The influence of COVID-19-related resilience on depression, job stress, sleep quality, and burnout among intensive care unit nurses

Resilience and Social Support Protect Nurses from Anxiety and Depressive Symptoms: Evidence from a Cross-Sectional Study in the Post-COVID-19 Era

Background: Nurses experience high levels of anxiety and depression since they work in a highly stressful environment. Thus, the identification of preventive factors against nurses' anxiety and depression is essential to improve their quality of life. In this context, our aim was to examine the impact of resilience and social support on nurses' anxiety and depressive symptoms. Methods: A cross-sectional online study was implemented in Greece in September 2024. We used the Brief Resilience Scale, Multidimensional Scale of Perceived Social Support, and Patient Health Questionnaire-4 to measure resilience, social support, anxiety, and depressive symptoms, respectively. Results: Our sample included 677 nurses with a mean age of 37.73 years (standard deviation: 9.38). Our multivariable linear regression models identified a negative relationship between resilience and anxiety (adjusted standardized beta coefficient =-0.38; p < 0.001) and depressive symptoms (adjusted standardized beta coefficient = -0.36; p < 0.001). Similarly, we found that significant others' support was associated with reduced anxiety (adjusted standardized beta coefficient = -0.27; p < 0.001) and depressive symptoms (adjusted standardized beta coefficient = -0.23; p < 0.001). The standardized beta coefficient indicated that resilience has a greater impact on anxiety and depressive symptoms than significant others' support. Conclusions: Our findings suggest resilience and social support have a protective function against nurses' anxiety and depressive symptoms. Managers and policymakers should adopt appropriate interventions to improve nurses' resilience and social support and, thus, to improve their mental health and quality of life.

The relationship between sleep quality and resilience among intensive care unit nurses: A cross-sectional study

Resilience is essential for intensive care unit (ICU) nurses, but poor sleep quality negatively affects their well-being and performance. This study analysed the link between sleep quality and resilience among 138 ICU nurses, considering socio-demographic variables (age, sex, education, professional experience). Data showed high rates of poor sleep (56.5%) and low and average resilience (84%). No significant relationship between socio-demographic variables and resilience or sleep quality was found, but a moderate negative correlation between sleep quality and resilience was identified (r = -.30; p < .001). Interventions to improve sleep and resilience are needed to enhance ICU nurses' well-being and performance. Increasing the level of resilience among ICU nurses is an important health-related protective factor. Moreover, an increase in resilience can enhance work commitment and improve their abilities to cope with many problems, ultimately contributing to their development.

Coping Strategies Among Healthcare Workers During the COVID-19 Pandemic: Emotional Responses, Challenges, and Adaptive Practices

Background and Objectives: The COVID-19 pandemic has posed unprecedented challenges to healthcare workers, leading to significant psychological distress, altered health-related behaviors, and reliance on various coping mechanisms. Understanding these impacts is critical for developing targeted interventions to support healthcare professionals. This study aimed to evaluate the psychological stressors, emotional responses, changes in healthy behaviors, and coping mechanisms employed by healthcare workers during the COVID-19 pandemic. The study further examined differences across demographic and professional groups and explored correlations between stressors, coping strategies, and emotional outcomes. Materials and Methods: A cross-sectional survey was conducted among 338 healthcare workers, including physicians and nurses, in urban and rural healthcare settings during the pandemic. Data were collected using validated instruments to measure emotional responses (anxiety and anger), lifestyle behaviors (dietary habits, sleep patterns, physical activity, and smoking), and coping strategies. Statistical analyses included descriptive, inferential, and correlation techniques to assess relationships between variables. Results: Fear of infecting family members (M = 3.36, SD = 0.86) and concerns about inadequate protective equipment (M = 2.80, SD = 0.95) were the most significant stressors, strongly associated with heightened anxiety and anger. Changes in healthy behaviors were observed: 69.2% maintained a healthy meal schedule, 56.5% reported disrupted sleep patterns, and only 39.6% engaged in regular physical activity. Among smokers (27.5%), 31.1% increased smoking as a maladaptive coping strategy, while 21.1% reduced smoking. Nurses predominantly relied on emotion-focused strategies, such as religious coping and venting, whereas physicians favored problem-focused strategies like planning and active coping. Social support emerged as a protective factor, mitigating stress and facilitating adaptive coping. Conclusions: The study revealed significant psychological and behavioral impacts on healthcare workers during the COVID-19 pandemic. Key stressors included the fear of infecting family members, concerns about inadequate protective measures, and the prolonged uncertainty of the pandemic, which contributed to heightened levels of anxiety and anger. Changes in healthy behaviors, such as disrupted sleep patterns, decreased physical activity, and increased reliance on maladaptive coping mechanisms, further underscored the multifaceted challenges faced by healthcare professionals. Although the acute phase of the pandemic has passed, the long-term consequences on the mental health and well-being of healthcare workers remain critical concerns. Further research is essential to develop effective strategies for monitoring, preventing, and addressing psychological distress among healthcare professionals, ensuring their preparedness for future public health crises.

Nurses' Sleep Quality and Its Influencing Factors During the First Explosive COVID-19 Outbreak in Zhejiang, China, After the Relaxation of Epidemic Prevention and Control Measures: A Multicentre Cross-Sectional Study

AIM

To investigate the sleep quality and its influencing factors among nurses in hospitals in Zhejiang, China, during the first explosive COVID-19 outbreak following the relaxation of prevention and control measures.

DESIGN

A multicentre cross-sectional study.

METHODS

Between 10 January and 20 January 2023-approximately 1 month after the policy was loosened-a total of 573 nurses from tertiary and community hospitals in Zhejiang participated in an online, self-administered survey. The participants were recruited using convenience sampling, and the survey was distributed via the WeChat platform. The survey included a general information form; the Self-Rating Scale of Sleep (SRSS); the Depression, Anxiety, and Stress Scale-21 (DASS-21); the Perceived Social Support Scale (PSSS); and the Brief Resilience Scale (BRS). Data analysis was conducted using SPSS version 26.0. Statistical methods employed included t-tests, one-way analysis of variance (ANOVA), chi-square tests and Mann-Whitney U-tests for comparisons between groups. Pearson correlation coefficients were calculated to analyse the relationship between the SRSS score and the DASS-21, PSSS and BRS scores. A multiple linear stepwise regression analysis was conducted to determine the independent influencing factors of sleep quality.

RESULTS

More than 90% of the nurses were infected with COVID-19, and 60.6% had sleep disorders. The regression analysis revealed that anxiety, the BRS score, comorbidities, hospital grade, clinical front-line, age and COVID-19 infection independently predicted sleep quality. The scores for several SRSS items were higher than the Chinese norm, especially for the nurses in tertiary hospitals.

PATIENT AND PUBLIC CONTRIBUTION

No patient or public contribution.

Relationships among perceived social support, mindful self-care, and resilience among a sample of nurses in three provinces in China: a cross-sectional study

Objective

In this study, we aimed to determine the relationships among perceived social support, mindful self-care, and resilience in a sample of nurses in three provinces of China.

Methods

A cross-sectional study was conducted in seven hospitals in Guangdong, Guizhou, and Henan provinces between August and October, 2023; the provinces are located in south, southwest, and central China. A total of 389 nurses were surveyed using a self-designed sociodemographic characteristics questionnaire and the Chinese versions of Multidimensional Scale of the Perceived Social Support, Brief-Mindful Self-Care Scale and the 10-item Connor-Davidson Resilience Scale (CD-RISC-10).

Results

Of the 389 nurses, the majority were women (n = 365; 93.8%), aged 26-35 years (n = 244; 62.7%) and had bachelor's degrees (n = 337; 86.6%), had worked for 10-20 years (n = 136; 35%), with junior professional titles (n = 331; 85.1%), and had a monthly income in the range 3,001-6,000 yuan in CNY (n = 239; 61.4%). Nurses' resilience was measured using the CD-RISC-10, which ranges from 10 to 40 points. And average score of nurses' resilience was (23.94 ± 6.95). Multiple linear regression showed that scores for resilience were higher among nurses who had higher educational attainment (95% confidence interval: 0.568-3.024, p < 0.01), professional titles (95% confidence interval: 0.009-1.693, p < 0.05), scores of mindful self-care (95% confidence interval: 0.086-0.155, p < 0.01), and scores of perceived social support (95% confidence interval: 0.242-0.328, p < 0.01).

Conclusion

Nurses with higher educational attainment and professional titles exhibited higher levels of resilience. Perceived social support and mindfulness self-care are significantly positively correlated with resilience of nurses. The findings of this study are beneficial to further our understanding of nurses' resilience. The identification of associated factors is conducive to providing more support for nurses who tend to have lower resilience earlier, and can provide useful information for research targeted intervention and support plans aimed at improving nurses' resilience in the future.

Covid-19 pandemic? Mental health implications among nurses and Proposed interventions

Background

With its abrupt and huge health and socio-economic consequences, the coronavirus disease (COVID-19) pandemic has led to a uniquely demanding, intensely stressful, and even traumatic period. Healthcare workers (HCW), especially nurses, were exposed to mental health challenges during those challenging times.

Objectives

Review the current literature on mental health problems among nurses caring for COVID-19 patients.

Methods

This is a narrative review and critical evaluation of relevant publications.

Results

Nurses experienced higher levels of stress, burnout, anxiety, depression, frustration, stigma, and depersonalization compared to other HCW. Factors that increased this symptomatology included concerns about infection or infection of family members, inadequate staff protective equipment, extended working hours, insufficient information, a reduced sense of security, and post-traumatic stress disorder. The factors that improved the psychopathology included a general positive attitude, job satisfaction, adequate information and education, harmonious group relationships, post-traumatic development, emotional intelligence, psychological counseling, mindfulness-based stress reduction, stable leadership, guidance, and moral and practical administrative support.

Conclusions

Recent studies clearly show that nurses, especially women, are the most vulnerable subgroup among HCW and are particularly prone to mental health impacts during the COVID-19 pandemic. The documented mental health vulnerability of frontline nursing staff during the COVID-19 pandemic requires preventive nursing management actions to increase resilience and to develop relevant defense mechanisms.

Perceived risk of COVID-19 hurts mental health: the mediating role of fear of COVID-19 and the moderating role of resilience

BACKGROUND

Depression and anxiety have been found prevalent during all phases of the COVID-19 pandemic. In late December 2022, almost all COVID-19 control measures were lifted in China, leading to a surge in COVID-19 infections. The public's perceived risk and fear of COVID-19 would be increased. This study aims to examine the prevalence of depression and anxiety in the Chinese general population and explores the mediating role of fear of COVID-19 between COVID-19 perceived risk and depression/anxiety and the moderating role of resilience between fear of COVID-19 and depression/anxiety.

METHODS

A cross-sectional online survey was conducted in Wenzhou, China, immediately following almost all COVID-19 control measures lifted. The 9-item Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), the COVID-19 Risk Perception Scale, the Fear of COVID-19 Scale, and the Connor-Davidson Resilience Scale (CD-RISC) were used to evaluate depression, anxiety, COVID-19 perceived risk, fear of COVID-19, and resilience, respectively. Structural Equation Modeling (SEM) with Maximum Likelihood (ML) estimator and adjusted for significant background factors was performed to test the moderated mediation. Data obtained from 935 participants were analyzed.

RESULTS

The prevalence of moderate to severe depression and anxiety was 23.7% and 9.5%, respectively. The present study revealed positive associations among COVID-19 perceived risk, fear of COVID-19 and depression/anxiety, and negative associations between resilience and fear of COVID-19/depression/anxiety. Fear of COVID-19 partially mediated the association between COVID-19 perceived risk and depression/anxiety. Furthermore, resilience significantly moderated the association between fear of COVID-19 and depression/anxiety. Two moderated mediation models were constructed.

CONCLUSION

Depression and anxiety were prevalent among Chinese adults during the final phase of the pandemic in China. The significant mediation role of fear of COVID-19 implies that reducing fear of COVID-19 may effectively alleviate depression and anxiety symptoms. Moreover, enhancing public resilience during an epidemic crisis is crucial for promoting mental health.

Sleep Quality and Its Relationship to Anxiety and Hardiness in a Cohort of Frontline Italian Nurses during the First Wave of the COVID-19 Pandemic

INTRODUCTION

The COVID-19 pandemic has had a considerable impact on the psychological and psychopathological status of the population and health care workers in terms of insomnia, anxiety, depression, and post-traumatic stress disorder. The primary aim of this study was to describe and evaluate the impact of the pandemic on insomnia levels of a cohort of Italian nurses, particularly those involved in the care of COVID-19 patients. The secondary aim was to identify the interaction between insomnia and hardiness, anxiety, and sleep disturbances.

MATERIALS AND METHODS

A descriptive-exploratory study was conducted using an online survey during the first wave of the COVID-19 pandemic (March to July 2020). The questionnaire consisted of multiple-choice, open-ended, closed, and semi-closed questions. The psychometric tools administered were the Dispositional Resilience Scale (DRS-15), the State-Trait Anxiety Inventory (STAI-Y), and the Insomnia Severity Index (ISI).

RESULTS

a cohort of 1167 nurses fully completed the questionnaire (86.2% of total respondents). The insomnia scale survey showed an increase in post-pandemic scores compared to those before the pandemic, implying that insomnia levels increased after the first pandemic wave. Insomnia scores were directly correlated with anxiety levels (r = 0.571; p ≤ 0.05) and inversely correlated with hardiness levels (r = -0.324; p < 0.001). Multivariate analysis revealed the following protective factors: not having worked in COVID-19 wards, high levels of hardiness (commitment), and the presence of high pre-pandemic insomnia disorder. The main risk factor for insomnia reported in the analysis was a high anxiety score.

DISCUSSION AND CONCLUSION

Anxiety represented the main risk factor for insomnia severity in our sample, while hardiness was confirmed as a protective factor. Thus, it is necessary to design further studies to identify additional risk factors for poor sleep quality and to develop educational courses and strategies aimed at enhancing rest and sleep quality, especially for frontline nurses.