.

CLINICAL RELEVANCE

The evidence gathered over 1 year of the pandemic may be helpful for a better understanding of the challenges facing frontline nurses and preparing for future healthcare crises. As a part of the preparedness plan for the future, evidence-based interventions that raise frontline nurses' resilience, as well as family and spiritual support, should be considered.

Post-Traumatic Growth in Professionals Caring for People with Intellectual Disabilities during COVID-19: A Psychological Intervention

BACKGROUND

Health professionals present a greater vulnerability to the effects of COVID-19 on their mental health, especially those who work with vulnerable groups such as those who suffer from intellectual disability (ID). The objective of the present research was to develop and verify the effectiveness of a psychological intervention for professionals in the field of ID to improve their mental health during this health crisis.

METHODS

A total of 32 professionals participated. The variables measured were: post-traumatic growth, mental health, burnout, coping strategies, resilience, life satisfaction, optimism, and cognitive and affective empathy.

RESULTS

The results revealed statistically significant differences in the post-traumatic growth variable. In the rest of the variables (mental health, burnout, coping strategies, resilience, vital satisfaction, optimism, and empathy), no significant differences between groups were found.

CONCLUSIONS

An increase in the levels of post-traumatic growth was observed in the intervention group after a brief online psychological intervention. However, given the small sample size, these results should be taken with caution. Institutions should foster and promote interventions aimed at reducing the high emotional impact produced by COVID-19 in professionals that care for people diagnosed with ID.

Doctors Dealing With COVID-19 in Pakistan: Experiences, Perceptions, Fear, and Responsibility

This study aimed to describe the dealings of 20 biomedical doctors with coronavirus disease-19 (COVID-19) in the Sindh province of Pakistan. Focusing on physicians from three different hospitals, we describe their challenges, emotions, and views concerning the pandemic. Many regarded the virus from a biomedical standpoint. Yet some also perceived it as a “tool of a proxy war” and a “plot,” without giving agency to anyone for that “plot.” Furthermore, these care providers faced a great fear of infection and an even greater fear of transmitting the virus to their families and friends. A few also feared stigmatization as viral carriers. Whether they experienced fear or not, all of our physician interlocutors emphasized their sense of responsibility to “serve humanity,” yet some also expressed a strong belief in the inevitability of the will of Allah. Some were satisfied with the role of the government in containing the virus, while others expressed concerns and felt that the government should be doing much more. All expressed confidence in the use of personal protective equipment (PPE), viewing it as an effective buffer against viral contagion. We conclude with a call for further research especially ethnographic studies on dealings of physicians with COVID-19 across Pakistan as frontline care providers.

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

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

Risk Perception and Emotion Reaction of Chinese Health Care Workers Varied During COVID-19: A Repeated Cross-Sectional Research

Objectives: To examine risk perception and negative emotions during two periods of the COVID-19 and provide plausible intervention points for the psychological aid under a stressful condition. Methods: The current study adopted the repeated cross-sectional research and was participated by a cohort of Chinese HCWs who were assigned to work at the current disease resistance line. The between-group information about gender, profession, and location was collected in the demographic questionnaire. Risk perception questionnaire was adapted for COVID-19 to assess risk perception and the Chinese version of emotional self-rating scale (PANAS) was used to evaluate HCWs' negative emotions. Results: Findings revealed the risk perception and negative emotions of HCWs varied in different gender, profession, location, as well as different periods of COVID-19. Over the different periods, the predominated negative emotion expressed by HCWs varied, but negative emotion was consistently associated with risk perception and could be a significant indicator of risk perception. Conclusion: The significance of this research lies in its examination of risk perception and negative emotions of HCWs confronting the COVID-19 during two periods of the pandemic, which underscored the importance of monitoring the risk perception and negative emotions of HCWs to ensure safety and prevent the return of the pandemics.

Influencing factors for mental health of general practitioners in Hebei Province under the outbreak of COVID-19: A cross-sectional study

OBJECTIVE

This study aimed to understand the mental health status of general practitioners (GPs) in Hebei Province during the outbreak of coronavirus disease 2019, analyse influencing factors, and establish and evaluate the risk prediction model.

METHODS

During February 25-29, 2020, a self-designed questionnaire was used to conduct an online survey of GPs in Hebei Province. The survey included a questionnaire on GPs' basic information, a questionnaire on GPs' working hardware and software facilities, and a questionnaire on GPs' mental health condition. A total of 1040 participants returned the completely filled valid questionnaire, and the answers were analyzed using the χ² test, Wilcoxon rank-sum test and logistic regression with SPSS 20.0 software. Based on the results of binary logistic regression analysis, a risk prediction model was established, and the receiver operating characteristic curve was used to evaluate the model.

RESULTS

The results showed that 44.2% (460/1040) of GPs expressed anxiety after the outbreak. Absence of prescreening clinics, fever clinics or isolated observation rooms in primary medical institutions; persons in the administrative area required to be isolated; low sleep quality of GPs and less than 6 hours of sleep per day of GPs were risk factors affecting the mental health status of GPs. Also, epidemic-related training and adequate protective equipment were the protective factors for the mental health status of GPs.

CONCLUSION

The government should strengthen the infrastructure construction of community institutions, equip them with sufficient epidemic protection equipment, ensure the rest time of GPs and strengthen mental health training to ensure the mental and physical health of GPs.

Severe Burnout and Poor Mental Health Among Healthcare Workers 6 Months After COVID-19 Pandemic Declaration: What Can We Learn for Future Emergencies?

OBJECTIVES

The aim of this study was to examine the predictors associated with severe burnout and poor mental health among healthcare workers during the COVID-19 pandemic as a learning opportunity for future emergent situations.

BACKGROUND

Modifiable predictors of mental health need to be further examined and quantified to prioritize human resource support in organizations as healthcare workers confront stressful situations.

METHODS

A cross-sectional survey was conducted among 271 healthcare workers from September 8 to October 10, 2020.

RESULTS

Approximately one-third reported severe burnout, as well as moderate/severe anxiety and depression. Feeling protected working with COVID-19 patients, high family functioning, and spirituality were associated with 2- to 4-fold lower odds of severe burnout. Satisfaction with the organization's communications predicted 2-fold lower odds of anxiety, whereas high resilience was associated with almost 4-fold lower odds of stress and depression.

CONCLUSIONS

Healthcare organizations may consider adopting programs to foster resilience, family and spiritual support, and effective communication strategies to reduce burnout and poor mental health among healthcare workers during pandemics and other situations of high stress.

Exploring the factors associated with the mental health of frontline healthcare workers during the COVID-19 pandemic in Cyprus

INTRODUCTION

The spread of COVID-19 into a global pandemic has negatively affected the mental health of frontline healthcare-workers. This study is a multi-centre, cross-sectional epidemiological study that uses nationwide data to assess the prevalence of stress, anxiety, depression and burnout among health care workers managing COVID-19 patients in Cyprus. The study also investigates the mechanism behind the manifestation of these pathologies, as to allow for the design of more effective protective measures.

METHODS

Data on the mental health status of the healthcare workers were collected from healthcare professionals from all over the nation, who worked directly with Covid patients. This was done via the use of 64-item, self-administered questionnaire, which was comprised of the DASS21 questionnaire, the Maslach Burnout Inventory and a number of original questions. Multivariable logistic regression models were used to investigate factors associated with each of the mental health measures.

RESULTS

The sample population was comprised of 381 healthcare professionals, out of which 72.7% were nursing staff, 12.9% were medical doctors and 14.4% belonged to other occupations. The prevalence of anxiety, stress and depression among the sample population were 28.6%, 18.11% and 15% respectively. The prevalence of burnout was 12.3%. This was in parallel with several changes in the lives of the healthcare professionals, including; working longer hours, spending time in isolation and being separated from family.

DISCUSSION

This study indicates that the mental health of a significant portion of the nation's workforce is compromised and, therefore, highlights the need for an urgent intervention particularly since many countries, including Cyprus, are suffering a second wave of the pandemic. The identified risk factors should offer guidance for employers aiming to protect their frontline healthcare workers from the negative effects of the COVID-19 pandemic.

To prevent being stressed-out: Allostatic overload and resilience of general practitioners in the era of COVID-19. A cross-sectional observational study

Background

Responsibility of general practitioners (GPs) in delivering safe and effective care is always high but during the COVID-19 pandemic they face even growing pressure that might result in unbearable stress load (allostatic overload, AO) leading to disease.

Objectives

We aimed to measure AO of Hungarian GPs during the COVID-19 pandemic and explore their recreational resources to identify potential protective factors against stress load.

Methods

In a mixed-method design, Fava’s clinimetric approach to AO was applied alongside the Psychosocial Index (PSI); Kellner’s symptom questionnaire (SQ) to measure depression, anxiety, hostility and somatisation and the Public Health Surveillance Well-being Scale (PHS-WB) to determine mental, social, and physical well-being. Recreational resources were mapped. Besides Chi-square and Kruskal-Wallis tests, regression analysis was applied to identify explanatory variables of AO.

Results

Data of 228 GPs (68% females) were analysed. Work-related changes caused the biggest challenges leading to AO in 60% of the sample. While female sex (OR: 1.99; CI: 1.06; 3.74, p = 0.032) and other life stresses (OR: 1.4; CI: 1.2; 1.6, p < 0.001) associated with increased odds of AO, each additional day with 30 min for recreation purposes associated with 20% decreased odds (OR: 0.838; CI: 0.72; 0.97, p = 0.020). 3–4 days a week when time was ensured for recreation associated with elevated mental and physical well-being, while 5–7 days associated with lower depressive and anxiety symptoms, somatisation, and hostility.

Conclusion

Under changing circumstances, resilience improvement through increasing time spent on recreation should be emphasised to prevent GPs from the adverse health consequences of stress load.