Exploring PTSD in emergency operators of a major University Hospital in Italy: a preliminary report on the role of gender, age, and education

Distressing memories: A continuum from wellness to PTSD

BACKGROUND

Exposure to traumatic events is a frequent source of distress, provoking isolated symptoms such as distressing memories (DM) to full-blown post-traumatic stress disorder (PTSD). We aimed to assess the continuum theory using DM as an isolated symptom, and to examine trauma consequences in a exposed to traumatic events.

METHODS

Using data from the National Epidemiologic Study of Alcohol and Related Conditions III, we assessed the prevalence of DM in a trauma exposed sample, and examined their sociodemographic and lifetime psychiatric correlates, comparing three groups: (i) controls (no DM, no PTSD); (ii) participants with isolated DM without PTSD; (iii) participants with PTSD. We estimated the sensitivity and specificity of DM for PTSD diagnosis.

RESULTS

In our sample of 17,505 participants exposed to trauma, 13 % had PTSD and 42 % had DM without PTSD. The sensitivity of DM for the diagnosis of PTSD was 95.14 %, specificity was 51.91 %. Participants with DM and those with PTSD shared the same socio-demographic correlates. Participants with DM reported more lifetime psychiatric disorders (mood disorders - mainly depressive disorders and bipolar type 1 disorder; anxiety disorders - mainly social anxiety disorder, substance use disorders - mainly opioid use disorder and cannabis disorder; eating disorders - mainly binge eating disorder; personality disorders - mainly borderline personality disorder- and suicidality) than controls, but less than participants with PTSD.

CONCLUSION

DM represent an intermediate state between well-being and post-traumatic stress disorder; DM is also associated with other psychiatric disorders. It should be considered as a transdiagnostic psychiatric symptom useful for clinicians in identifying psychiatric vulnerability.

Posttraumatic Stress and Opioid Use and Pain among Individuals with Probable Posttraumatic Stress Disorder and Self-Reported Chronic Pain: The Role of Health Literacy

BACKGROUND

Chronic pain and opioid misuse are a prevalent comorbidity with deleterious health outcomes. Growing work indicates that posttraumatic stress disorder (PTSD) can increase the risk for chronic pain and opioid misuse and dependence. However, there is little understanding of social determinants of health (SDoH) that may account for interrelations of PTSD with chronic pain and opioid misuse and dependence. Health literacy is one relevant SDoH construct, reflecting the ability to gather, process, and comprehend health-related information required to engage in a healthcare setting.

OBJECTIVE

The purpose of the present cross-sectional study was to examine the indirect effect of health literacy in the association between PTSD and opioid misuse, opioid dependence, pain intensity, and pain disability.

METHOD

The sample included 142 adults (Mage = 35.2, SD = 9.9; 67.4% female; 70.1% White/Caucasian) with self-reported chronic pain and probable PTSD who were using opioid medication.

RESULTS

Results demonstrated that PTSD symptom severity had a small indirect effect on opioid misuse and opioid dependence via health literacy; no indirect effects were evident for pain intensity and disability.

CONCLUSION

The present investigation provides evidence that health literacy may serve as an important explanatory factor in associations between PTSD symptom severity and opioid misuse and dependence among adults with co-occurring probable PTSD and chronic pain.

The relationship between trait mindfulness and resilience: A meta-analysis

Resilience is a positive psychological resource that promotes health. Trait mindfulness was found to be related to resilience. However, previous studies on this relationship have shown contradictory results. The current meta-analysis explored the relationship between trait mindfulness and resilience based on a three-level random-effects meta-analysis model. A significant and positive relationship between trait mindfulness and resilience (r = 0.385; p < 0.0001) was revealed by analyzing 197 effect sizes from 103 studies. Furthermore, the subsequent moderator analysis found that the facet of mindfulness (e.g., awareness, nonjudging) (F(6, 190)  = 6.181; p < 0.001), measurement of mindfulness (e.g., the Mindful Attention Awareness Scale) (F(7, 191)  = 4.758; p < 0.001), aspect of resilience (e.g., family resilience) (F(5, 191)  = 3.455; p < 0.05), measurement of resilience (e.g., the Connor-Davidson Resilience Scale) (F(11, 185)  = 2.256; p < 0.05), and age (F(1, 150)  = 4.588; p < 0.05) acted as significant moderators. Overall, this study confirmed the positive relationship between trait mindfulness and resilience, suggesting that people with higher levels of trait mindfulness were more likely to have higher levels of resilience. The current findings provided insightful information for interventions targeted at improving resilience.

Bereavement Experiences of Families of Elderly Individuals Who Died Due to COVID-19

This study was conducted to evaluate the bereavement experiences of families of elderly individuals who died due to the COVID-19 pandemic. One of the qualitative research methods, the case study method, was used in the study. The sample of the research consisted of 19 people who agreed to participate in the research between April and July 2022. The research data were collected using a Personal Information Form and a Semi-Structured Interview Form, which was created to conduct individual in-depth interviews. As a result of the descriptive analysis, four main themes, the ability to perform religious rituals related to the bereavement experience, feelings and thoughts about death, attitudes of those around after death, and coping strategies in the COVID-19 process. It was determined that individuals had difficulty accepting death, felt inadequate about spirituality due to limited religious rituals, had feelings of despair and guilt, and limitedly utilized social support systems.

Prevalence of burnout and mental health problems among medical staff during the COVID-19 pandemic: a systematic review and meta-analysis

OBJECTIVE

The COVID-19 pandemic has had a significant impact on the burnout and mental health of medical staff. This meta-analysis aims to provide additional (and updated) evidence related to burnout and mental health problems among medical staff using a broader data pool.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

PubMed, Embase, Cochrane Library, CNKI, Wanfang data and three preprint databases (SSRN, bioRxiv and medRxiv) were searched from 1 January 2020 to 17 May 2021.

ELIGIBILITY CRITERIA

We included observational studies investigating the prevalence of burnout and mental health problems among medical staff during the COVID-19 pandemic, including cross-sectional study, cohort study and case-control study.

DATA EXTRACTION AND SYNTHESIS

Two independent reviewers used a self-designed form to extract the primary data. The Joanna Briggs Institute quality appraisal tool was used to assess the quality of selected studies. Heterogeneity among studies was assessed by I² statistic. A random-effects model was used to pool the prevalence. Subgroup analysis was performed to explore between-group differences.

RESULTS

250 studies were included, with a sample of 292 230 participants from 46 countries. The pooled prevalence of burnout, anxiety, depression, insomnia, stress, post-traumatic stress disorder symptoms and somatic symptoms was 43.6% (95% CI 36.3% to 51.2%), 37.1% (95% CI 34.7% to 39.7%), 37.6% (95% CI 35.0% to 40.4%), 43.7% (95% CI 39.1% to 48.5%), 41.3% (95% CI 35.1% to 47.9%), 30.6% (95% CI 23.6% to 38.5%) and 25.0% (95% CI 16.7% to 35.6%), respectively. Subgroup analysis showed a higher prevalence of anxiety, depression and insomnia in frontline workers than in non-frontline workers, and a higher prevalence of anxiety in females than males. Mild cases accounted for the most significant proportion of the outcomes except for stress.

CONCLUSIONS

This study highlights that identifying the risks of burnout and mental health problems and adopting preventive interventions are priorities for policymakers and medical staff to avoid long-term occupational, health and social impacts.

PROSPERO REGISTRATION NUMBER

CRD42021254425.

The impact of pandemic-related stress on attentional bias and anxiety in alexithymia during the COVID-19 pandemic

The COVID-19 pandemic had negative consequences for mental health, yet it is unknown how and to what extent the psychological outcomes of this stressful event are moderated by individual traits. Alexithymia is a risk factor for psychopathology, and thus likely predicted individual differences in resilience or vulnerability to stressful events during the pandemic. This study explored the moderating role of alexithymia in the relationships of pandemic-related stress with anxiety levels and attentional bias. The participants were 103 Taiwanese individuals who completed a survey during the outbreak of the Omicron wave. Additionally, an emotional Stroop task including pandemic-related or neutral stimuli was used to measure attentional bias. Our results demonstrate that pandemic-related stress had a lesser impact on anxiety in individuals with a higher level of alexithymia. Moreover, we found that in individuals with higher exposure to pandemic-related stressors, a higher level of alexithymia indicated less attentional bias toward COVID-19-related information. Thus, it is plausible that individuals with alexithymia tended to avoid pandemic-related information, which could temporarily relieve stressors during the pandemic.

Evaluation of the relationship between theory of mind relating to cognitive performance and post-traumatic stress disorder in Syrian refugee amputees living in Turkey

BACKGROUND

According to the available literature, studies examining the relationship between theory of mind (ToM) and post-traumatic stress disorder (PTSD) have a small sample size and are few in number.

AIMS

This study aims to investigate the relationship between the potential presence of PTSD in Syrian refugee amputees living in Turkey, ToM skills measured by Reading the Mind in the Eyes Test (RMET), and variables related to amputation.

METHOD

Our 69 follow-up amputee patients answered a socio-demographic and amputation data form, and the RMET, PTSD checklist for DSM-5 (PCL-5), and Beck Depression Inventory-II (BDI-II) completed a ToM task.

RESULTS

Those with potential PTSD were significantly less educated than those without (p = .017). Prosthesis usage time (p = .002) and duration of post-amputation (p = .033) were significantly shorter in those with potential PTSD compared to those without. The RMET neutral valence (p = .035) and RMET total (p = .017) accuracy scores were significantly lower in patients with potential PTSD. Those with potential PTSD were higher significantly more depressed (p < .001). In our regression analyses, lower education level (p < .05), shorter prosthesis usage time (p = .008), and lower RMET neutral valence (p = .006) / RMET total (p = .032) accuracy scores predicted the presence of potential PTSD.

CONCLUSIONS

Lower education level, prosthesis use for a shorter period, and poor mind-reading skills from neutral and total eye expressions were predictive of the potential presence of PTSD in amputees, even though they were largely exposed to similar traumas. Our findings suggest that treatment and follow-up of PTSD should also target deficits in cognitive and emotional abilities.

Predictors and comorbidity patterns of maternal birth-related posttraumatic stress symptoms: A Latent Class Analysis

Birth-related posttraumatic stress symptoms (PTSS) place a significant burden on mothers and their families. The aim was to (1) identify differential profiles of maternal birth-related PTSS; (2) determine the predictive value of established risk factors; (3) examine comorbidity patterns related to depression and anxiety symptoms. As part of the Norwegian Ahus Birth Cohort, 2,088 (expectant) mothers completed self-report questionnaires from 17 weeks of gestation to 2 years postpartum. The Impact of Event Scale was used to assess PTSS 8 weeks after birth. Latent class analysis revealed four latent classes: a High birth-related PTSS class (4%), a Moderate birth-related PTSS class (16%) particularly characterized by endorsement of intrusion symptoms, a Mild birth-related PTSS class (47%), as well as a No birth-related PTSS class (33%). We found similar (younger age, worse subjective birth experience, higher fear of childbirth) and differential predictors (prior posttraumatic stress disorder, lower education, birth complications). Women classified with High, Moderate, or Mild birth-related PTSS showed higher depression and anxiety symptoms compared to women with No birth-related PTSS. A considerable number of mothers experienced birth-related PTSS, most on a subclinical level, but these women still showed signs of mental distress 2 years postpartum, calling for more universal prevention approaches.

Post-traumatic stress symptoms and burnout in healthcare professionals working in neonatal intensive care units: Results from the STRONG study

BACKGROUND

Newborns' deaths and life-threatening conditions represent extremely stressful events for parents and professionals working in NICUs, facilitating the onset of secondary traumatic stress symptoms. The STRONG study aims to better understand the psychological impact on Italian NICUs staff of bereavement care.

METHODS

The STRONG (STress afteR lOss in NeonatoloGy) study is a cross-sectional study based on a web survey consisted of four sections: sociodemographic, CommuniCARE-Newborn questionnaire, the Maslach Burnout Inventory and the Impact of Event Scale-Revised.

RESULTS

227 NICU workers (42.7% nurses, 23.3% midwives, 22.2% physicians, 11.8% other HCPs) answered the survey. The hardest tasks were "communicating baby's death" and "informing on autopsy results"; 44.7% of HCPs did not receive formal training in communicating bad news, 44.2% 'learned from the field' by watching other colleagues; 41.2% declared that they do not have any communication strategy. More than 90% of professionals thought that training on bereavement care is necessary. The majority of HCPs showed some degree of post-traumatic stress symptoms: 34% medium and 35.3% severe. Professionals with training in bereavement care and/or in communication had less probability to develop stress symptoms. A multivariate analysis showed that higher levels of burnout were associated with 4 or more monthly losses and medium or severe stress symptoms. Having a well-defined communication strategy for breaking bad news was independently associated with a better personal accomplishment.

CONCLUSION

Dealing with newborns' deaths is a highly stressful task; professionals should receive proper support such as debriefing, psychological support and training in order to prevent post-traumatic stress symptoms and reduce professional burnout.

Post Traumatic Growth (PTG) in the Frame of Traumatic Experiences

The psychopathological consequences of traumatic experiences have been object of study from the beginning of medical science. During the last centuries, the scientific literature in the field of mental health mainly focused on the negative consequences of traumatic events. More recently, increasing interest was paid to the features of resilience and to the possible positive consequences of trauma, leading to the concept of Post Traumatic Growth (PTG). However, the eventual co-existence of both the conditions should also be considered. The role of vulnerability and environmental factors in the balance between positive and negative outcomes after life events is discussed, particularly in light of a neurodevelopmental approach to psychopathology.

Analysis of Symptom Characteristics, Influencing Factors, and Their Predictive Value for Posttraumatic Stress Disorder in Nurses: A Cross-Sectional Questionnaire Study

Nurses often face a variety of nursing-related stresses, making them more prone to symptoms of posttraumatic stress disorder (PTSD). We aimed to explore symptom characteristics, influencing factors, and their predictive value for PTSD in nurses, so as to prevent the occurrence of PTSD in nurses. This was a cross-sectional study conducted in two tertiary hospitals in Yangzhou. A total of 1290 valid questionnaires were received in our study, and 190 nurses (14.7%) were positive for PTSD symptoms. The results show that individuals with higher scores on the Perceived Stress Scale-10 (PSS-10), Patient Health Questionnaire-15 (PHQ-15), Generalized Anxiety Disorder Scale-7 (GAD-7), and maladaptive cognitive emotion regulation strategies questionnaire (maladaptive CERS) were more likely to experience PTSD symptoms, whereas those with lower scores on the Perceived Social Support Scale (PSSS) were more likely to experience PTSD symptoms. Compared with the PSS-10, PHQ-15, and PSSS, GAD-7 and maladaptive CERS had higher predictive value. This study provided the optimal threshold of relevant factors that may have a positive effect on the prevention of PTSD symptoms. This has guiding implications for active prevention and intervention in some institutions.

Somatic, Emotional and Behavioral Symptomatology in Children during COVID-19 Pandemic: The Role of Children's and Parents' Alexithymia

The COVID-19 pandemic has deeply affected the psychophysical wellbeing of children worldwide. Alexithymia, a personality trait involving difficulties in identifying and expressing feelings represents a vulnerability factor for stress-related disorders. Under pandemic stress exposure, we aimed to investigate the role of parents' and children's alexithymia in the psychophysical symptomatology shown by children and to evaluate possible differences according to age, gender and history of COVID-19 infections. The perception of parents and children about the impact of the pandemic on children's emotional, social and physiological wellbeing was also explored. Sixty-five familial triads were surveyed in the period from March to May 2022: children (n = 33 males; mean age = 9.53, sd = 1.55), mothers (mean age = 44.12; sd = 6.10) and fathers (mean age = 47.10; sd = 7.8). Both parental and children's alexithymia scores were significantly associated with somatic and externalizing symptomatology in children. Self-reported anger and externally oriented thinking scores were higher in younger children (age 8-9.9 years) than in older ones (10-12 years). Girls scored higher than boys in somatic complaints, as reported by parents. No difference emerged between children affected/not affected by COVID-19. Notably, children reported a greater negative impact of the pandemic on their emotional and psychosocial well-being than their parents. The findings emphasize the role of alexithymia in the occurrence of psychophysical symptoms in children during the COVID-19 pandemic. The reduced parental awareness of the emotional burden imposed by the pandemic on children indicates the need to better consider how epidemics affect children's mental health and to develop adequate preventive strategies to support them in these exceptional times.

Posttraumatic Stress Disorder Among Health Care Workers During the COVID-19 Pandemic

BACKGROUND

Coronavirus disease 2019 (COVID-19) has taken a significant toll on people worldwide, and in particular, on the health care workers (HCWs) who have worked on the frontlines in the fight against the pandemic. The goal of this study was to investigate the prevalence of posttraumatic stress disorder (PTSD) and related factors in HCWs in the era of COVID-19.

METHODS

This cross-sectional survey study was conducted between September 15, and October 15, 2020, among HCWs in Turkey. The survey consisted of self-administered questionnaires, which included questions about sociodemographic variables, experiences caring for patients with COVID-19, and the Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5), a trauma screening tool. The online survey was completed by 1833 HCWs. Univariate and multivariate logistic regression analyses were used to identify independent predictors of PTSD.

RESULTS

The mean age of the participants was 32.7±7.0 years; 81.9% were physicians, and 56.5% were female. The rates of COVID-19 history in the respondents, a family member, or a coworker were 13.6%, 32.3%, and 12.6%, respectively. Among the HCWs who participated, 39.9% met the criteria for PTSD. Compared with the physicians, the nonphysician HCWs had a higher rate of PTSD (49.5% vs. 36%) (P<0.001) and higher PCL-5 scores (53.31±19.6 vs. 42.5±20.3) (P<0.001). In addition, 9.7% of the surveyed HCWs reported having suicidal ideation during the COVID-19 pandemic. Independent predictors of PTSD in HCWs were working on a COVID-19 unit, feeling isolated, suicidal ideation, being a nonphysician HCW, fear of spreading coronavirus to family, female sex, and a history of having COVID-19.

CONCLUSIONS

HCWs were at risk for impairment in mental well-being in the era of COVID-19, with a significant number experiencing PTSD as well as suicidal ideation. Therefore, HCWs, especially those who are working on a COVID-19 unit and are female, should be monitored regularly for PTSD.

A qualitative, cross-cultural investigation into the impact of potentially traumatic work events on Saudi and UK ambulance personnel and how they cope

Background

Post-traumatic stress disorder (PTSD) is common among ambulance personnel, but its prevalence varies between developed and developing countries. This study aimed to investigate the lived experience of potentially traumatic work events between Saudi and UK ambulance personnel.

Methods

Semi-structured interviews with 16 ambulance workers from Saudi Arabia and the United Kingdom (8 participants from each country) were conducted to explore their lived experiences of potentially traumatic events at work. Data were analyzed using thematic analysis.

Results

Four key themes were identified from interviews: (1) some events are inherently more stressful than others; (2) pressure of organizational and interpersonal stressors; (3) convergence and divergence in cross-cultural coping strategies; and (4) preferring formal and confidential support.

Conclusions

There were differences in the nature of traumatic events and the ways of coping between the two cultures, but paramedics in both cultures had an agreement about their preference for individual and formal support. The results of this study may help inform the development of interventions and PTSD prevention programs for ambulance personnel.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12873-022-00666-w.

The role of alexithymia and perceived stress in mental health responses to COVID-19: A conditional process model

BACKGROUND

Little is known about the psychological mechanisms underlying the mental health problems related to the COVID-19 pandemic. Hypothetically, perceived stress and alexithymia may be factors involved in the mental distress response to the pandemic; however, this remains largely unstudied. This study aims to explore the moderating role of alexithymia and the moderated mediation effects of perceived stress on the mental health change due to the pandemic.

METHODS

The conditional process model was used to examine the moderated mediation. The sample consists of 659 parents from the FinnBrain Birth Cohort Study who completed the Toronto Alexithymia Scale (TAS-20) at 6 months after delivery, the Edinburgh Postnatal Depression Scale (EPDS) and the Symptom Checklist-90 (SCL-90) at 2 or 4 years postpartum between 2014 and 2019; and a questionnaire for pandemic events, a brief 4-item version of the Perceived Stress Scale (PSS-4) and the follow-up EPDS/SCL-90 in 2020 after 3 months from the outbreak of COVID-19 pandemic in Finland.

RESULTS

Alexithymia moderated the perceived stress-mediated relations between the pandemic events and the changes of depressive and anxiety symptoms through enhancing the detrimental effect of perceived stress on mental health.

LIMITATIONS

This study was mainly limited by the causality and generalizability of the findings.

CONCLUSIONS

Our findings indicate the moderated mediation effects of alexithymia and perceived stress on the psychological symptoms, which has implications for understanding how and when stressful situations translate to mental health problems, identifying vulnerable individuals, and tailoring preventive and psychotherapeutic interventions.

A Public Health Perspective of Post-Traumatic Stress Disorder

Trauma exposure is one of the most important and prevalent risk factors for mental and physical ill-health. Prolonged or excessive stress exposure increases the risk of a wide variety of mental and physical symptoms, resulting in a condition known as post-traumatic stress disorder (PTSD). The diagnosis might be challenging due to the complex pathophysiology and co-existence with other mental disorders. The prime factor for PTSD development is exposure to a stressor, which variably, along with peritraumatic conditions, affects disease progression and severity. Additionally, many factors are thought to influence the response to the stressor, and hence reshape the natural history and course of the disease. With sufficient knowledge about the disease, preventive and intervenient methods can be implemented to improve the quality of life of the patients and to limit both the medical and economic burden of the disease. This literature review provides a highlight of up-to-date literature on traumatic stress, with a focus on causes or triggers of stress, factors that influence response to stress, disease burden, and the application of the social-ecological public health model of disease prevention. In addition, it addresses therapeutic aspects, ethnic differences in traumatic stress, and future perspectives, including potential biomarkers.

Effectiveness of mindfulness-based intervention on post-traumatic stress symptoms among emergency nursing students

Background

Clinical training stress may negatively affect nursing students’ academic achievement, clinical performance, learning outcomes, well-being, general health, and quality of life. This study aimed to evaluate the effect of mindfulness-based intervention on post-traumatic stress symptoms among emergency nursing students. This study was conducted at the technical institute of nursing, Zagazig University. Three tools were used in the current study: the sociodemographic data sheet, the impact of event scale, and the 15-item Five-Facet Mindfulness Questionnaire.

Results

Emergency nursing students had a wide range of PTSS at the pre-intervention period. These symptoms significantly improved after the implementation of a mindfulness-based intervention. Mindfulness level also improved after the intervention. Post-traumatic stress symptoms were positively correlated with the number of training hours and negatively correlated with students’ age, mother’s occupation, and educational level.

Conclusions

Mindfulness-based intervention was effective in reducing post-traumatic stress symptoms among emergency nursing students.

The impact of COVID-19 on social support perception and stress of prehospital care providers

Background

This study seeks to explore the impact of COVID-19 outbreak on the social support perception and acute stress disorder of prehospital care providers (PCPs) in the province of Denizli.

Methods

This descriptive and cross-sectional study was conducted between December 25, 2020 and January 25, 2021. Out of 510 ambulatory care staff constituting the study population, there were 287 PCPs (%56.2), including 13 physicians, 89 paramedics, 134 emergency medical technicians, and 51 individuals from other occupational groups (nurse, driver, cleaning staff, medical secretary) based at emergency health services. The data collection tools employed in the study include an introductory information form, Multidimensional Scale of Perceived Social Support (MSPSS), and National Stressful Events Survey Acute Stress Disorder Short Scale (NSESSS), which was organized as an online questionnaire.

Results

We analyzed the data from 287 PCPs that completed the form and scales. The mean score of the NSESSS was calculated as 1.53 ± 0.79. The PCPs who experienced health problems (1.85 ± 0.69), suffered from mental problems and received psychotherapy and medication (2.57 ± 0.57), encountered COVID-19 patients (1.58 ± 0.8), provided care for COVID-19 patients (1.59 ± 0.79), and took polymerase chain reaction (PCR) tests (1.68 ± 0.78) had higher acute stress symptom levels. The total mean score of MSPSS was calculated as 66.28 ± 17.22. Total MSPSS scores of the participants varied significantly in terms of age, marital status, taking a COVID-19 test, suffering from mental problems, status of encountering a COVID-19 patient, and workplace satisfaction (p < 0.05).

Conclusions

The findings are suggestive of high perceptions of multidimensional social support and low acute stress symptom levels of the PCPs during the COVID-19 pandemic period.

PREVALENCE AND PREDICTORS OF POSTTRAUMATIC STRESS DISORDER, DEPRESSION, AND ANXIETY IN PERSONNEL WORKING IN EMERGENCY DEPARTMENT SETTINGS: A SYSTEMATIC REVIEW

BACKGROUND

Professionals working in the emergency department (ED) are regularly exposed to traumatic events. Rates of posttraumatic mental health conditions vary widely in the literature and there is no agreement that rates in ED staff are elevated relative to other populations.

OBJECTIVE

We conducted a systematic review of international literature reporting prevalence of posttraumatic stress disorder (PTSD), depression, and anxiety in ED personnel to determine whether prevalence is elevated compared to the general community, and to evaluate convergent evidence across the literature for predictive factors. To our knowledge, there is no comprehensive review on this topic in the literature at this time.

METHODS

Seven databases were searched for studies reporting rates of PTSD, depression, and anxiety in ED personnel. Two independent researchers screened studies and assessed quality using Munn's Prevalence Critical Appraisal Instrument. Best-evidence synthesis determined whether conditions demonstrated elevated prevalence compared to the general population of Canada, a conservative benchmark.

RESULTS

Twenty-four studies from 12 countries and a combined sample size of 4768 were included. PTSD rates ranged from 0% to 23.6% (mean 10.47%), depression ranged from 0.7% to 77.1% (mean 24.8%), and anxiety rates ranged from 2.4% to 14.6% (mean 9.29%). Each condition was elevated compared to the general population. Sociodemographic variables were not consistent predictors. Elevated PTSD seemed most strongly related to workplace exposure and maladaptive coping.

CONCLUSIONS

ED professionals have an elevated risk of experiencing PTSD, depression, and anxiety. Identification of organizational and workplace predictors are needed to inform interventions that will reduce risk and provide optimal treatment and management of PTSD, depression, and anxiety in ED settings.

Supporting business educators and students against COVID-19 trauma using trauma-focused cognitive behavioral therapy

BACKGROUND

The outbreak of COVID-19 manifests in peoples' mental health and psychological dispositions and may also result to acute distress, depression, anxiety and post-traumatic stress disorder (PTSD) on victims. The objective of this study was to support business educators' and students' mental health against coronavirus trauma using trauma-focused cognitive behavioral therapy (TF-CBT).

METHODS

The participants (n = 74 - educators and students) who indicated PTSD symptoms based on the self-reporting questionnaire they filled, were randomly assigned to treatment and waitlist control groups. The TF-CBT manual was used for the intervention. The intervention was a 14-week treatment with 2 weeks follow-up meeting. Using repeated measures of Analysis of Variance, we determined the level of improvement of each participant in the treatment group against Coronavirus trauma at the end of the intervention.

RESULTS

The study established that gender has no significant difference in determining the effects of Coronavirus trauma on participants. Through intervention, the PTSDs and depression arising from Coronavirus event were significantly reduced in the treatment group. Again, there was a significant improvement in the participants' general mental health at the end of the intervention. Hence, we established the implication for research and practice in line with the outcome of the study. The study advocates that TF-CBT should be employed by educational institutions in Nigeria to cushion the traumatic effects of coronavirus and future disasters on both workers and students.

CONCLUSION

We conclude that mental health problems remain a serious challenge among business educators and students in this COVID-19 pandemic era. The study established that low educational qualifications, PTSD symptoms and negative coping strategies are the factors aggravating the general low mental health of the study participants. Finally, we advocate that the educational institutions in Nigeria should adopt TF-CBT interventions to support staff and students' mental health against adverse effects of COVID-19.

Psychological Impact of the Very Early Beginning of the COVID-19 Outbreak in Healthcare Workers: A Bayesian Study on the Italian and Swiss Perspectives

Background

We investigated the COVID19-related psychological impact on healthcare workers in Italy and in Italian-speaking regions of Switzerland, three weeks after its outbreak. All professional groups of public hospitals in Italy and Switzerland were asked to complete a 38 questions online survey investigating demographic, marital and working status, presence of stress symptoms and need for psychological support.

Results

Within 38 h a total of 3,038 responses were collected. The subgroup analysis identified specific categories at risk according to age, type of work and region of origin. Critical care workers, in particular females, reported an increased number of working hours, decline in confidence in the future, presence of stress symptoms and need for psychological support. Respondents reporting stress symptoms and those with children declared a higher need for psychological support.

Conclusions

The large number of participants in such a short time indicates for a high interest on topic among health-care workers. The COVID19 outbreak has been experienced as a repeated trauma for many health-care professionals, especially among female nurses' categories. Early evidence of the need of implementating short and long-term measures to mitigate impact of the emotional burden of COVID-19 pandemic are still relevant.

The Correlates of Post-Traumatic Stress Disorder in Ambulance Personnel and Barriers Faced in Accessing Care for Work-Related Stress

We investigated factors associated with increased risk for post-traumatic stress disorder (PTSD) in ambulance personnel and the barriers faced in accessing support for work-related stress (WRS). A cross-sectional study of 388 ambulance personnel used self-administered questionnaires to assess for PTSD and level of occupational stressors: Impact of Event Scale-Revised, Emergency Medical Services (EMS) Critical Incident Inventory, EMS Chronic Stress Questionnaire, SF-36 Quality of Life and the Connor–Davidson Resilience Scale. The prevalence of PTSD in the study population was 30%. The participants were predominantly female (55%), with a median age of 38 (IQR; 31–44) years. PTSD was associated with smoking (OR = 1.76, 95% CI: 1.05–2.95), illicit drug use (OR = 16.4, 95% CI: 1.87–143.86) and problem drinking (OR = 3.86, 95% CI: 1.80–8.23). A self-reported mental health condition (OR = 3.76, 95% CI: 1.96–7.21), being treated for a medical condition (OR = 1.95, 95% CI: 1.22–3.11), exposure to critical incident stress (OR = 4.27, 95% CI: 2.24–8.15) and chronic WRS (OR = 4.46, 95% CI: 1.93–10.31) were associated with PTSD risk. Barriers to seeking help included concerns that services were not confidential and the negative impact on the participant’s career. The increased levels of WRS, strong associations with substance use and barriers to accessing care offer starting points for workplace interventions to reduce the impact of PTSD in ambulance personnel.

The interplay between acute post-traumatic stress, depressive and anxiety symptoms on healthcare workers functioning during the COVID-19 emergency: A multicenter study comparing regions with increasing pandemic incidence

BACKGROUND

Healthcare workers (HCWs) deployed to the frontline during the COVID-19 pandemic are at risk for developing mental disorders, with a possible impact on their wellbeing and functioning. The present study aimed at investigating post-traumatic stress symptoms (PTSS), anxiety and depressive symptoms and their relationships with impairment in the functioning impairment among frontline HCWs from three Italian regions differently exposed to the first wave of the COVID-19 emergency: Tuscany (low), Emilia-Romagna (medium) and Lombardy (high).

METHODS

514 frontline HCWs were consecutively enrolled in hospital units devoted to the treatment of COVID-19 patients. They completed the IES-R, PHQ-9 and GAD-7 to assess PTSS, depressive and anxiety symptoms respectively, and the WSAS to investigate functioning impairment.

RESULTS

A total of 23.5% of HCWs reported severe PTSS, 22.4% moderate-severe anxiety symptoms, 19.3% moderate-severe depressive symptoms and 22.8% impairment in global functioning. HCWs from the higher-exposure regions reported significantly higher scores in all instruments than those from lower-exposure regions. In a multiple linear regression model, PTSS, depressive and anxiety symptoms presented a significant positive association with the functioning impairment. Both PTSS and depression resulted to be independently related to functioning impairment.

LIMITATIONS

The cross-sectional design and the use of self-report instruments.

CONCLUSIONS

Depressive and PTSS appear to be the greatest contributors to functioning impairment in HCWs exposed to a massive stressful sanitary event as the COVID-19 pandemic. A more accurate assessment of work-related mental health outcomes in such population could help planning effective prevention strategies and therapeutic interventions.

A longitudinal study of post-traumatic stress, depressive and anxiety symptoms trajectories in subjects with Bipolar Disorder during the COVID-19 pandemic

Background

Bipolar disorder (BD) is recognized to be at high risk for developing negative psychopathological sequelae to potentially traumatic events. Nevertheless, scant data are still available about the effects of the COVID-19 emergency on the clinical course of BD. The present study examined prospectively the development and trajectories of post-traumatic stress, depressive, and anxiety symptoms among subjects with BD that were followed in an outpatient psychiatric clinic at the time of pandemic onset.

Methods

A cohort of 89 subjects with BD was enrolled during the first wave of the COVID-19 pandemic, and assessed at baseline (T0), 2-months (T1), and 6-months (T2) follow-up. A K-means cluster analysis was used to identify distinct trajectories of depressive, anxiety, and post-traumatic stress symptoms during the three time points.

Results

We identified three trajectories: the Acute reaction (13.5%); the Increasing severity (23.6%); and the Low symptoms (62.9%) groups, respectively. In the Acute reaction group a significant prevalence of female gender was reported with respect to the Low symptoms one. Subjects in the Increasing severity group reported significantly lower employment rate, and higher rate of relatives at risk for COVID-19 medical complications. Subjects in the Increasing Severity group reported higher rates of previous hospitalization and manic symptoms at baseline than those included in the Low symptoms one.

Conclusions

Our results describe three distinct symptom trajectories during the COVID-19 emergency in a cohort of subjects suffering from BD, suggesting the need of a long-term follow-up for detecting the impact of the COVID-19 pandemic in this vulnerable population.

ANALYSIS OF POST-TRAUMATIC STRESS DISORDER IN NURSING PROFESSIONALS DURING THE COVID-19 PANDEMIC

ABSTRACT Objective to analyze the prevalence of Post-Traumatic Stress Disorder and factors associated with its development in Nursing professionals during the COVID-19 pandemic. Method an observational, analytical and cross-sectional study conducted with 309 Nursing professionals, using a questionnaire to assess sociodemographic data and work-related information, in addition to the Impact Event Scale - Revised, which aims at collecting diverse information related to Post-Traumatic Stress Disorder symptoms. Results the study participants were 176 nurses and 133 nursing technicians: 83.82% female and 56.96% male nurses. As for the hour load, 55.66% asserted working up to 40 weekly hours 47.90% had more than one employment contract, 89.32% were active in the front line against the pandemic, and 60.19% reported an increase in workload. However, 64.40% presented symptoms or were diagnosed with COVID-19 and 43.37% indicated emotional impairment. Using the classifications of the overall Impact Event Scale - Revised score, 29 (53.40%) obtained scores of at least 33, the cutoff point for likely diagnosis of Post-Traumatic Stress Disorder. Conclusion it was evidenced that more than half of the study sample presented a high risk of developing Post-Traumatic Stress Disorder in the Impact Event Scale - Revised scale. Factors associated with the development of Post-Traumatic Stress Disorders in Nursing professionals during the COVID-19 pandemic include use of psychotropic drugs, age up to 35 years old, and occurrence of physical and emotional changes.

ANÁLISE DO TRANSTORNO DO ESTRESSE PÓS-TRAUMÁTICO EM PROFISSIONAIS DE ENFERMAGEM DURANTE A PANDEMIA DA COVID-19

RESUMO Objetivo analisar a prevalência de Transtorno de Estresse Pós-Traumático e os fatores associados ao desenvolvimento do Transtorno de Estresse Pós-Traumático em profissionais de enfermagem durante a pandemia da COVID-19. Método estudo observacional, analítico e transversal, realizado com 309 profissionais de enfermagem, utilizando questionário para avaliar dados sociodemográficos e informações sobre o trabalho, além da Escala do Impacto do Evento - Revisada (IES-R), que visa coletar informações relacionadas à sintomatologia do Transtorno de Estresse Pós-Traumático. Resultados o estudo contou com 176 enfermeiros e 133 técnicos de enfermagem, sendo 83,82% do sexo feminino e 56,96% de enfermeiros. Quanto ao trabalho, 55,66% possuíam carga horária de até 40 horas semanais, 47,90% tinham mais de um vínculo, 89,32% atuaram na linha de frente da pandemia e 60,19% apontaram aumento da carga de trabalho. Não obstante, 64,40% apresentaram sintomas ou foram diagnosticados com COVID-19 e 43,37% apontaram prejuízo emocional. Utilizando as classificações do escore geral da Escala do Impacto do Evento - Revisada, 29, 53,40% atingiram pontuação maior ou igual a 33, ponto de corte para o provável diagnóstico de Transtorno do Estresse Pós-Traumático. Conclusão foi evidenciado que mais da metade da amostra do estudo apresentou na escala Escala do Impacto do Evento - Revisada alto risco de desenvolver Transtorno do Estresse Pós-Traumático. Como fatores associados ao desenvolvimento do Transtorno de Estresse Pós-Traumático em profissionais de enfermagem durante a pandemia da COVID-19, estão o uso de medicamentos psicotrópicos, idade até 35 anos, mudança financeira e emocional.

Mental health assessment of Spanish healthcare workers during the SARS-CoV-2 pandemic. A cross-sectional study

INTRODUCTION

The SARS-CoV-2 outbreak is posing unprecedented care scenarios, increasing the psychological distress among healthcare workers while reducing the efficiency of health systems. This work evaluated the psychological impact of the Covid-19 pandemic on Spanish frontline healthcare workers of two tertiary hospitals.

MATERIAL AND METHODS

Healthcare workers were recruited from the medical units designated for the care of Covid-19 patients. The psychological assessment consisted of an individual, face-to-face session where gold-standard psychometric tests were administered to assess stress (VASS & PSS-10), anxiety (STAI), depression (PHQ-2) and posttraumatic stress disorder (PCL-5). Regression models were also fitted to identify predictors of psychological distress.

RESULTS

Overall, almost 13% of healthcare workers showed severe anxiety, while more than 26% had high levels of perceived stress. More than 23% presented severe posttraumatic stress symptoms, and another 13% had PHQ-2 scores equal to or above 3, compatible with Major Depressive Disorder (MDD) diagnosis, respectively. Women, stress-related medication, overworking, performing in Covid-19 wards, and substance abuse were risk factors for increased psychological distress. Instead, practising exercise reduced the burden.

CONCLUSION

This study outlines the severe psychological impact of the Covid-19 pandemic on Spanish frontline healthcare workers. The stress, depression and anxiety levels found were similar to those reported in similar works but much higher than in Wuhan healthcare workers. Knowledge of risk factors for increased psychological distress may help to develop comprehensive intervention strategies to prevent, control and reduce the mental health exacerbation of healthcare workers, thereby maintaining the effectiveness of health systems in critical scenarios.

“We will make you feel safe”: Female medical staff's experiences of meeting with raped women in Sweden

The focus of this study was on female emergency medical personnel's experiences of treating women who have been raped and on their own experiences of being women themselves working in this situation. We interviewed 12 female medical personnel in four focus groups of two to five participants each. The material was analysed using inductive thematic analysis. Participants’ experiences were structured under two main themes: Prerequisites for care and Effects on oneself. As women, the participants emphasized their understanding of other women and stressed the importance of offering flexible care and taking time with each patient. They described how their work affected them personally, making them increasingly aware of men's violence against women and their need for support from their colleagues. They also discussed structural barriers to both patient care and self-care. If unaddressed, such shortcomings risk negatively affecting raped women seeking medical care and may also be detrimental to the health and well-being of the professional offering care.

Gender and occupational role differences in work-related post-traumatic stress symptoms, burnout and global functioning in emergency healthcare workers

OBJECTIVES

To explore gender and occupational role impact on work-related Post-Traumatic Stress Symptoms, Post-Traumatic Stress Disorder, burnout and global functioning in a sample of emergency healthcare workers.

DESIGN

A cross-sectional study.

PARTICIPANTS/SETTING

126 healthcare workers of the Emergency Department, including Intensive Care Unit, Emergency Room and Emergency Medicine, of a major University Hospital in central Italy were recruited.

MAIN OUTCOME MEASURES

Participants were assessed by means of the: Trauma and Loss Spectrum-Self Report (TALS-SR) to explore Post-Traumatic Stress Spectrum Symptoms, Professional Quality of Life (ProQOL) Scale to assess Compassion Satisfaction, Burnout and Compassion Fatigue and Work and Social Adjustment Scale (WSAS) to measure global functioning.

RESULTS

The present findings showed females were more prone to develop Post-Traumatic Stress Symptoms, particularly re-experiencing (p = .010) and hyperarousal (p = .026) symptoms and medical doctors reporting higher Burnout (p < .001) and lower Compassion Satisfaction (p = .009) mean scores than nurses. Higher levels of functioning impairment emerged amongst medical doctors rather than nurses, in both social (p = .029) and private (p = .020) leisure activities. Linear correlations highlighted relationships between the TALS-SR, ProQOL and WSAS scores. Finally, medical doctor status was significantly associated with lower Compassion Satisfaction (p = .029) and higher Burnout (p = .015).

CONCLUSION

Our results highlight high post-traumatic stress symptoms and burnout levels in emergency healthcare workers with a relevant impact of female gender and occupational role, supporting the need for preventive strategies, also in light of the current COVID-19 pandemic.

Mediating Role of Stress at Work in the Relationship of Alexithymia and PTSD among Emergency Call Operators

Aim: The main purpose of this research was to investigate the relationship between alexithymia, stress at work, and post-traumatic stress disorder (PTSD) in impact emergency call center operators working in Poland (province of Greater Poland). The risk of exposure to critical life events was also considered. Methods: Data were collected using self-report questionnaires administered after dispatchers’ shifts. The emergency call center operators (N = 66) completed the Impact of Event Scale—Revised, 20-item Toronto Alexithymia Scale, Workplace Perceived Stress Questionnaire, and a questionnaire measuring the frequency and intensity of potentially traumatic events faced by emergency operators (a questionnaire developed by the authors). Results: Twenty of the most frequent events (e.g., child sexual harassment, rape, etc.) were identified. Results indicated that post-traumatic stress positively correlated with (a) work-related stress and (b) one aspect of alexithymia: difficulty expressing feelings. Additionally, work-related stress was identified as a mediator for the relation between alexithymia and the intensity of post-traumatic stress. Conclusions: The results of this study confirm that emergency operators are a high-risk group for the development of PTSD. The study results suggest that performing the work of an emergency dispatcher is not only demanding but also inherently involves participation in potentially traumatic events (as encountered through emergency calls).

Post-traumatic stress symptoms in an Italian cohort of subjects complaining occupational stress

OBJECTIVE

Work-related stress presents a significant impact on work performance and physical health. It has been associated with the onset of a multitude of symptoms. The main aim of this investigation is to better understand the impact of post-traumatic stress symptomatology, using a specific self-assessment questionnaire, in subjects experiencing occupational stress with the rationale to address the variegated symptoms expressed by this particular population in a post-traumatic dimensional perspective.

METHODS

Authors collected socio-demographic, occupational, and clinical data. They utilized Trauma and Loss Spectrum Self Report (TALS-SR), a questionnaire investigating post-traumatic stress symptoms. The population size was 345 subjects who presented at the Occupational Health Department of a university hospital over a 3 years period (2016-2018).

RESULTS

Data analysis revealed 33.9% of subjects who met post-traumatic stress disorder (PTSD) criteria. Gender distribution of this set was (36.4% female, 31% male). A family history or personal history of mental disorders were related to higher scores in almost all TALS-SR domains and were related, respectively, to higher scores of criterion B "intrusion symptoms" (P = .014), criterion D "negative alterations in cognitions and mood" (P = .023), and criterion E "arousal" (P = .033) of PTSD. Differences in TALS-SR scores also emerged based on age and gender.

CONCLUSIONS

PTSD symptoms manifest at a significant level in those who experience work-related stress. Personal background of individuals, both in terms of family and personal history for mental disorders, seems to increase their vulnerability to develop post-traumatic stress symptoms. This study suggests the importance of evaluating occupational stress from a post-traumatic stress perspective also at an early stage.

What Is the Role of Resilience and Coping Strategies on the Mental Health of the General Population during the COVID-19 Pandemic? Results from the Italian Multicentric COMET Study

The effects of the COVID-19 pandemic on mental health are now well documented, however, few studies have been focused on the role of coping strategies and resilience in counterbalancing these detrimental effects. Data are derived from the COvid Mental hEalth Trial (COMET), a national multicentric trial carried out in the Italian general population. The final sample consisted of 20,720 participants, 53.1% (n = 11,000) of the sample reported low levels of resilience. Adaptive coping strategies and resilience levels did not have any significant protective impact on the levels of depressive, anxiety, and stress symptoms. Only self-distraction was a risk factor for poor mental health (Beta Coefficient, B = 0.1, 95% Confidence Interval, CI: 0.003 to 0.267 for stress symptoms; B = 0.2; 95% CI: 0.077 to 0.324 for anxiety symptoms and B = 0.2, 95% CI: 0.105 to 0.382 for depressive symptoms). High levels of resilience were predicted by adaptive coping strategies, such as acceptance (B = 1.8, CI 95% = 1.4–2.7). Exposure to the different weeks of lockdown, being infected by COVID-19, and being a healthcare professional did not influence the levels of resilience. Our findings should be carefully considered, since the low levels of resilience may represent the missing link between the pandemic and the current increase in mental health problems.

The occurrence of post-traumatic stress disorder (PTSD), job burnout and its influencing factors among ICU nurses

OBJECTIVE

This study was designed to explore the occurrence of post-traumatic stress disorder (PTSD) symptoms, job burnout and its influencing factors among nurses in intensive care units (ICU).

METHODS

A total of 150 ICU nurses were selected for questionnaire survey by systematic sampling and 143 questionnaires were returned. The questionnaires included a PTSD Checklist-Civilian Version (PCL-C), Maslach Burnout Inventory (MBI), Connor-Davidson Resilience Scale (CD-RISC) and the Social Support Rating Scale (SSRS). ICU nurses were divided into positive and negative groups according to PCL-C scores, the differences between the groups were compared, and the influencing factors for the occurrence of PTSD were analyzed.

RESULTS

ICU nurses had PCL-C scores ranging from 11 to 55 and were divided into the positive group (PCL-C ≥ 38, N=32) and the negative group (PCL-C < 38, N=111) according to the presence of PTSD, with a positive rate of 22.38%. The total MBI scores and scores in emotional exhaustion, depersonalization, and personal accomplishment in the positive group were significantly higher than those in the negative group, (P < 0.05). Health status, years of experience, age, CD-RISC scores, and SSRS scores showed significant difference between the two groups (P < 0.05). Multivariate logistic regression showed that MBI score was an independent risk factor for the development of PTSD symptoms among ICU nurses (OR > 1, P < 0.05), while CD-RISC score was a protective factor (OR < 1, P < 0.05).

CONCLUSION

The incidence rate of PTSD among ICU nurses was 22.38%, and MBI score and CD-RISC score were independent influencing factors for the occurrence of PTSD symptoms.

Occupational health practices among dental care professionals before and during the COVID-19 pandemic

BACKGROUND

The COVID-19 pandemic has posed a substantial burden on dental care professionals. While dentistry is known as one of the most exposed and high-risk professions, dental care professionals are indeed at even greater risk.

OBJECTIVE

The aim of this study was to assess knowledge, attitudes, occupational health practices, personal protective equipment usage, and mental stressors during COVID-19 pandemic among dental care professionals.

METHODS

A cross-sectional study was conducted among dental care professionals who were subscribers to a dental hygiene journal using a self-administered online survey (n = 1047 respondents). Cross-tabulations were performed to determine differences in the responses to the statements related to different domains.

RESULTS

COVID-19 impacted the healthy work-life balance (p <  0.001) and caused sleeping difficulty among the respondents (p <  0.001). Moreover, a lower response on changing respirators and gloves for each patient compared with before viral pandemic was observed (p <  0.01).

CONCLUSIONS

Ongoing training on infection control, occupational health practices, and PPE usage can prevent the transmission of COVID-19 among dental care professionals and the public. Lack of adequate personal protective equipment (PPE) is a burden for applying occupational health practices in dental clinics and present a risk to the public. COVID-19 may contribute to developing psychological stress and disrupt healthy work-life balance among dental professionals.

Post-traumatic stress disorder, burnout and their impact on global functioning in Italian emergency healthcare workers

BACKGROUND

Post-traumatic stress disorder (PTSD) and burnout are severe and frequent conditions among emergency healthcare workers exposed to repeated work-related traumatic experiences. The aim of the present study was to investigate PTSD, burnout and global functioning in a sample of emergency healthcare workers (HCWs) of a major university hospital in Italy, exploring possible correlations between the two constructs.

METHODS

The study sample included 137 medical and nursing Emergency Room and Intensive Care Unit staff members of a major University Hospital in Italy (Pisa), all assessed by means of the Trauma and Loss Spectrum - Self Report (TALS-SR), for post-traumatic stress spectrum, the Professional Quality of Life Scale - Revision IV (ProQOL R-IV), for burnout related to work activities, and the Work and Social Adjustment Scale (WSAS), for global functioning.

RESULTS

Forty-nine subjects reported a full (18, 14.3%) or partial (31, 24.6%) symptomatological DSM-5 PTSD. HCWs with PTSD reported significantly higher burnout scores and global functioning impairment compared to those without PTSD. Mean to good significant correlations emerged between the TALS-SR total and domains scores, the ProQOL subscales and the WSAS scores.

CONCLUSIONS

This work, conducted before the COVID-19 pandemic, underlines a positive correlation between burnout and post-traumatic stress spectrum symptoms in emergency HCWs, showing the need for a deeper assessment of work-related post-traumatic stress symptoms in such population in order to improve the well-being and to prevent burnout.

Sense of coherence, engagement, and work environment as precursors of psychological distress among non-health workers during the COVID-19 pandemic in Spain

BACKGROUND

The interrelationship between the sense of coherence, work environment, work engagement, and psychological distress have particular interest in non-health workers who carried out essential activities during the COVID-19 pandemic.

OBJECTIVE

To assess the effects of the COVID-19 on the physical and mental health of non-health workers.

DESIGN

Observational descriptive cross-sectional study.

DATA SOURCES

1089 questionnaires have been analysed. Engagement (UWES-9), sense of coherence (SOC-13), mental health (Goldberg GHQ-12), demographic data, perception of health and stress and work environment were assessed.

RESULTS

At low levels of engagement, the percentage of distress is higher (77.9%). Low levels of sense of coherence correspond to the highest percentages of distress (86.3%). The 94.1% believe it necessary for professionals and volunteers involved in COVID-19 to receive psychological support. Low comprehensibility is mediated by the perception of stress; if the perception is low, comprehensibility is modulated by the level of significance; if it is low, it generates 95.9% of distress.

CONCLUSION

The interrelationship between the sense of coherence, work environment, work engagement, and psychological distress have particular interest in non-health workers who carried out essential activities during the COVID-19 pandemic. Almost all respondents believed that professionals and volunteers involved in COVID-19 should receive psychological support. This may be an indicator of the effect of the COVID-19 pandemic on workers' mental health.

Positivity explains how COVID-19 perceived risk increases death distress and reduces happiness

The novel coronavirus (COVID-19) pandemic has produced an unprecedented impact on all aspects of life, including mental outcomes like death distress. This study examined the mediating effect of positivity on the association between COVID-19 related perceived risk, death distress, and happiness. Participants were 3109 Turkish adults (Mean age = 38.64 ± 10.40) who completed online measures of perceived risk, positivity, death distress, and happiness during the pandemic. Results showed that perceived risk had a significant direct effect on positivity, death distress, and happiness. Positivity had a significant direct effect on death distress and happiness. Mediation analysis indicated that positivity mediated the effect of perceived risk on death distress and happiness. Results suggest that positivity is an important aspect of developing strength-based preventions and interventions aiming to reduce psychological distress and improve happiness.

Post-traumatic stress disorder symptoms in healthcare workers: a ten-year systematic review

Background and aims:

Healthcare workers (HCWs) employed in hospital settings frequently experience many occupational stressors leading to post-traumatic stress disorder (PTSD) symptoms. Literature has increasingly highlighted PTSD as a major issue that involves both staff and healthcare organizations; the consequences of PTSD may include medication errors and lower standards of care. The current COVID-19 pandemic poses the need for preventing PTSD in HCWs working closely with COVID-19 patients. The purpose of this systematic review was to analyze the latest developments in assessing and managing the occupational risk of PTSD symptoms in hospital HCWs.

Methods:

We searched for publications in MEDLINE/Pubmed using selected keywords. Each article was reviewed and categorized into one or more of the following four categories based on its subject matter: risk assessment, risk management and occurrence rates.

Results:

Our search resulted in a total of 32 publications that matched our inclusion criteria. Increased years of service, older age, previous year exposure to violence, personality traits (i.e. neuroticism), history of mental disorders, being non-graduates, were found to be workers’ pre-trauma factors predicting PTSD symptoms.

Conclusions:

The findings suggest the need to prioritize preventative interventions aimed to anticipate the effects of traumatic exposure by training HCWs in evidence based anticipatory methods of coping with stressful events. With regard to the current COVID-19 pandemic, we found evidence of the need to strength social support and training targeted at psychological skills of medical staff who treated COVID-19 patients. (www.actabiomedica.it)

PTSD and post-traumatic stress spectrum in the Italian Navy Operational Divers Group and corps of Coast Guard Divers employed in search and rescue activities in the Mediterranean refugees emergences and Costa Concordia shipwreck

Rescue personnel is at high risk for Post-traumatic Stress Disorder (PTSD) because of the possible repetitive exposition to "cruel details of traumatic events" (DSM-5). Literature reported PTSD rates in combat exposed veterans, although the Italian Navy military personnel has been frequently involved in no-war activities in most recent years, such as Search and Rescue (SAR) activities of civilians involved in catastrophic events. The study aimed at exploring the prevalence of PTSD and its impact on social and work functioning among divers of the Italian Navy employed in the SAR activities for the Costa Concordia shipwreck (2012), the collapsed control tower of the Genoa harbour (2013), and the "Mare Nostrum" and "Triton" immigrant emergency Operations in the Mediterranean Sea. The 85 Italian Navy and Coast Guard Divers on duty for these activities were involved in the study and forty fulfilled the assessments, including the: Impact Event Scale (IES-r), Trauma and Loss Spectrum Self-Report (TALS-SR) and Work and Social Adjustment Scale (WSAS). In the three years before enrollment 77.5% of the sample (n = 31) performed at least one rescue operation, with full and partial DSM-5 PTSD rates being 7.5% and 22.5%, respectively. A correlation emerged between WSAS domains or total scores and TALS-SR score domains for PTSD. Rescue Navy personnel resulted to be at risk for post-traumatic stress symptoms, and these subthreshold PTSD manifestations appear to impact on functioning. Further studies are needed to better investigate PTSD risk and resilience factors in this particular group of workers.

PTSD symptoms in healthcare workers facing the three coronavirus outbreaks: What can we expect after the COVID-19 pandemic

The COronaVIrus Disease-19 (COVID-19) pandemic has highlighted the critical need to focus on its impact on the mental health of Healthcare Workers (HCWs) involved in the response to this emergency. It has been consistently shown that a high proportion of HCWs is at greater risk for developing Posttraumatic Stress Disorder (PTSD) and Posttraumatic Stress Symptoms (PTSS). The present study systematic reviewed studies conducted in the context of the three major Coronavirus outbreaks of the last two decades to investigate risk and resilience factors for PTSD and PTSS in HCWs. Nineteen studies on the SARS 2003 outbreak, two on the MERS 2012 outbreak and three on the COVID-19 ongoing outbreak were included. Some variables were found to be of particular relevance as risk factors as well as resilience factors, including exposure level, working role, years of work experience, social and work support, job organization, quarantine, age, gender, marital status, and coping styles. It will be critical to account for these factors when planning effective intervention strategies, to enhance the resilience and reduce the risk of adverse mental health outcomes among HCWs facing the current COVID-19 pandemic.

Mindfulness, Age and Gender as Protective Factors Against Psychological Distress During COVID-19 Pandemic

OBJECTIVE

Mindfulness disposition is associated with various psychological factors and prevents emotional distress in chronic diseases. In the present study, we analyzed the key role of mindfulness dispositions in protecting the individual against psychological distress consequent to COVID-19 social distancing and quarantining.

METHODS

An online survey was launched on March 13, 2020, with 6,412 responses by April 6, 2020. Socio-demographic information, exposure to the pandemic, and quarantining were assessed together with psychological distress and mindfulness disposition. Multivariate linear regression analysis was performed to study the influence of predictive factors on psychological distress and quality of life in Italian responders during the early days of lockdown. Pearson correlations were calculated to study the relationship between mindfulness and psychiatric symptoms.

RESULTS

Multivariate linear regression run on socio-demographics, COVID-19-related variables, and mindfulness disposition as moderators of overall psychological distress showed that mindfulness was the best predictor of psychological distress (β = -0.504; p < 0.0001). High negative correlations were found between mindfulness disposition and the overall Global Severity Index (r = -0.637; p < 0.0001), while moderate to high associations were found between mindfulness and all SCL-90 sub-scales.

DISCUSSION

Findings showed that high dispositional mindfulness enhances well-being and helps in dealing with stressful situations such as the COVID-19 pandemic. Mindfulness-based mental training could represent an effective intervention to stem post-traumatic psychopathological beginnings and prevent the onset of chronic mental disorders.

Individual Differences, Economic Stability, and Fear of Contagion as Risk Factors for PTSD Symptoms in the COVID-19 Emergency

On January 30th 2020, the World Health Organization (WHO) declared the COVID-19 pandemic a Public Health Emergency of International Concern (PHEIC). Italy has been one of the most affected countries in the world. To contain further spread of the virus, the Italian government has imposed an unprecedented long-period lockdown for the entire country. This dramatic scenario may have caused a strong psychological distress, with potential negative long-term mental health consequences. The aim of the present study is to report the prevalence of high psychological distress due to the COVID-19 pandemic on the general population, especially considering that this aspect is consistently associated with PTSD symptoms. Furthermore, the present study aims to identify the risk factors for high PTSD symptoms, including individual differences and subjective perception of both economic and psychological aspects. We administered an online survey to 1253 participants during the peak period of the contagion in Italy. A logistic regression on the Impact of Event Scale - Revised (IES-R) scores was used to test the risk factors that predict the possibility to develop PTSD symptoms due to the COVID-19 pandemic. Gender (female), lower perceived economic stability, higher neuroticism, and fear and consequences of contagion were predictors of high PTSD symptomatology. The results, highlighted in the present study, extend our understanding of the COVID-19 pandemic's impact on the population's mental health, by identifying individuals at high-risk of developing PTSD. This may help with the implementation of specific protocols to prevent the possibility of developing symptoms of PTSD in target populations.

PTSD and Burnout are Related to Lifetime Mood Spectrum in Emergency Healthcare Operator

Background:

PTSD and burnout are frequent conditions among emergency healthcare personnel because exposed to repeated traumatic working experiences. Increasing evidence suggests high comorbidity between PTSD and mood symptoms, particularly depression, although the real nature of this relationship still remains unclear. The purpose of this study was to investigate the relationship between PTSD, burnout and lifetime mood spectrum, assessed by a specific scale, among health-care professionals of a major University Hospital in Italy.

Methods:

N=110 Emergency Unit workers of the Azienda Ospedaliero-Universitaria Pisana (Pisa, Italy) were assessed by the TALS-SR, MOODS-SR lifetime version and the ProQOL R-IV.

Results:

Approximately 60% of participants met at least one PTSD symptom criterion (criterion B, 63.4%; criterion C, 40.2%; criterion D 29.3%; criterion E, 26.8%), according to DSM-5 diagnosis. Almost sixteen percent of the sample reported a full symptomatic DSM-5 PTSD (work-related) diagnosis, and these showed significantly higher scores in all MOODS-SR depressive domains, as well as in the rhythmicity domain, compared with workers without PTSD. Further, mood-depressive and cognition-depressive MOODS-SR domains resulted to be predictive for PTSD. Significant correlations emerged between either PTSD diagnosis and criteria or ProQOL subscales and all the MOOD-SR domains.

Conclusion:

A significant association emerged among PTSD, burnout and lifetime MOOD Spectrum, particularly the depressive component, in emergency health care operators, suggesting this population should be considered at-risk and undergo regular screenings for depression and PTSD.

Professional Quality of Life and Mental Health Outcomes among Health Care Workers Exposed to Sars-Cov-2 (Covid-19)

The novel coronavirus disease 2019 (COVID-19) is a global pandemic spreading worldwide, and Italy represented the first European country involved. Healthcare workers (HCWs) facing COVID-19 pandemic represented an at-risk population for new psychosocial COVID-19 strain and consequent mental health symptoms. The aim of the present study was to identify the possible impact of working contextual and personal variables (age, gender, working position, years of experience, proximity to infected patients) on professional quality of life, represented by compassion satisfaction (CS), burnout, and secondary traumatization (ST), in HCWs facing COVID-19 emergency. Further, two multivariable linear regression analyses were fitted to explore the association of mental health selected outcomes, anxiety and depression, with some personal and working characteristics that are COVID-19-related. A sample of 265 HCWs of a major university hospital in central Italy was consecutively recruited at the outpatient service of the Occupational Health Department during the acute phase of COVID-19 pandemic. HCWs were assessed by Professional Quality of Life-5 (ProQOL-5), the Nine-Item Patient Health Questionnaire (PHQ-9), and the Seven-Item Generalized Anxiety Disorder scale (GAD-7) to evaluate, respectively, CS, burnout, ST, and symptoms of depression and anxiety. Females showed higher ST than males, while frontline staff and healthcare assistants reported higher CS rather than second-line staff and physicians, respectively. Burnout and ST, besides some work or personal variables, were associated to depressive or anxiety scores. The COVID-19 pandemic represents a new working challenge for HCWs and intervention strategies to prevent burnout and ST to reduce the risk of adverse mental health outcomes are needed.

The Quality of Life, Psychological Health, and Occupational Calling of Korean Workers: Differences by the New Classes of Occupation Emerging Amid the COVID-19 Pandemic

This study aimed to create new classifications for occupations that have emerged from the COVID-19 pandemic in Korea, based on Reich's classifications for the United States. We examined Korean workers' occupational calling, psychological health, and quality of life. An online questionnaire was administered and data from 1029 Korean workers were analyzed. The questionnaire comprised the Korean version of the Multidimensional Calling Measure to assess occupational calling, the Psychosocial Well-being Index-short form for psychological health, and the Control, Autonomy, Self-realization, and Pleasure (CASP-19) scale for quality of life. We created a Korean-adapted version of the classes of occupation based on those created by the COVID-19 situation in the USA. Our results showed that Korean workers had a high perceived calling to work, and different classes showed different levels of quality of life and psychological health. We need a health concentration management system for essential groups or personal safety protection equipment should be provided. Education on infection control should be offered and effective medical system processes should be in place. We need to develop technology to respond to medical needs online, remotely, or telephonically. The government should implement policies to ensure job security and to improve wages and welfare.

Mindfulness, Compassion, and Self-Compassion Among Health Care Professionals: What's New? A Systematic Review

Health care professionals (HCPs) are a population at risk for high levels of burnout and compassion fatigue. The aim of the present systematic review was to give an overview on recent literature about mindfulness and compassion characteristics of HCPs, while exploring the effectiveness of techniques, involving the two aspects, such as MBSR or mindfulness intervention and compassion fatigue-related programs. A search of databases, including PubMed and PsycINFO, was conducted following the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines and the methodological quality for this systematic review was appraised using AMSTAR-2 (A MeaSurement Tool to Assess systematic Reviews-2). The number of articles that met the inclusion criteria was 58 (4 RCTs, 24 studies with pre-post measurements, 12 cross-sectional studies, 11 cohort studies and 7 qualitative studies). MBSR intervention was effective at improving, and maintaining, mindfulness and self-compassion levels and to improve burnout, depression, anxiety, stress. The most frequently employed interventional strategies were mindfulness-related trainings that were effective at improving mindfulness and self-compassion, but not compassion fatigue, levels. Compassion-related interventions have been shown to improve self-compassion, mindfulness and interpersonal conflict levels. Mindfulness was effective at improving negative affect and compassion fatigue, while compassion satisfaction may be related to cultivation of positive affect. This systematic review summarized the evidence regarding mindfulness- and compassion-related qualities of HCPs as well as potential effects of MBSR, mindfulness-related and compassion-related interventions on professionals' psychological variables like mindfulness, self-compassion and quality of life. Combining structured mindfulness and compassion cultivation trainings may enhance the effects of interventions, limit the variability of intervention protocols and improve data comparability of future research.