Coping With COVID-19: Emergency Stress, Secondary Trauma and Self-Efficacy in Healthcare and Emergency Workers in Italy

Exploration of the Challenges of COVID-19 from the Perspective of Emergency Medicine Specialists

Background

Emergency physicians are at the forefront of the medical system in the face of the COVID-19 crisis. Identifying the challenges, along with the strategies and effective measures implemented by them in the face of the COVID-19 crisis, can be a roadmap for future crisis management planning. This study aims to explain the challenges faced by emergency physicians regarding COVID-19.

Methods

This study is a qualitative content analysis. Data were collected using individual and semistructured interviews. Twenty-seven emergency medical specialists in Fars University of Medical Sciences, Iran, participated in the study by purposive sampling method and were interviewed using semistructured interviews.

Results

Participants' experience of COVID-19 led to the extraction of four main themes, including structural factors, threats to the health of the medical team, fluctuations of extremism and wastage in the face of COVID-19, and the country's policymaking hierarchy.

Conclusions

Emergency physicians face challenges such as structural factors, health threats, extreme fluctuations, and national policymaking. To avoid surprises and threats, they must predict acute scenarios, provide necessary equipment, address skilled manpower shortages, and adopt appropriate management policies. This includes culture-building, cross-sector coordination, planning, and efficient management to prevent virus spread.

Association Between Suboptimal Health Status and Health-Related Productivity Loss in Primary Healthcare Workers in China: a Cross-Sectional Survey

Objective

This study aimed to clarify the association between suboptimal health status and health-related productivity loss among primary healthcare workers in China.

Material and Methods

A field questionnaire survey was conducted with a multistage sampling among primary healthcare workers. The data on sub-health and health-related productivity loss were collected using the Sub-health Measurement Scale Version 1.0 and Work Productivity and Activity Impairment Questionnaire: General Health, respectively. Ordinary least squares regression was used to evaluate the association of the suboptimal health and health-related productivity loss. Subgroup analyses were performed by occupation (physician and nurse).

Results

Front-line primary healthcare workers (N = 1709) from 31 provinces in China responded to the survey. Of all participants, 73.43% experienced suboptimal health. The status of being in physical suboptimal health (Coef. = 0.050, p < 0.001, 95% CI = [0.031,0.070]) and mental suboptimal health (Coef. = 0.040, p < 0.001, 95% CI = [0.020,0.059]) status exerted significant effect on the extent of health-related productivity loss among primary healthcare workers in China. Nurses in social adaptation suboptimal health status (Coef. = 0.030, p = 0.027, 95% CI = [0.003,0.057]) had significant effect on health-related productivity loss.

Conclusion

The prevalence of suboptimal health is high among the respondents. Providing support for primary healthcare workers from bio-psycho-social aspects is an effective measure to promote their occupational health and improve their productivity.

Retrospective study on the emotional status of healthcare workers in a COVID-19 field hospital in Oman

Overview

To combat the overwhelming demand for medical services and care during the COVID-19 Pandemic, the Sultanate of Oman launched the COVID-19 Field Hospital in 2020, designed to respond and alleviate the burden on the medical infrastructure. Several studies globally and from the Middle East suggested that frontline healthcare workers (HCW) were at risk of developing markers of psychological distress. It was further understood through research findings that HCW were resilient during times of crisis. However, there is a dearth in studies evaluating the emotional status of frontline HCW posted in the COVID-19 field hospitals in Gulf Countries, including Oman. This study attempts to shed light on the emotional status of HCW that were on the frontlines in the field hospital in the Sultanate of Oman.

Aim

This study aims to quantify and evaluate the emotional status of HCW in the frontline field hospital by screening for symptoms of depression, anxiety, and sleep quality.

Method

The data was collected by a local private mental healthcare facility as part of digital feedback to design and implement supportive strategies. Data was collected between September 2021 and October 2021 from 121 HCW in the COVID-19 Field hospital in Oman via 'WhatsApp'.

Results

Chi square and binary logistic regression tests were administered to evaluate the data. The participants comprised of 63.6% females and 79.3% were between 30 and 39 years of age. Majority of the participants (65.2%) described themselves as 'financially unstable' and possess an average of 7.5 years of work experience. Of the participants 73.6% of the HCW were based solely in the field hospital for 6-9 months at the time of the survey. Majority of the participants denied the presence of emotional distress expressed through depression (92.6%), anxiety (92.6%) and poor quality of sleep (59.5%).

Conclusion

The findings of the present study reflect the HCW ability to cope during challenging situations likely owing to a variety of environmental, social and personal protective factors. The findings of this study can translate into further research on identifying and addressing stressors and targeting the enhancement of protective factors to safeguard the well-being of HCW.

Exploring the consequences of nurses' involvement in disaster response: findings from a qualitative content analysis study

BACKGROUND

The presence of nurses during disasters can lead to many consequences. Understanding the nurses' experiences of these consequences can provide valuable insights. Therefore, this study was conducted to explore the experiences of Iranian nurses regarding the consequences they faced when being present during disasters.

METHODS

This qualitative descriptive study employed a content analysis approach to examine the topic at hand. 20 nurses working in the emergency units of Kerman hospitals were selected through purposive sampling. In-depth semi-structured interviews were conducted to collect the data. The data were analyzed using qualitative content analysis proposed by Graneheim and Lundman. MAXQDA 10 was used to manage data.

RESULTS

After analysis of the interviews, two main categories were identified: overlapping of job frustrations and acquiring experience in difficult conditions. The main category of acquiring experience in difficult conditions comprised the following subcategories: improved quality of care, experience and dedication in fulfilling the role, reduced stress, occupational motivation and enthusiasm, increased self-confidence, and improved social status. On the other hand, the category of overlapping of job frustrations also consisted of the subcategories of physical strength deterioration, psychological and emotional distress, discontinued from supports, feelings of hopelessness, increased exposure to violence and aggression, and occurrence of family problems.

CONCLUSION

Being present during disasters and obtaining the necessary competencies can have positive consequences that serve as turning points in the personal and professional growth of nurses. Additionally, favorable outcomes can help nurses cope with adverse circumstances. Managers can utilize the findings of this study to develop strategies aimed at reducing negative outcomes and enhancing positive ones among nurses during disasters.

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

OBJECTIVE

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

DESIGN

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

IMPLICATIONS

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

REPORTING METHOD

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

Emotional exhaustion and traumatic stress among healthcare workers during the COVID-19 pandemic: Longitudinal changes and protective factors

BACKGROUND

Healthcare workers (HCWs) are at high risk of experiencing work-related stress, burnout syndrome, and depression, especially during infectious disease outbreaks like COVID-19. Contributing factors include increased workload, lack of personal protective equipment, and inadequate support from the healthcare administration. Longitudinal studies have shown that the mental health status of HCWs has deteriorated over time. Social support and compassion satisfaction (CS) are protective factors that can mitigate adverse mental health effects. The present longitudinal study examined the mental health status of HCWs during the COVID-19 outbreak and aimed to identify potential predictors and protective factors.

METHODS

The study comprised 386 healthcare workers in Hungary and was conducted in two waves (T1 and T2) from January 2021 to January 2022. Participants completed an online survey including the Professional Quality of Life Scale, Maslach Burnout Inventory, demographic and work-related background factors. Statistical analyses included descriptive statistics, and a cross-lagged panel model (CLPM).

RESULTS

Frontline HCWs had higher levels of secondary traumatic stress (STS) and emotional exhaustion (EE) than non-frontline healthcare workers. Both groups experienced significant increases in these measures between T1 and T2. The CLPM indicated that EE had a significant lagged effect on STS among frontline workers, while STS had a significant lagged effect on EE among non-frontline workers. CS had a significant protective effect on both STS and EE in both groups.

CONCLUSIONS

The findings suggest that CS protects EE and STS, particularly among frontline HCWs. The study also showed that different causative relationships exist between these factors among frontline and non-frontline HCWs, which underlines the possible cyclical relationship between the two depending on the circumstances. The results provide insights into the protective role of positive work experiences and the importance of considering the needs of both frontline and non-frontline HCWs in preventive intervention programs.

Becoming futile: the emotional pain of treating COVID-19 patients

Introduction

The COVID-19 pandemic has had a profoundly detrimental impact on the emotional wellbeing of health care workers. Numerous studies have shown that their rates of the various forms of work-related distress, which were already high before the pandemic, have worsened as the demands on health care workers intensified. Yet much less is known about the specific social processes that have generated these outcomes. This study adds to our collective knowledge by focusing on how one specific social process, the act of treating critically ill COVID-19 patients, contributed to emotional pain among health care workers.

Methods

This article draws from 40 interviews conducted with intensive care unit (ICU) staff in units that were overwhelmed with COVID-19 patients. The study participants were recruited from two suburban community hospitals in Massachusetts and the interviews were conducted between January and May 2021.

Results

The results show that the uncertainty over how to treat critically ill COVID-19 patients, given the absence of standard protocols combined with ineffective treatments that led to an unprecedented number of deaths caused significant emotional pain, characterized by a visceral, embodied experience that signaled moral distress, emotional exhaustion, depersonalization, and burnout. Furthermore, ICU workers' occupational identities were undermined as they confronted the limits of their own abilities and the limits of medicine more generally.

Discussion

The inability to save incurable COVID-19 patients while giving maximal care to such individuals caused health care workers in the ICU an immense amount of emotional pain, contributing to our understanding of the social processes that generated the well-documented increase in moral distress and related measures of work-related psychological distress. While recent studies of emotional socialization among health care workers have portrayed clinical empathy as a performed interactional strategy, the results here show empathy to be more than dramaturgical and, in this context, entailed considerable risk to workers' emotional wellbeing.

Exploring Disparities in Self-Reported Mental Health Symptoms Across Professional Categories in Spain's Emergency Medical Services: A Nationwide Cross-Sectional Study

OBJECTIVE

This study aimed to analyze stress, anxiety, depression, and self-efficacy levels among Spanish out-of-hospital emergency medical professionals from February 1, 2021, to April 30, 2021.

METHODS

A nationwide survey was completed by 1666 Emergency Medical Services (EMS) workers. The Depression, Anxiety, and Stress Scale (DASS-21) and the General Self-Efficacy Scale (GSE) were used. Data analysis used chi-squared, análisis of variance (ANOVA), and logistic regressions.

RESULTS

The sample comprised 833 (50%) men, with an average age of 44.3 ± 9.9 y (range: 19-67 y). Occupational distribution included 453 (27.2%) physicians, 474 (28.4%) nurses, and 739 (44.4%) emergency medical technicians (EMTs). EMTs exhibited higher odds of severe or extremely severe depression compared with physicians (odds ratio [OR]: 1.569; 95% confidenceinterval [95% CI]: 1.213-2.030) and nurses (OR: 1.561; 95% CI: 1.211-2.012). EMTs also displayed higher probabilities of severe or extremely severe anxiety compared with nurses (OR: 1.944; 95% CI: 1.529-2.701). Furthermore, EMTs demonstrated elevated probabilities of severe or extremely severe stress compared with physicians (OR: 1.387; 95% CI: 1.088-1.770). However, no significant differences were found in self-efficacy, with a median value of 73 [20].

CONCLUSIONS

Out-of-hospital EMS workers experienced mental health challenges, showing varying levels of depression, stress, and anxiety across different occupational groups. EMTs were particularly affected.

Coping strategies and emotional responses adopted by health care workers during COVID-19 pandemic-braving the storm

Background and Aims

Health care workers (HCWs) are caught in the middle of the COVID-19 pandemic storm and are exposed to a large degree of physical and emotional stress. This study was planned to describe the stressors, stress levels, emotional responses, and coping strategies adopted by HCWs amidst this pandemic.

Material and Methods

This cross-sectional, web-based survey was conducted after ethics approval, using a structured performa incorporating standardized stress (PSS-10 C), emotional responses (PANAS-10), and coping strategy (Brief COPE) scales. The snowball sampling technique was used to conduct the study and collect data. Data were analyzed using SPSS 26 version (SPSS Inc., Chicago, IL, USA) statistical software. A P value of <0.05 was considered significant.

Results

Out of 402 participants (65% doctors and 35% nurses), 87% perceived moderate stress levels, and nearly half of the participants were interns, residents, and medical officers. Infection to self or family members (77.1%), survival of sick patients (75.6%), aggression by patients and relatives (70.3%), and long duty hours (67%) were some of the major stressors as reported by HCWs. The most common positive emotion felt was being alert (19.17 ± 5.57) and negative emotion perceived was being upset (15.6 ± 6.06). Many participants adopted emotion and problem-focused coping strategies such as planning and strategization (68%) and positive reframing (67.6%), whereas dysfunctional coping strategies such as venting and denial were adopted less commonly.

Conclusion

Moderate stress levels perceived by HCWs are a cause for concern. Emotional responses of HCWs to stress vary; however, appropriate coping strategies including emotional and problem-focused coping strategies are the need of the hour to tackle pandemic-related stress.

Role of resilience and self-coping strategy in determining positive emotions during pandemic among healthcare professionals in Iran

BACKGROUND

The unprecedented COVID-19 pandemic placed immense stress on healthcare professionals worldwide. This strain often resulted in imbalances in their physical and mental well-being, necessitating effective coping mechanisms. In light of this context, this study investigates the correlations between the fear of COVID-19, self-coping strategies, and positive emotions, with particular reference to the Iranian health care industry.

METHODS

Data were collected from 1050 healthcare professionals in Iran and the data were analysed sing structural equation modelling.

RESULTS

The study revealed that pandemic fear negatively impacts self-coping strategies and positive emotions during crisis scenarios. Conversely, self-coping strategies have a positive correlation with positive emotions. The research also underscored the role of resilience in reinforcing the favorable link between self-coping strategies and positive emotions.

CONCLUSIONS

This study is one of the first to explore the significance of resilience and self-coping strategies among Iranian healthcare professionals during the pandemic. Its findings offer valuable insights for researchers and practitioners, paving the way for further contributions in this field. Future research endeavors may consider investigating the effects of various psychological interventions, including breathing techniques, self-talk, physical exercises, yoga, optimizing sleep, and dietary measures on the resilience and self-coping practices of healthcare professionals.

An Integrative Review of Measures of Secondary Traumatic Stress

Background and Purpose: Secondary traumatic stress (STS) results in detrimental effects in healthcare professionals, impacting the safety of patients and their care. There are multiple instruments being used to measure STS, reflecting the uncertainty on how to best measure STS. The purpose of this review is to present an overview of the state of measurement of STS. Methods: PubMed, CINAHL, and Cochrane Database of Systematic Reviews databases were searched using the terms "secondary traumatic stress" and "measurement." Results: The search resulted in nine applicable articles and four instruments used to measure STS. Utility and psychometric properties of the instruments are examined. Conclusions: The secondary traumatic stress scale is most appropriate to measure STS given that it is the only instrument intended to measure only STS, but psychometric testing with nurses is needed.

Factors associated with stigma and manifestations experienced by Indian health care workers involved in COVID-19 management in India: A qualitative study

Healthcare personnel who deal with COVID-19 experience stigma. There is a lack of national-level representative qualitative data to study COVID-19-related stigma among healthcare workers in India. The present study explores factors associated with stigma and manifestations experienced by Indian healthcare workers involved in COVID-19 management. We conducted in-depth interviews across 10 centres in India, which were analysed using NVivo software version 12. Thematic and sentiment analysis was performed to gain deep insights into the complex phenomenon by categorising the qualitative data into meaningful and related categories. Healthcare workers (HCW) usually addressed the stigma they encountered when doing their COVID duties under the superordinate theme of stigma. Among them, 77.42% said they had been stigmatised in some way. Analyses revealed seven interrelated themes surrounding stigma among healthcare workers. It can be seen that the majority of the stigma and coping sentiments fall into the mixed category, followed by the negative sentiment category. This study contributes to our understanding of stigma and discrimination in low- and middle-income settings. Our data show that the emergence of fear of the virus has quickly turned into a stigma against healthcare workers.

Psychosocial model of burnout among humanitarian aid workers in Bangladesh: role of workplace stressors and emotion coping

BACKGROUND

While trauma exposure is an established predictor of poor mental health among humanitarian aid workers (HAWs), less is known about the role of psychosocial work-related factors. This study aims to establish a psychosocial model for burnout and psychological distress in HAWs that tests and compares the effects of adversity exposure and workplace stressors in combination, and explores the potential mediating role of individual coping styles.

METHODS

Path analysis and model comparison using cross-sectional online survey data were collected from full-time international and local HAWs in Bangladesh between December 2020 and February 2021. HAWs self-reported on exposure to adversities, workplace psychosocial stressors (Third Copenhagen Psychosocial Questionnaire), coping styles (Coping Inventory for Stressful Situations), burnout (Maslach Burnout Inventory-Human Services Survey), and psychological distress (Kessler-6).

RESULTS

Among N = 111 HAWs, 30.6%, 16.4%, 12.7%, and 8.2% screened positive for moderate psychological distress (8 ≤ Kessler-6 ≤ 12), emotional exhaustion (EE ≥ 27), depersonalization (DP ≥ 13), and severe psychological distress (K-6 ≥ 13), respectively. 28.8% reported a history of mental disorder. The preferred model showed distinct pathways from adversity exposure and workplace stressors to burnout, with negative emotion-focused coping and psychological distress as significant intervening variables. While greater exposure to both types of stressors were associated with higher levels of burnout and distress, workplace stressors had a stronger association with psychological outcomes than adversity exposure did (β = .52, p ≤ .001 vs. β = .20, p = .032). Workplace stressors, but not adversities, directly influenced psychological distress (β = .45, p ≤ .001 vs. β = -.01, p = .927). Demographic variables, task-focused and avoidance-focused coping were not significantly associated with psychological outcomes.

CONCLUSIONS

Compared to exposure to adversities, workplace stressors primarily influenced occupational stress syndromes. Reducing workplace stressors and enhancing adaptive coping may improve psychological outcomes in humanitarian staff.

Effects of Cognitive Appraisals on Perceived Self-Efficacy and Distress during the COVID-19 Lockdown: An Empirical Analysis Based on Structural Equation Modeling

During the COVID-19 lockdown, individuals and households had to responsibly manage the difficulties and problems caused by the restrictions on their mobility, such as the interruptions to work schedules, insecure food supplies, and the procurement of services and health care. The perceptions of risk as well as the fear of disease were strongly linked to worry, defined as a sequence of thoughts that evoke negative emotions and elevated levels of anxiety and distress. This study evaluated how different cognitive appraisals of an individual's sources of worry could influence their perceived self-efficacy and directly or indirectly moderate their perceived general distress. A sample of 544 participants completed a survey that included questions based on the generalized self-efficacy scale, the sources of concern during the epidemic, the cognitive appraisal scale in emergency, and perceived discomfort. Subsequently, a structural-equation-modeling (SEM) analysis was performed to test the moderating role of cognitive appraisals and perceived self-efficacy on participants' overall distress during a lockdown. Overall, the model reported acceptable fit values and confirmed the hypotheses of the study. An individual's worries activated either a dysfunctional threat appraisal, which prompted a fear-and-closure response that then increased their overall state of distress; or two other functional appraisals (i.e., adaptive or supportive) that contributed to significantly improving the individual's self-efficacy. Higher self-efficacy was shown to be associated with lower levels of perceived distress. For the purposes of prevention and distress containment, it would be appropriate to promote psycho-educational interventions that promote the adoption of appraisal strategies that are functional and beneficial for perceived self-efficacy.

Linguistic Predictors of Psychological Adjustment in Healthcare Workers during the COVID-19 Pandemic

COVID-19 broke out in China in December 2019 and rapidly became a worldwide pandemic that demanded an extraordinary response from healthcare workers (HCWs). Studies conducted during the pandemic observed severe depression and PTSD in HCWs. Identifying early predictors of mental health disorders in this population is key to informing effective treatment and prevention. The aim of this study was to investigate the power of language-based variables to predict PTSD and depression symptoms in HCWs. One hundred thirty-five HCWs (mean age = 46.34; SD = 10.96) were randomly assigned to one of two writing conditions: expressive writing (EW n = 73) or neutral writing (NW n = 62) and completed three writing sessions. PTSD and depression symptoms were assessed both pre- and post-writing. LIWC was used to analyze linguistic markers of four trauma-related variables (cognitive elaboration, emotional elaboration, perceived threat to life, and self-immersed processing). Changes in PTSD and depression were regressed onto the linguistic markers in hierarchical multiple regression models. The EW group displayed greater changes on the psychological measures and in terms of narrative categories deployed than the NW group. Changes in PTSD symptoms were predicted by cognitive elaboration, emotional elaboration, and perceived threat to life; changes in depression symptoms were predicted by self-immersed processing and cognitive elaboration. Linguistic markers can facilitate the early identification of vulnerability to mental disorders in HCWs involved in public health emergencies. We discuss the clinical implications of these findings.

Mediating Effect of Challenges on Demographics and Coping Strategies of Indian Healthcare Workers during COVID-19

Healthcare workers (HCWs) including doctors, nurses and allied workers struggled to cope up with the stressful situation as the COVID-19 pandemic unsettled healthcare systems, including India's. Many factors (commonly called as stressors) acted as major sources of stress and resulted in poor mental health of HCWs. Therefore, this study predicted and explained the mediating effect of challenges on demographic characteristics and coping strategies of HCWs. Data from a cross-sectional study was collected from the district hospital of Rajasthan, India, during the period of August 2022-October 2022. HCW's experience level, shift type and distance of greenspaces from their accommodation were significantly correlated with the challenges they faced at work, specifically societal challenges. Thus, HCWs were more inclined to adopt a meaning-focused coping strategy to retain good mental health during the pandemic. Therefore, these findings call for interventions requiring a layered response, comprising strategies and actions that are structural. At the organizational level, these actions may provide supportive workplace environments.

Correlates of burnout among healthcare workers during the COVID-19 pandemic in South Korea

Burnout is a form of negative emotional and physical response to job stress. This study aimed to investigate the prevalence of burnout among healthcare workers responding to the coronavirus disease 2019 (COVID-19) outbreak in Korea and to explore correlates of burnout among healthcare workers. A nationwide questionnaire-based survey was conducted from December 1, 2020, to January 29, 2021 on 1425 healthcare workers who worked in one of the 16 healthcare facilities designated for COVID-19 care, in public health centers, or as paramedics in Korea. Burnout was assessed using 16 Korean-adapted items based on the Oldenburg Burnout Inventory (OLBI). Data were collected using a structured questionnaire and analyzed using the R version 4.1.1 software program. OLBI results indicate clinically exhaustion in 84.5% (1204/1425) and clinically disengagement in 91.1% (1298/1425), and 77.3% (1102/1425) met the score criteria for both the exhaustion and disengagement subscales for burnout. Burnout rate was significantly increased in the group with chronic fatigue symptoms (Fatigue Severity Scale ≥ 3.22) after the outbreak of COVID-19 (OR, 3.94; 95% CI 2.80-5.56), in the female group (OR, 2.05; 95% CI 1.46-2.86), in the group with physical symptoms (Patient Health Questionnaire-15 ≥ 10) after the outbreak of COVID-19 (OR, 2.03; 95% CI 1.14-3.60), in the group with a higher Global Assessment of Recent Stress scale (OR, 1.71; 95% CI 1.46-2.01), in the group with post-traumatic stress symptoms (Primary Care Post-Traumatic Stress Disorder-5 ≥ 2) (OR, 1.47; 95% CI 1.08-2.01), and in the younger age group(OR, 1.45; 95% CI 1.22-1.72). The chronic fatigue symptoms were correlated with cumulative days of care (OR, 1.18; 95% CI 1.02-1.37). The physical symptoms were correlated with average contact hours with COVID-19 patients per day (OR, 1.34; 95% CI 1.17-1.54), and cumulative days of care (OR, 1.21; 95% CI 1.06-1.38). Most Korean healthcare workers suffered from burnout related to excessive workload during the COVID-19 pandemic. During a widespread health crisis like COVID-19, it is necessary to regularly check the burnout status in healthcare workers and reduce their excessive workload by supplementing the workforce and providing appropriate working hours sufficient rest hours.

Influence of Previous Mental State on Psychological Outcomes of Spanish Out-of-Hospital Professionals during the COVID-19 Pandemic

This study aimed to describe factors relating to the psychological distress of healthcare workers (HCWs) in Spanish out-of-hospital emergency medical services (EMS), according to the previous or non-use of psychotropic drugs or psychotherapy. A multicentre, cross-sectional descriptive study was designed. The study population were all physicians, nurses, and emergency medical technicians (EMTs) working in any Spanish out-of-hospital EMS between February and April 2021. The main outcomes were the levels of stress, anxiety, depression, and self-efficacy, assessed by DASS-21 and G-SES. Differences in levels of stress, anxiety, depression, and self-efficacy, according to sex, age, previous use of psychotropic drug or psychotherapy, work experience, professional category, type of work, and modification of working conditions were measured using the Student's t-test for independent samples, one-way ANOVA, Pearson's correlation, or 2-factor analysis of covariance. A total of 1636 HCWs were included, of whom one in three had severe mental disorders because of the pandemic. The interaction of the previous or non-use of psychotropic drugs or psychotherapy with the rest of the factors considered did not modify the levels of stress, anxiety, depression, and self-efficacy. However, HCWs with a history of psychotropic drug or psychotherapy use had a more intense negative emotional response and lower self-efficacy, regardless of their sex, professional category, type of work, or change in the working conditions. These HCWs are considered particularly vulnerable to the development or recurrence of new disorders or other comorbidities; therefore, the implementation of monitoring and follow-up strategies should be a priority.

The mediating role of coping strategies between depression and social support and the moderating effect of the parent-child relationship in college students returning to school: During the period of the regular prevention and control of COVID-19

Objective

According to the WHO, compared to before the COVID-19 pandemic, young people showed a significant increase in depressive symptoms. In light of the recent coronavirus pneumonia pandemic, this study was conducted to determine how social support, coping style, parent-child relationships, and depression are associated. We investigated how these factors interacted and affected the prevalence of depression during this challenging and unheard-of time. Our research may help both individuals and healthcare professionals better comprehend and assist those who are coping with the pandemic's psychological effects.

Design and main outcome measures

3,763 students from a medical college in Anhui Province were investigated with Social Support Rate Scale, Trait Coping Style Questionnaire, and Self-rating Depression Scale.

Results

When the pandemic situation was normalizing, social support was associated with depression and the coping style of college students (p < 0.01). During the period of pandemic normalization, the parent-child relationship moderated the relationship between social support and positive coping (t = -2.45, p < 0.05); the parent-child relationship moderated the relationship between social support and negative coping (t = -4.29, p < 0.01); and the parent-child relationship moderated the association between negative coping and depression (t = 2.08, p < 0.05).

Conclusion

Social support has an impact on depression in the period of the regular prevention and control of COVID-19 through the mediating role of coping style and the moderating effect of the parent-child relationship.

COVID-19 Stressors and Aggression among Chinese College Students: The Mediation Role of Coping Strategies

Although college students experienced excessive stressors (COVID-19 disease and negative COVID-19 news) during the COVID-19 pandemic, few studies have been aimed at coping strategies used by college students to deal with stress caused by the pandemic. Coping strategies are efforts to deal with anxiety in the face of a perceived threat or stress. Aggression is harmful social interaction with the intention of inflicting damage or harm upon another individual. In the present study, we aimed to examine the direct effect of stressors resulting from the pandemic on college students' aggression, as well as the indirect effect via their coping strategies. Through a cross-sectional survey of 601 Chinese college students (M-age = 20.28), we tested the proposed framework. We first found that information stressors of COVID-19 ranked highest among the four stressors of the pandemic. Results also indicated that college students' stressors of COVID-19 were directly and positively associated with their aggressive behavior. For the indirect effect, college students would adopt both adaptive coping strategies (self-help strategy) and maladaptive coping strategies (avoidance strategy and self-punishment strategy) with the stressors of COVID-19. Furthermore, adaptive coping strategy (approach strategy) was negatively related to their aggression, whereas maladaptive coping strategy (avoidance strategy and self-punishment strategy) was positively related to their aggressive behavior. The present research extends the general strain theory in the COVID-19 context. Practical implications are also discussed.

The Impact of Mental Well-Being, Stress, and Coping Strategies on Resilience among Staff Nurses during COVID-19 in Saudi Arabia: A Structural Equational Model

Previous studies have revealed various factors related to nurses' resilience and predictors of resilience. However, there are no studies analysing the association of three variables-mental well-being, coping strategies, and stress-with resilience. This study aims to assess the impact of mental well-being, levels of stress, and coping strategies on resilience using path analysis. This study used a cross-sectional approach that involved 763 nurses from 16 major hospitals in the eastern and northern regions of Saudi Arabia during the COVID-19 pandemic. The data gathering was conducted from August to November 2022. The staff nurses possessed positive mental wellness (3.75 ± 1.08), moderate stress levels (3.06 ± 1.21), adequate coping skills (3.33 ± 1.23), and a low level of resilience (2.90 ± 1.040). Age had a small effect on resilience (β = 0.040; p < 0.001) but work experience (β = -0.019; p > 0.139) and marital status (β = 0.019; p > 0.072) were not significant. Conversely, mental well-being (β = 0.043; p < 0.001) and stress (β = -0.089; p < 0.001) had a small effect on resilience, but coping strategies (β = 0.561; p < 0.001) had a large effect on resilience. Therefore, coping strategies must be reinforced at all times to assist nurses and other healthcare professionals in identifying contributing elements that maintain these workers' resilience in the face of unforeseen and protracted pandemics and other life events.

It Is Not the Virus Exposure: Differentiating Job Demands and Resources That Account for Distress during the COVID-19 Pandemic among Health Sector Workers

A cross-sectional study of 3860 health-sector workers across two data collections was conducted to identify the predictive power of different job demands and job resources during the COVID-19 pandemic based on four indicators of distress (COVID-19 traumatic stress, burnout, generalised anxiety, and depression) among health-sector workers. Exploratory and confirmatory factor analyses, measurement invariance checks, and structural equation models were used to evaluate the dimensionality and the effect of the job demands and resources on distress indictors. The identified job demands were workload, confinement, loss, and virus exposure, while the identified job resources were self-efficacy, momentary recuperation, and meaning making. Loss and workload predicted the distress indicators best, while confinement and virus exposure mainly predicted COVID-19 traumatic stress and were less important for the other distress outcomes. Self-efficacy and meaning making negatively predicted distress, while momentary recuperation, controlled for the other demands and resources, was positively related to the distress indicators. Of the typical pandemic-related demands and resources, the experience of loss due to COVID-19 infection was the most important predictor of distress outcomes. Confinement, and especially the awareness of virus exposure, were far less important predictors.

Assessing the Prevalence, Predictors, and Consequences of Secondary Traumatic Stress Among Emergency Nurses in Palestine During the COVID-19 Pandemic

Introduction

Emergency nurses who are working in direct contact with COVID-19 patients are at an increased risk of developing secondary traumatic stress disorder. This study aimed to assess the prevalence, predictors, and consequences of secondary traumatic stress among emergency nurses in Palestine during the COVID-19 pandemic.

Methods

The study utilized a cross-sectional design and recruited a total of 189 emergency nurses from multiple healthcare centers in Palestine. Data collected from January 21, 2021, to March 31, 2021.

Results

The study revealed that emergency nurses had a high degree of secondary traumatic stress with the prevalence of high to severe symptoms of secondary traumatic stress being 61% of the total participants. In terms of predictors, the results showed that years of experience, level of education, burnout, and organizational support were significantly correlated with secondary traumatic stress and thus that years of experience and burnout are predictors of secondary traumatic stress.

Conclusion

Based on our findings, nurses in emergency departments in Palestine have a high degree of secondary traumatic stress disorder which impacts their lives on a personal and professional level.

Secondary traumatic stress and dissociative coping strategies in nurses during the COVID-19 pandemic: The protective role of resilience

During the COVID-19 pandemic, nurses are repeatedly exposed to acute stress at their workplace, and therefore, they are at high risk for developing mental health symptoms. The prolonged exposure of healthcare professionals may lead to Secondary Traumatic Stress (STS). STS is an aspect of "cost of care", the natural consequence of providing care to people who suffer physically or psychologically. The purpose of this study was to investigate the levels of STS in nurses during the first phase of the COVID-19 pandemic in Greece and to detect aggravating and protective factors. Participants were 222 nurses (87.4 % women; mean age 42.3 years) who completed an online survey. The questionnaire comprised of the Secondary Traumatic Stress Scale, the Brief Resilience Scale, and the Brief Coping Orientation to Problems Experienced Inventory. Nurses had high levels of STS. The hierarchical regression analyses showed that STS and its dimensions Avoidance and Arousal were positively predicted mainly by denial and self-distraction coping strategies and inversely by resilience. Resilience exhibited a protective (partial mediation) effect on the strong relationship between the dissociative coping strategies (denial, self-distraction, venting and behavioral disengagement) and STS. Trauma-informed care psychosocial interventions are needed to support the already overburdened nursing staff during the coronavirus pandemic.

Do we cope similarly with different adversities? COVID-19 versus armed conflict

BACKGROUND

Varied populations may react differently to similar crises, depending on their social, cultural, and personal backgrounds; conversely, the same populations may respond differently to varied adversities. The current study aimed to examine three types of resilience (individual, community, and societal resilience) predicting six coping mechanisms (sense of danger, anxiety and depressive symptoms, well-being, hope, and morale) among the same sample of people that faced across two different adversities-COVID-19 and an armed conflict.

METHODS

Two repeated measurements of the same Israeli sample (N = 593) were employed, through an internet panel. The research variables were examined through a structured, quantitative questionnaire that consisted of nine scales, based on validated and reliable questionnaires.

RESULTS

Results indicated that: (a) respondents reported more difficulties in coping with the COVID-19 crisis, compared to the armed conflict, in all variables but morale. (b) similar patterns of correlations among the study variables were found in both measurements. (c) path's analysis indicated similar patterns of prediction of distress and well-being by individual and societal resilience. Use of the coping mechanism varied depending on the perception of the threat: COVID -19 is perceived as a less familiar and predictable adversity, which is harder to cope with, compared with the more familiar risk - an armed conflict, which is a recurrent threat in Israel. The correlations between the investigated psychological responses and the impacts of resilience on the coping and distress mechanism were similar in both adversities.

CONCLUSIONS

The results indicate that respondents tend to react in a similar pattern of associations among resilience, distress, and well-being across different adversities, such as COVID and armed conflict. However, individuals tend to regard unfamiliar, less predictable adversities as more complex to cope with, compared to better-known crises. Furthermore, respondents tend to underestimate the risks of potential familiar adversities. Healthcare professionals must be aware of and understand the coping mechanisms of individuals during adversities, to appropriately design policies for the provision of medical and psychological care during varied emergencies.

Psychological Health in Intensive Care Unit Health Care Workers after the COVID-19 Pandemic

BACKGROUND

Although the COVID-19 pandemic had an impact on the general population, health care workers (HCWs) constituted one of the groups that were most adversely affected by the associated risks, owing to the significant consequences on their mental health. This study examined these psychological effects on HCWs who cared for COVID-19 patients who were admitted to the intensive care unit in an Italian hospital.

METHODS

Subjects were administered several self-reported questionnaires: Kessler 10 Psychological Distress Scale (K10), Perceived Stress Scale-10 (PSS), Impact of Event Scale Revised (IES-R), and Post-traumatic Growth Inventory (PTGI), as well as two open-ended questions oriented toward understanding their positive and negative emotional experience and differentiating between two phases of the emergency.

RESULTS

Overall, 45% of HCWs showed medium-to-high anxiety/depressive symptoms, whereas 60% presented with medium-to-high levels of perceived stress. In addition, 37% of subjects developed symptoms of PTSD and 50% showed post-traumatic growth in the "appreciation of life" and "new possibilities" dimensions. With regard to the open-ended questions, three themes were identified: quality of workplace relationships, sense of emotional-relational competence, and sense of clinical-technical competence. In addition, two macrocategories of responses were identified in the answers: growth and block.

CONCLUSIONS

The mental health of HCWs who are involved in the front line of COVID-19 was significantly impacted by this experience, showing high levels of post-traumatic stress and anxiety and depressive symptoms more than 1 year after the emergency began. A qualitative analysis of staff experiences can be a useful guide for structuring interventions and prevention.

Is This All COVID-19's Fault? A Study on Trainees in One of the Most Affected Italian Cities

Many studies have investigated the state of the health of healthcare workers during the acute period of the pandemic. Yet, few studies have assessed the health of such professionals after the pandemic and in a less dramatic period. This study involved a particular sample represented by residents in anaesthesia-resuscitation and psychiatry at a university in northern Italy particularly affected by the pandemic. The objectives were to investigate some indicators of health and well-being and compare the two groups of trainees. Using Google Forms, the following tests were proposed: the General Health Questionnaire, Maslach Burnout Inventory, Subjective Happiness Scale, Satisfaction with Life Scale, Coping Inventory for Stressful Situations, Brief Resilience Scale, State-Trait Anxiety Inventory, as well as an ad hoc questionnaire. A qualifying element of the work was the discussion of the results with the trainees. Various strengths have emerged, such as high values of resilience and job satisfaction; a positive assessment of the support received from the work team; an articulate use of coping strategies; and good levels of happiness and satisfaction with life, in both specialities. However, a widespread anxiety also emerged, which appears to be more attributable to concerns about professional evaluation, rather than the pandemic itself. In summary, the trainees seem to have found a fair amount of personal balance, whereas the relationship with the patient seems to be more compromised. In the comparison between specialities, the only significant differences are the levels of depersonalisation and resilience, both of which are higher in anaesthetists.

Causes of Stress among Healthcare Professionals and Successful Hospital Management Approaches to Mitigate It during the COVID-19 Pandemic: A Cross-Sectional Study

The outbreak of the COVID-19 pandemic posed an immediate challenge to the management of hospitals in Germany and elsewhere. The risk of stress for front-line healthcare professionals forced occupational health and safety units to adopt a variety of protective measures, not all of which have been thoroughly validated. The main objective of the present analysis is to assess what the most important sources of stress were and which of the protective measures applied to counteract stress among healthcare staff had the greatest impact. A better understanding of these factors will improve hospital management and worker safety in a future health crisis situation and may also prove to be beneficial in non-crisis situations. For this purpose, in 2020, an exploratory, cross-sectional and quantitative study using a questionnaire created for this purpose was carried out on a total of 198 professionals-133 nurses and 65 physicians-at the Klinikum Mittelbaden Balg hospital in Baden-Baden, Germany, during the first wave of the pandemic. Statistical analyses showed that nurses suffer more stress than physicians and that stress is higher among professionals in critical care and emergency units than in units that are less exposed to infected patients. It was also found that measures such as salary incentives, encouragement of work in well-integrated teams, and perceived support from hospital management mitigate stress. These findings highlight the importance of support measures from management and superiors. Knowing the actual effectiveness of the measures applied by management and the factors mentioned above could help to protect healthcare professionals in the event of another pandemic or similar situations and may still be of value in dealing with the continuing COVID-19 pandemic.

The predictors of secondary traumatic stress and psychological resilience in healthcare workers during the COVID-19 pandemic: A cross-sectional study in Turkey

This study aims to investigate the relationship between predictive factors of secondary traumatic stress (STS), that is, sociodemographic and work characteristics, and the psychological resilience of healthcare professionals working in different regions of Turkey. This cross-sectional study included 1416 healthcare workers (HCWs). An independent sample t-test and hierarchical regression analysis were performed to analyse the data. The predictor variables for STS included perception of health, fear of contagion, anxiety about infecting family members, psychological resilience, type of work, having a COVID-19 diagnosis in the family, and experiencing a loss due to COVID-19 (p < 0.05). The variables that predicted psychological resilience included socioeconomic status, health status, age, marital status, work experience, and type of work (p < 0.05). A low number of resilient HCWs experienced secondary traumatic stress.

Career resilience of the tourism and hospitality workforce in the COVID-19: The protection motivation theory perspective

By applying the protection motivation theory, the study aims to investigate factors influencing tourism and hospitality (T&H) workers' career resilience when faced with health-related risks at work during a pandemic. Data were collected from 495 part-time and full-time employees in the Vietnamese tourism and hospitality sector. The study found that workers' perceived vulnerability and perceived severity of the pandemic were positively associated with career resilience. Perceived severity was positively related to self-efficacy and response efficacy, while perceived vulnerability was positively associated with self-efficacy only. Both self-efficacy and response efficacy positively influenced career resilience through the mediating role of health risk preventative behavior. Theoretically, the study advances the stream of research in resilience in general and career resilience in particular among T&H workers when faced with a health-related crisis. Practical implications are provided with recommendations on how to facilitate career resilience among T&H employees working in the current high-risk environment.

Bibliometric visualisation of industrial and organisational psychology during COVID-19 pandemic: Insight for future research

Orientation

Industrial and organisational psychology (IOP) researchers have shown their contribution to solving COVID-19 pandemic in the workplace through the enormous number of studies.

Research purpose

This study intended to map IOP research related to the COVID-19 crisis to provide the research issues that have emerged and potential for future research.

Motivation for the study

All the IOP levels (worker, team and organisation) were impacted by COVID-19, and they continuously change. Researchers must be careful in directing their research and avoid focusing on certain levels or problems.

Research approach/design and method

A bibliometric visualisation analysis method was adopted in this study.

Main findings

The bibliometric results showed that the prominent keywords in IOP research-related COVID-19 are ‘human(s)’, ‘COVID-19’, keywords related to subject characteristics and mental health. Six clusters on the map showed the prominent themes: mental health, health care workers as the research subject, specific workplace issues, digital technology, methodologies used, and country. Furthermore, in every cluster, the depth overview of study results is presented. The top issues were at the worker-level, while the organisational-level issues gained limited attention.

Practical/managerial implications

For practitioners and managers, this study provides a complete picture of emerging issues during COVID-19 crisis ranging from causes, risk factors and solutions. For researchers, this study can provide insight for further research.

Contribution/value-add

This study provides a comprehensive overview of the IOP issues related-COVID-19 that will be beneficial as the basis for policymaking and recommendations for future potential areas.

Fear of COVID-19 and secondary trauma: Moderating role of self-efficacy

COVID-19 has affected millions of people around the globe. People's mental health, especially those of nurses, has been primarily affected by the fear of this virus. More focus has been paid to vaccination and treatment of the virus, but less attestation has been given to addressing the mental health of people affected by the virus. Empirical studies show that different external factors are not easily manageable and controllable by the individual. This study preliminarily explores the connection between fear of COVID-19 and secondary traumatic stress in nurses. Further, it examines the moderating effects of occupational self-efficacy on the relationship between fear of COVID-19 and secondary traumatic stress. Data for the study was collected from the nurses of six large hospitals in Karachi, Pakistan. The final analysis was performed on 243 samples. Studies on COVID-19 suggest that increased occupational self-efficacy decreases fear and its impact. This study offers insights for managers to develop stress management programs and provide proper training and counseling sessions to the nurses to motivate them emotionally. Theoretically, this study broadens the understanding of the theory of emotions by using the pandemic as a stressor. Future studies may explore different roles of occupational self-efficacy and study its influential role in managing different kinds of emotions explained by the theory of emotions. Managers at the workplace could design different self-efficacy training for nurses to increase their self-motivation to fight different types of stress they face at the workplace.

Critical Clinical Events and Resilience Among Emergency Nurses in 3 Trauma Hospital-Based Emergency Departments: A Cross-Sectional Study

INTRODUCTION

Emergency nurses experience occupational stressors resulting from exposures to critical clinical events. The purpose of this study was to identify the critical clinical events for emergency nurses serving 3 patient populations (general, adult, pediatric) and whether the resilience of these nurses differed by the patient population served.

METHODS

This study used a cross-sectional survey design. A total of 48 emergency nurses were recruited from 3 trauma hospital-based emergency departments (general, adult, pediatric). Clinical Events Questionnaire, Connor-Davidson Resilience scale, and an investigator-developed demographic questionnaire were used to collect data from respondents.

RESULTS

All respondents were female (n = 48, 100%), and most were White (n = 46, 96%). The average age of participants was 39.6 years, the average number of years as a registered nurse was 12.7 years, and the average number of years as an emergency nurse was 8.8 years. Clinical events considered most critical were providing care to a sexually abused child, experiencing the death of a coworker, and lack of responsiveness by a colleague during a serious situation. The least stress-provoking event was incidents with excessive media coverage. Nurses were less affected by the critical events they experienced more frequently at work. Nurses in the 3 trauma settings had high level of resilience, with no statistically significant differences between groups.

DISCUSSION

The occupational stress from exposure to significant clinical events varied with the patient population served by emergency nurses. It is important that interventions be adopted to alleviate the effect of work-related stressors and promote the psychological health of emergency nurses.

Individual and organizational resilience—Insights from healthcare providers in Germany during the COVID-19 pandemic

We explored the effects of resilience in the healthcare setting during the COVID-19 pandemic in Germany. Our study sheds light on the cross-level effects of resilience in hospitals and thus responds to calls to research this empirically. In a cross-sectional study design, the perceptions of resilience of employees in hospitals and of transformations at the individual, team, and organizational level were analyzed. An online survey was conducted in summer 2020 in Germany in which 1,710 healthcare workers completed a self-report questionnaire. Results indicate that resilience is both a highly interrelated construct on the individual and organizational level and also positively linked to perceptions of transformation as an indicator for demonstration of resilience. We also found a partial mediation effect of organizational resilience and team efficacy, respectively, on the relationship between individual resilience and perceived transformation on the individual and organizational level as well as a full mediation on the team level. The study highlights the interdependence of individual and organizational resilience (which is mediated by team efficacy) and its impact on perceived transformation in German hospitals during the COVID-19 pandemic. Whereas team efficacy is crucial for performance in regular work operations, during a pandemic the organizational level becomes more relevant. Theoretical and practical implications are discussed.

Psychopathological burden and coping strategies among frontline and second-line Italian healthcare workers facing the COVID-19 emergency: Findings from the COMET collaborative network

BACKGROUND

The aim of this study was to explore the psychopathological burden related to COVID-19 together with coping strategies in healthcare workers, focusing on differences between frontline and second-line workers.

METHODS

This is a cross-sectional study part of the COvid Mental hEalth Trial (COMET). Participants' socio-demographic and COVID-19-related information was collected through an online survey. Psychiatric symptoms and coping strategies were also investigated. Multivariate analyses, corrected for demographic characteristics, were adopted to assess differences between frontline and second-line workers.

RESULTS

The sample consisted of 20,720 individuals. Healthcare workers (n = 2907) presented with significantly higher risk for mental health disturbances as compared to the rest of the sample (p < 0.001). Healthcare professionals working versus not working on the front line differed in living in severely impacted areas (p < 0.001), precautionary isolation by COVID-19 (p < 0.001), infection by COVID-19 (p < 0.001). Frontline workers also reported significantly increased insomnia (p < 0.001), depression (p = 0.007), anxiety (p < 0.001), obsessive-compulsive symptoms (p < 0.001), non-specific chronic and acute traumatic stress (p < 0.001; p < 0.001), as well as more adaptive coping strategies (p = 0.001).

LIMITATIONS

The survey was conducted between March and June 2020, at the peak of the COVID-19 outbreak in Italy. Accordingly, the mental health impact of the COVID-19 pandemic might have changed over time. The survey design involved online invitation and it was not possible to assess the participation rate.

CONCLUSIONS

To our knowledge, this is the largest study addressing the psychopathological burden of Italian healthcare professionals during the COVID-19 outbreak and associated coping strategies. Empowering supportive interventions is crucial for the whole healthcare workforce.

Health Care Workers' Perceived Self-Efficacy to Manage COVID-19 Patients in Central Uganda: A Cross-Sectional Study

Background

The novel coronavirus disease 2019 (COVID-19) pandemic placed health workers at the frontline of the emergency task force response; a duty that requires professional expertise and confidence to rapidly identify and treat patients with COVID-19. This study explored perceived self-efficacy (PSE) of health care workers (HCWs) in the management of patients with COVID-19 and associated factors in central Uganda.

Methods

We recruited 418 HCWs from four national referral hospitals in Uganda. Multivariate linear regression analysis was utilized to determine factors associated with PSE. A p-value > 0.05 was considered statistically significant.

Results

Majority of the participants were female, about half were nurses/midwives, and had 10 years of work experience on average. Overall, HCWs reported moderate PSE in managing COVID-19 patients which reduced with increasing severity of the COVID-19 illness. Having a PhD, being a medical doctor, agreeing or completely agreeing that one has knowledge about COVID-19 management, and having COVID-19 management training were significantly associated with increase in one’s level of PSE.

Conclusion

This study highlights an unsatisfactory, moderate level of PSE among HCWs in the management of patients with COVID-19 in central Uganda. The health sector should focus on improving HCWs’ self-efficacy through continuous training of all HCWs in the clinical management of especially the severe and critically ill cases of COVID-19. Non-doctor HCWs should be given priority as they scored lower levels of PSE; yet they are the corner stone of the primary health care system and make majority of the health human resource in low- and middle-income countries. Interventions towards creating a safe working environment for HCWs through provision of adequate infection prevention and control strategies are essential in boosting HCWs confidence to manage COVID-19 patients.

COVID-19 Posttraumatic Stress Disorder in Clinical Nurse Specialists

The purpose of this study was to examine if a relationship exists between the coronavirus 2019 pandemic and posttraumatic stress disorder in clinical nurse specialists.

The Wounded Healer: A Phenomenological Study on Hospital Nurses Who Contracted COVID-19

Since the pandemic began nurses were at the forefront of the crisis, assisting countless COVID-19 patients, facing unpreparedness, social and family isolation, and lack of protective equipment. Of all health professionals, nurses were those most frequently infected. Research on healthcare professionals' experience of the pandemic and how it may have influenced their life and work is sparse. No study has focused on the experiences of nurses who contracted COVID-19 and afterwards returned to caring for patients with COVID-19. The purpose of this study was therefore to explore the lived personal and professional experiences of such nurses, and to describe the impact it had on their ways of approaching patients, caring for them, and practicing their profession. A phenomenological study was conducted with 54 nurses, through 20 individual interviews and 4 focus groups. The main finding is that the nurses who contracted COVID-19 became “wounded healers”: they survived and recovered, but remained “wounded” by the experience, and returned to caring for patients as “healers,” with increased compassion and attention to basic needs. Through this life-changing experience they strengthened their ability to build therapeutic relationships with patients and re-discovered fundamental values of nursing. These are some of the ways in which nurses can express most profoundly the ethics of work done well.

Emergency Stress, Hardiness, Coping Strategies and Burnout in Health Care and Emergency Response Workers During the COVID-19 Pandemic

Objective

Stress is a growing problem in the general population, but most especially for workers responding to the COVID-19 crisis. The present study examines stress and Burnout in Health Care workers and Emergency Responders during the third COVID wave in Italy. In addition, we explore the value of psychological Hardiness and positive coping strategies as protective factors against the ill-effects of stress.

Methods

Over a 5-month period in 2021, surveys were administered across all Italian regions to several groups including Health Care workers (N = 220), Emergency Responders (firefighters, civil protection, ambulance personnel; N = 121), volunteer Italian Red Cross workers (N = 328), and a comparison group (N = 400) drawn from the General Population of Italy.

Results

Results showed that among the groups, Health Care workers had the highest levels of Emergency Stress, while the Red Cross volunteers had relatively lower stress levels. Hardiness and positive coping levels were highest among Red Cross workers, and lowest in the General Population sample. The biggest impact on Burnout was seen among health care workers, especially on Emotional Exhaustion and Depersonalization. Multiple regression results showed that Hardiness operates as a moderator of the effects of Emergency Stress on Emotional Exhaustion and Depersonalization aspects of Burnout, while problem focused coping and Stopping Negative Thoughts-Emotions also showed moderating effects.

Conclusion

These results suggest that Health Care workers and Emergency Responders would benefit from additional training in hardiness and positive coping skills.

COVID-19 and Australian school psychology: Qualitative perspectives for enhancing future practice

The challenges and changes driven by the Coronavirus Disease 2019 (COVID-19) pandemic in the education sector have been linked to high rates of anxiety, depression, and post-traumatic symptoms in school-aged populations. Despite this, it is also acknowledged that children and young people can be resilient and adaptable, with the right support in place. In schools, psychologists play an important role in supporting students' learning, behavior, wellbeing, and mental health. The aim of this study is to investigate the practices of Australian school psychologists during COVID-19 related school closures, focusing on their experiences and challenges and how they adapted their practices. Twelve Australian school psychologists were interviewed and, after member checks were undertaken, interview transcripts were analyzed using thematic analysis. Six interrelated themes were identified including: (a) heightened student psychological stress, (b) alternative delivery modes and associated challenges, (c) close collaboration with families, (d) participants personal challenges during COVID-19, (e) assessment during COVID-19, and (f) possible long-term practice changes post pandemic. The results of this study have implications for policies to support students in future pandemics or where physical school attendance is disrupted (e.g., natural disasters).

Self-efficacy among patients with hemodialysis during the COVID-19 pandemic

Patients with hemodialysis face various problems with self-care behavior. Therefore, these patients need to control and manage adherence to enhance self-care, especially during the COVID-19 pandemic, which has particularly high morbidity in the elderly and co-morbid peoples. Self-efficacy was identified as a number of psychological factors that improve adherence and treatment outcomes among hemodialysis patients. This study aimed to investigate self-efficacy among patients with hemodialysis during the COVID-19 pandemic. A comparative descriptive research design was used to conduct the study. A convenience sample of 95 hemodialysis patients (male and females) was selected from Port-Said city, Egypt, and 115 hemodialysis patients (male and females) were selected from Saudi Arabia. Data collection included a structured interview with three parts assessing socio-demographic characteristics, anthropometric measurements, and self-efficacy. This study revealed a statistically significant difference between Egyptian and Saudi hemodialysis patients, mainly in the main score and levels of self-efficacy (p=0.001). There is a significant relationship between socio-demographic characteristics and chronic disease self-efficiency among Egyptian hemodialysis patients in terms of sex, age, marital status, work, and level of education.

The Fear of COVID-19: Gender Differences among Italian Health Volunteers

Background: During the COVID-19 pandemic, the fear of being infected was a major concern, resulting in both physical and psychological effects. Despite several studies on fear of COVID-19 in the general population, the effects on healthy volunteers who face COVID-19 on the frontlines have not yet been investigated. Methods: An online survey on specific psychological variables related to COVID-19 was administered to 720 healthy volunteers, and gender differences were investigated. Results: The primary finding was that females showed higher scores in all dimensions assessed. A multiple linear regression conducted on both genders exhibited a similar pattern of predictors, highlighting the pivotal role of negative affect in the male group. Conclusions: The findings suggest that COVID-19 had significant effects on healthy volunteers, especially in the female group. Although the previous literature did not report the crucial role played by the negative affect in the male sample, these results highlight the need to deepen how both genders use different emotional strategies to cope with stressful situations. This study may be useful in the development of specific psychological support and ad hoc training for healthy volunteers.

Influence of the Cumulative Incidence of COVID-19 Cases on the Mental Health of the Spanish Out-of-Hospital Professionals

This study aimed to analyze the psychological affectation of health professionals (HPs) of Spanish Emergency Medical Services (EMSs) according to the cumulative incidence (CI) of COVID-19 cases in the regions in which they worked. A cross-sectional descriptive study was designed, including all HPs working in any EMS of the Spanish geography between 1 February 2021 and 30 April 2021. Their level of stress, anxiety and depression (DASS-21) and the perception of self-efficacy (G-SES) were the study’s main results. A 2-factor analysis of covariance was used to determine if the CI regions of COVID-19 cases determined the psychological impact on each of the studied variables. A total of 1710 HPs were included. A third presented psychological impairment classified as severe. The interaction of CI regions with the studied variables did not influence their levels of stress, anxiety, depression or self-efficacy. Women, younger HPs or those with less EMS work experience, emergency medical technicians (EMT), workers who had to modify their working conditions or those who lived with minors or dependents suffered a greater impact from the COVID-19 pandemic in certain regions. These HPs have shown high levels of stress, anxiety, depression and medium levels of self-efficacy, with similar data in the different geographical areas. Psychological support is essential to mitigate their suffering and teach them to react to adverse events.

Frontline Mongolian Healthcare Professionals and Adverse Mental Health Conditions During the Peak of COVID-19 Pandemic

Background

The relatively young and inexperienced healthcare professionals in Mongolia faced with an unprecedent service demand in response to the COVID-19 pandemic. Due to the small size of the healthcare workforce the Mongolian Health Ministry had no choice but to mandate continuous and long workhours from the healthcare workforce. Many of the healthcare professionals exhibited signs and symptoms of mental health disorders. This study aimed to discern the prevalence various mental health concerns, i.e., depression, anxiety and stress, insomnia, and to discern the factors that increased susceptibility to mental health disorders among frontline healthcare professionals providing healthcare services for COVID-19 patients in Mongolia.

Methods

A Cross-sectional research design was implemented. We collected data from 965 healthcare professional, randomly selected from 18 government hospitals, in four regions of Mongolia. Data were collected using the Depression Anxiety Stress-21, the General Self-Efficacy Scale, and the Insomnia Severity Index instruments. We constructed the scale of Pandemic Response Symptoms (PaReSy) which captured stress, depression, and anxiety. Data were analyzed using descriptive statistics, Kruskal-Wallis statistical test and multinominal logistic regression analysis.

Results

Prevalence of depression (52.3%, CI 95%: 49.1-55.5%), anxiety (70.2%, CI 95%: 67.2-73.0%), and stress (35.8%, CI 95%: 32.7-38.9%) was documented among Mongolian healthcare professionals. Perception of self-efficacy reduced susceptibility to PaReSy either at mild/moderate (OR = 0.948, 95% CI = 0.911-0.988, P = 0.011) or severe/extremely severe level (OR = 0.911, 95% CI = 0.861-0.963, P = 0.001). Within each stratum of insomnia, the risk of experiencing PaReSy increased almost linearly both in the category of mild/moderate PaReSy and in the category of severe/extremely severe PaReSy.

Conclusion

Improving self-efficacy and sleeping quality can assist healthcare workers to manage depression, anxiety, and stress. Findings provide important evidence to implement measures and strategies to assist healthcare professionals in low- and middle-income countries to constructively address their mental health concerns and needs.

The cognitive basis of psychosocial impact in COVID-19 pandemic. Does it encircle the default mode network of the brain? A pragmatic proposal

Epigenetics, hypothalamic-pituitary axes, environmental and metabolic influences, and transgenerational plasticity govern social behavior. Cognitive research considers the brain's default mode network (DMN) as a central hub that integrates various cognitive and social processing domains responsible for emotion perception, empathy, theory of mind, and morality. Hence, DMN is regarded as the "social brain." Upsurge in social turmoil, social anxiety, panic, depression, post-traumatic stress, hoarding, herd behavior, substance and behavioral addictions, sexual abuse, and violence in the time of the COVID-19 pandemic are intricately related to personality traits resulting in disruptive social cognition and social behavior, conceptualized as the result of unsettling and disruption of the functional nexus of the DMN. Considering overt and conspicuous display of neuroticism during the current pandemic, its impact upon modulation of the DMN functional nexus and the DMN itself, and the potential to presage cognitive impairment in the future, the authors caution that an increase in the global burden of dementia may be one of the long-term ramifications of COVID-19. Social behavior, a functional derivative of the DMN, can strikingly affect the functional nexus of DMN and the DMN itself, in a centripetal way via the phenomenon called "Experience-Dependent Plasticity," with long-term consequences. In this review, we intend to 1) decipher the association between social cognition and social behavior with the DMN, in time of COVID-19; and to 2) discuss the prospective aftermath of disrupted social behavior during the pandemic on modulation/alteration of functional connectomes of DMN or the DMN itself in the time ahead.

Lessons Learned about the Need for Early Screening for Depression during the First Months of the COVID-19 Pandemic in the United States

A nationwide survey assessed the prevalence and pandemic-related risk factors of major depressive disorder (MDD) at the initial onset of the COVID-19 pandemic. Findings showed a significant increase in the prevalence of MDD (22.7%) compared to the pre-pandemic 12-month estimate (10.4%). Specific pandemic-related concerns, along with significant increases in stress, loneliness, fatigue, and substance use behaviors are noted for those with the provisional diagnosis of MDD. Early screening and detection for potential MDD cases can reduce the severity and duration of maladaptive symptoms, decreasing the risk for future depression episodes and the potential loss of quality of life and productivity.

Prevalence Estimates and Risk Factors of Anxiety among Healthcare Workers in Jordan over One Year of the COVID-19 Pandemic: A Cross-Sectional Study

This study investigates the changes in prevalence estimates, severity, and risk factors of anxiety among healthcare workers (HCWs) over the first year of the COVID-19 pandemic. A survey was distributed among HCWs using snowball sampling, collecting their socio-demographics, occupation, and anxiety symptoms as measured by the Generalized Anxiety Disorder-7 (GAD-7) scale. It was distributed one month after the pandemic’s onset in Jordan between 15 and 30 April 2020 (onset group) and after one year between 15 and 30 March 2021 (one-year group). A total of 422 HCWs were included (211 in each group). The one-year group reported a higher risk of GAD (30.8% vs. 16.6%; p = 0.001), a higher mean (SD) GAD-7 score (7.94 (5.29) vs. 6.15 (4.15); p < 0.001), and more severe symptoms (p = 0.003). Univariate analyses showed that participants who were younger, women, unmarried, had lower monthly incomes, underwent testing for COVID-19, had higher contact with COVID-19 patients, did not receive special education, and were unsatisfied with the institutional COVID-19 preparedness scored higher on the GAD-7 scale and had more severe symptoms than their counterparts in both groups. Unlike the onset group, occupation as a physician, COVID-19 infection history, and perception of remarkable changes in work were associated with higher anxiety scores and severity among the one-year group. The COVID-19 vaccine was a relative protective action. Logistic regression analyses showed that the female gender was a risk factor for developing GAD at the pandemic onset, while poor satisfaction with institutional preparedness was a significant GAD risk factor in the one-year group. Low monthly income and lack of special education were the shared risk factors for GAD in both groups. This study reveals a significant rise in anxiety among HCWs over a year of the COVID-19 pandemic and shows the vulnerable sub-groups who likely need psychological interventions.

Beyond Burnout and Resilience: The Disillusionment Phase of COVID-19

In caring for patients during the COVID-19 pandemic, nurses are experiencing a crisis of emotional highs and lows that will have lasting implications for their professional and personal well-being. As a result, much attention has been focused on nurse burnout, but the range of nurses' experiences is more nuanced, complicated, and profound. With the recognition that the nursing workforce was already experiencing burnout before the pandemic, this article explores how individuals respond to disasters and the detrimental effects of the repeated surges of critically ill patients, which have led nurses to experience an extended period of disillusionment that includes secondary traumatic stress, cumulative grief, and moral distress. This article describes the range of psychological responses to the COVID-19 pandemic so that nurse leaders can better identify resources and interventions to support nurses.

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

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

The Impact of the COVID-19 Pandemic on Burnout, Compassion Fatigue, and Compassion Satisfaction in Healthcare Personnel: A Systematic Review of the Literature Published during the First Year of the Pandemic

This literature review aimed to determine the level of burnout, compassion fatigue, and compassion satisfaction, as well as their associated risks and protective factors, in healthcare professionals during the first year of the COVID-19 pandemic. We reviewed 2858 records obtained from the CINAHL, Cochrane Library, Embase, PsycINFO, PubMed, and Web of Science databases, and finally included 76 in this review. The main results we found showed an increase in the rate of burnout, dimensions of emotional exhaustion, depersonalization, and compassion fatigue; a reduction in personal accomplishment; and levels of compassion satisfaction similar to those before the pandemic. The main risk factors associated with burnout were anxiety, depression, and insomnia, along with some sociodemographic variables such as being a woman or a nurse or working directly with COVID-19 patients. Comparable results were found for compassion fatigue, but information regarding compassion satisfaction was lacking. The main protective factors were resilience and social support.