Anxiety and depression among medical doctors in Catalonia, Italy, and the UK during the COVID-19 pandemic

Professional and Psychological Influence of the COVID-19 Pandemic on the Training of Medical Residents

OBJECTIVES

Coronavirus disease 2019 (COVID-19) has profoundly impacted residency and fellowship training and education. However, how and to what extent the COVID-19 pandemic in Lebanon compromised the daily involvement of trainees on the clinical and ethical levels is currently unknown, which this study will shed light on.

METHODS

We conducted a cross-sectional survey (30 questions) targeting medical residents delivering healthcare services in Lebanon. Residents from different specialties were included in the study to assess the effect of the pandemic on their education and the ethical obstacles they faced when dealing with patients.

RESULTS

A total of 221 postgraduate medical students participated in our study. Results showed that about half of the residents (52.1%) were only able to do a basic physical examination rather than a full examination as a mandatory requirement in the residency curriculum. The majority (60%) agreed that the doctor-patient relationship is contravened. In addition, almost all residents suffered from fear and emotional distress that affected their education (83.7%).

CONCLUSION

The findings of this study identify the effect of COVID-19 on residents' training, which affects treatment outcomes and greatly impacts the mental well-being of both healthcare workers and patients.

Time for You: A process evaluation of the rapid implementation of a multi-level mental health support intervention for frontline workers during the COVID-19 pandemic

The coronavirus (COVID-19) pandemic had wide-ranging negative impacts on mental health. The pandemic also placed extraordinary strain on frontline workers who were required to continue working and putting themselves at risk to provide essential services at a time when their normal support mechanisms may not have been available. This paper presents an evaluation of the Time for You service, a rapidly developed and implemented intervention aimed at providing frontline workers with quick access to flexible online mental health support. Time for You provided service users with three service options: self-guided online cognitive behavioural therapy (CBT) resources; guided engagement with online CBT resources; 1-1 psychological therapy with trainee sport and exercise psychologists and trainee health psychologists. A process evaluation informed by the Consolidated Framework for Implementation Research considered service fidelity, adaptations, perceived impact, reach, barriers, and facilitators. Interviews with project managers (n = 5), delivery staff (n = 10), and service users (n = 14) explored perceptions of the service implementation and outcomes, supported by data regarding engagement with the online CBT platform (n = 217). Findings indicated that service users valued the flexibility of the service and the speed with which they were able to access support. The support offered by Trainee Psychologists was perceived to be of high quality, and the service was perceived by service users to have improved mental health and wellbeing. The rapid implementation contributed to issues regarding appropriate service user screening that led to trainee psychologists being unable to provide the service users with the support they needed as the presenting issues were outside of trainees' competencies. Overall, the findings suggest that interventions offering flexible, online psychological support to frontline workers can be an effective model for future interventions. Trainee psychologists are also able to play an important role in delivering such services when clear screening processes are in place.

Factors associated with depression among healthcare workers during the COVID-19 pandemic: a systematic review and meta-analysis

The COVID-19 pandemic has had a profound impact on the mental health of healthcare workers (HCWs). We aimed to identify the factors associated with depression among HCWs during the pandemic. We conducted literature search using eight electronic databases up to July 27 2022. Observational studies with more than 200 participants investigating correlates of depression in HCWs after COVID-19 outbreak were included. We used fixed- and random-effects models to pool odds ratios (ORs) across studies, and Cochran's chi-squared test and I 2 statistics to assess study heterogeneity. Publication bias was evaluated by funnel plots. Thirty-five studies involving 44,362 HCWs met the inclusion criteria. Female (OR=1.50, 95% CI [1.23,1.84]), single (OR=1.36, 95% CI [1.21,1.54]), nurse (OR=1.69, 95% CI [1.28,2.25]), history of mental diseases (OR=2.53, 95% CI [1.78,3.58]), frontline (OR=1.79, 95% CI [1.38,2.32]), health anxiety due to COVID-19 (OR=1.88, 95% CI [1.29,2.76]), working in isolation wards (OR=1.98, 95% CI [1.38,2.84]), and insufficient personal protective equipment (OR=1.49, 95% CI [1.33,1.67]) were associated with increased risk of depression. Instead, HCWs with a positive professional prospect (OR=0.34, 95% CI [0.24,0.49]) were less likely to be depressed. This meta-analysis provides up-to-date evidence on the factors linked to depression among HCWs during the COVID-19 pandemic. Given the persistent threats posed by COVID-19, early screening is crucial for the intervention and prevention of depression in HCWs.

Long-Term Trajectory and Risk Factors of Healthcare Workers' Mental Health during COVID-19 Pandemic: A 24 Month Longitudinal Cohort Study

BACKGROUND

Research has shown the substantial impact of the COVID-19 pandemic on healthcare workers' (HCWs) mental health, however, it mostly relies on data collected during the early stages of COVID-19. The aim of this study is to assess the long-term trajectory of HCWs' mental health and the associated risk factors.

METHODS

a longitudinal cohort study was carried out in an Italian hospital. At Time 1 (July 2020-July 2021), 990 HCWs took part in the study and completed the General Health Questionnaire (GHQ-12), the Impact of Event Scale (IES-R), and the General Anxiety Disorder (GAD-7)questionnaire. McNemar's test measured changes in symptoms' trajectories, and random effects models evaluated risk factors associated with scores above the cut-off.

RESULTS

310 HCWs participated to the follow-up evaluation (Time 2; July 2021-July 2022). At Time 2, scores above cut-offs were significantly lower (p < 0.001) than at Time 1 for all scales (23% vs. 48% for GHQ-12; 11% vs. 25% for IES-R; 15% vs. 23% for GAD-7). Risk factors for psychological impairment were being a nurse (IES-R: OR 4.72, 95% CI 1.71-13.0; GAD-7: OR 2.82, 95% CI 1.44-7.17), a health assistant (IES-R: OR 6.76, 95% CI 1.30-35.1), or having had an infected family member (GHQ-12: OR 1.95, 95% CI 1.01-3.83). Compared to Time 1, gender and experience in COVID-19 units lost significance with psychological symptoms.

CONCLUSIONS

data over more than 24 months from the pandemic onset showed improvement of HCWs' mental health; our findings suggested the need to tailor and prioritize preventive actions towards healthcare workforce.

Anxiety and Depression Levels and Coping Strategies among Polish Healthcare Workers during the COVID-19 Pandemic

During the COVID-19 pandemic, medical staff were commonly exposed to stress, work under pressure, and long shifts, and may have experienced a fear of infecting loved ones or a fear for their own health. All of these factors may have increased the likelihood that healthcare workers will experience the symptoms of depression, anxiety, or other mental health disorders. In this cross-sectional study, a group of respondents was gathered from the employees of 78 hospitals in Poland. A questionnaire was completed electronically by 282 people, aged between 20 and 78 years. The study used the Hospital Anxiety and Depression Scale (HADS) and the MiniCOPE questionnaire to examine anxiety and depression symptoms, and coping strategies, respectively. With age, the respondents declared fewer symptoms of anxiety and tended to have milder symptoms of depression. Participants with chronic illnesses, mood disorders, or anxiety disorders also reported higher levels of anxiety and depression symptoms. More than 20% of healthcare workers felt the need to consult with a psychologist. In the entire group of healthcare professionals surveyed, the most commonly used strategies for coping with stress were "denial", "psychoactive drug and alcohol use", and "cessation of activities", while the least used strategy was "acceptance". Given the most commonly used strategies in the surveyed group of healthcare professionals, they may be predictors for a deterioration in mental state in the long run. The obtained results also suggest that it is likely that pre-existing health problems had a greater impact on the mental health of medical staff during the COVID-19 pandemic than the profession itself. Therefore, taking care of the well-being and mental health of healthcare workers should be a priority for employers.

The stress response of intensive care unit medical doctors facing repeated severe emergencies

Objectives

This study assesses the psychopathological distress experienced by doctors working in an Intensive care unit (ICU) during the COVID-19 pandemic. These doctors were the same who faced the consequences of a previous natural disaster, a severe 6.3 magnitude earthquake. A second objective is to evaluate their current mental attitude, professional performances and coping strategies adopted in the pandemic in relation to the conditioning effect of that first emergency, the earthquake.

Methods

Thirty-seven ICU medical doctors were recruited and assessed using Rapid Stress Assessment (RSA) rating scale, Symptom Checklist-90 Revised (SCL-90-R), Zung Self-Rating Anxiety Scale, Beck Depression Inventory, Beck Hopelessness Scale, Millon Clinical Multiaxial Inventory III. Comparison between exposure to the earthquake and COVID pandemic has been made in terms of professional role and psychological burden.

Results

Comparison between 2009 earthquake catastrophe and COVID pandemic conditions evidenced relevant changes in professional role, team, environment, shifts, and work organization.

Conclusion

The doctors, who already experienced the 2009 earthquake reported a feeling of greater insecurity facing this latter catastrophe, the COVID pandemic, as well as perception of greater concern for their family and the global situation. However, having participated in the medical management of another emergency (the 2009 earthquake) appears to have contributed to limiting demoralization and psychological distress. The feeling of having greater decision-making possibilities and participation in the organization of work, strengthen coping skills in the face of the emergency.

Job satisfaction among healthcare workers in the aftermath of the COVID-19 pandemic

Using a unique survey of more than 7,000 respondents conducted immediately after the first wave of the COVID-19 pandemic in Italy, we investigate potential drivers of the job satisfaction of healthcare workers. Relying on a representative sample of Italian physicians and nurses, we show that, in addition to personal characteristics (e.g., age, gender, health status), contextual factors (i.e., working conditions) play the leading role in explaining variation in the level of satisfaction (58%). In particular, working in a high-quality facility increases worker satisfaction and willingness to remain in the profession, and in the current medical specialization, while working in a province with a perceived shortage of medical personnel yields the opposite result. Direct experience with COVID-19 (e.g., having tested positive) is not significantly correlated with the level of job satisfaction, which is instead significantly reduced by changes in the working conditions caused by the health emergency.

Immersive Therapy for Improving Anxiety in Health Professionals of a Regional Hospital during the COVID-19 Pandemic: A Quasi-Experimental Pilot Study

Background: Immersive therapy through virtual reality represents a novel strategy used in psychological interventions, but there is still a need to strengthen the evidence on its effects on health professionals’ mental health. Objective: To analyze the results of immersive therapy through virtual reality on the levels of anxiety and well-being of the health professionals working in a regional hospital in Olot (Spain). Methods: Pilot quasi-experimental study including a group of 35 female (mean age = 45.7, SD = 8.43) health professionals who undertook immersive therapy for 8 weeks. The intervention was implemented through virtual reality, and its effect on anxiety levels and well-being was evaluated through the Hamilton and Eudemon scales, respectively. Data on age, gender, active pharmacological or psychological treatment, mental health disorders and number of sessions were also collected. Results: A statistically significant (p < 0.001) improvement in anxiety and well-being was found, with large and moderate effect sizes (0.90 and 0.63 respectively). In addition, these changes were clinically significant. No significant associations were found between the improvements and the different variables, but a greater trend was identified among the group of professionals with untreated or unidentified levels of anxiety. Conclusion: This group of health professionals showed a statistically and clinically significant improvement in anxiety and well-being after the application of immersive therapy using virtual reality. Further studies with a control group are necessary to further analyze this novel intervention.

Maternal psychological distress during the COVID-19 pandemic and structural changes of the human fetal brain

Background

Elevated maternal psychological distress during pregnancy is linked to adverse outcomes in offspring. The potential effects of intensified levels of maternal distress during the COVID-19 pandemic on the developing fetal brain are currently unknown.

Methods

We prospectively enrolled 202 pregnant women: 65 without known COVID-19 exposures during the pandemic who underwent 92 fetal MRI scans, and 137 pre-pandemic controls who had 182 MRI scans. Multi-plane, multi-phase single shot fast spin echo T2-weighted images were acquired on a GE 1.5 T MRI Scanner. Volumes of six brain tissue types were calculated. Cortical folding measures, including brain surface area, local gyrification index, and sulcal depth were determined. At each MRI scan, maternal distress was assessed using validated stress, anxiety, and depression scales. Generalized estimating equations were utilized to compare maternal distress measures, brain volume and cortical folding differences between pandemic and pre-pandemic cohorts.

Results

Stress and depression scores are significantly higher in the pandemic cohort, compared to the pre-pandemic cohort. Fetal white matter, hippocampal, and cerebellar volumes are decreased in the pandemic cohort. Cortical surface area and local gyrification index are also decreased in all four lobes, while sulcal depth is lower in the frontal, parietal, and occipital lobes in the pandemic cohort, indicating delayed brain gyrification.

Conclusions

We report impaired fetal brain growth and delayed cerebral cortical gyrification in COVID-19 pandemic era pregnancies, in the setting of heightened maternal psychological distress. The potential long-term neurodevelopmental consequences of altered fetal brain development in COVID-era pregnancies merit further study.

Health Occupation and Job Satisfaction: The Impact of Psychological Capital in the Management of Clinical Psychological Stressors of Healthcare Workers in the COVID-19 Era

The COVID-19 pandemic greatly impacted global health. Frontline healthcare workers involved in the response to COVID-19 faced physical and psychological challenges that threatened their wellbeing and job satisfaction. The pandemic crisis, alongside pre-existing critical issues, exposed healthcare workers to constant emotional fatigue, creating an increased workload and vulnerability to stress. Maintaining such stress levels increased their levels of anxiety, irritability and loneliness. Evidence shows that the Psychological Capital (PsyCap) was a strong protective factor against these stressors. The aim of this study was to analyze the level of job satisfaction among health workers facing the COVID-19 pandemic. The possible antecedent factors to satisfaction and the role that PsyCap plays in preserving and fostering higher levels of job satisfaction were investigated. A total of 527 healthcare workers from different areas of Italy were recruited for the study. The results revealed that psychological stress factors have a considerable impact on job satisfaction. All four predictors (Stress Vulnerability, Anxiety Symptoms, Loneliness and Irritability) had the potential to decrease job satisfaction. Loneliness had a more significant effect than other factors assessed in this study. Moreover, the results showed how PsyCap could decrease the effects of psychological stressors on job satisfaction. Consistent with previous studies, our findings show that PsyCap could alleviate negative impacts in work-related circumstances.

Psychological Impacts of the COVID-19 Pandemic on Rural Physicians in Ontario: A Qualitative Study

Frontline rural physicians in Canada are vulnerable to the psychological impacts of the COVID-19 pandemic considering their high pre-pandemic burnout rates as compared to their urban counterparts. This study aims to understand the psychological impacts of the COVID-19 pandemic on rural family physicians engaged in full-time primary care practice in Ontario and the stressors behind any identified challenges. Recruitment combined purposive, convenience, and snowball sampling. Twenty-five rural physicians participated in this study. Participants completed a questionnaire containing Patient Health Questionnaire-2 (depression), General Anxiety Disorder-2 (anxiety), and Perceived Stress Scale-4 (stress) screening as well as questions exploring self-reported perceptions of change in their mental health, followed by a semi-structured virtual interview. Quantitative data showed an overall increase in self-reported depression, anxiety, and stress levels. Thematic analysis revealed seven qualitative themes including the positive and negative psychological impacts on rural physicians, as well as the effects of increased workload, infection risk, limited resources, and strained personal relationships on the mental health of rural physicians. Coping techniques and experiences with physician wellness resources were also discussed. Recommendations include establishing a rapid locum supply system, ensuring rural representation at decision-making tables, and taking an organizational approach to support the mental health of rural physicians.