Prevalence, Incidence, and Factors Associated with Posttraumatic Stress at Three-Month Follow-Up among New York City Healthcare Workers after the First Wave of the COVID-19 Pandemic

Mental health status and related factors influencing healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis

BACKGROUND

The mental health of healthcare workers during the coronavirus-2019 pandemic was seriously affected, and the risk of mental health problems was high. The present study sought to systematically evaluate the mental health problems of healthcare workers worldwide during the pandemic and to determine the latest global frequency of COVID-19 associated mental health problems.

METHODS

Data in the Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, Elsevier, MEDLINE, PubMed, PsycINFO and the Web of Science before November 11, 2022, were systematically searched. Cohort, case-control and cross-sectional studies were included. The meta-analysis used a random effects model to synthesize the comprehensive prevalence rate of mental health problems. Subgroup analyses were performed based on time of data collection; whether the country was or was not developed; continent; doctors and nurses; doctors/nurses vs. other healthcare workers; and psychological evaluation scale.

RESULTS

A total of 161 studies were included, including 341,014 healthcare workers worldwide, with women accounting for 82.8%. Occupationally, 16.2% of the healthcare workers were doctors, 63.6% were nurses and 13.3% were other medical staff. During the pandemic, 47% (95% confidence interval [CI], 35-60%) of healthcare workers reported job burnout, 38% (95% CI, 35-41%) experienced anxiety, 34% (95% CI 30-38%) reported depression, 30% (95% CI, 29-31%) had acute stress disorder, and 26% (95% CI, 21-31%) had post-traumatic stress disorder.

CONCLUSIONS

The study found that there were common mental health problems among health care workers during the COVID-19 pandemic. The most common was job burnout, followed by anxiety, depression, acute stress and post-traumatic stress disorder. Although the global pandemic has been brought under control, its long-term impact on the mental health of healthcare workers cannot be ignored. Additional research is required to develop measures to prevent, monitor and treat psychological disorders among healthcare workers.

The insomnia, fatigue, and psychological well-being of hospital nurses 18 months after the COVID-19 pandemic began: A cross-sectional study

BACKGROUND

Research has shown sleep problems, elevated fatigue, and high cases of burnout, as well as signs of post-traumatic stress and psychological distress among nurses during the COVID-19 pandemic. Many US hospitals attempted to minimise its impact on staff by providing basic resources, mental health services, and wellness programs. Therefore, it is critical to re-evaluate these well-being indices and guide future administrative efforts.

PURPOSE

To determine the long-term impact of the COVID-19 pandemic after 18 months on hospital nurses' insomnia, fatigue, burnout, post-traumatic stress, and psychological distress.

DESIGN

Cross-sectional.

METHODS

Data were collected online mainly through state board and nursing association listservs between July-September 2021 (N = 2488). The survey had psychometrically tested instruments (Insomnia Severity Index, Occupational Fatigue Exhaustion Recovery Scale, Maslach Burnout Inventory, Short Post-Traumatic Stress Disorder, and Patient Health Questionnaire-4) and sections on demographics, health, and work. The STrengthening the Reporting of Observational studies in Epidemiology checklist was followed for reporting.

RESULTS

Nurses had subthreshold insomnia, moderate-to-high chronic fatigue, high acute fatigue, and low-to-moderate intershift recovery. Regarding burnout, they experienced increased emotional exhaustion and personal accomplishment, and some depersonalisation. Nurses had mild psychological distress but scored high on post-traumatic stress. Nurses who frequently cared for patients with COVID-19 in the past months scored significantly worse in all measures than their co-workers. Factors such as nursing experience, shift length, and frequency of rest breaks were significantly related to all well-being indices.

CONCLUSION

Nurses' experiences were similar to findings from the early pandemic but with minor improvements in psychological distress. Nurses who frequently provided COVID-19 patient care, worked ≥12 h per shift, and skipped rest breaks scored worse on almost all well-being indices.

RELEVANCE TO CLINICAL PRACTICE

Administration can help nurses' recovery by providing psychological support, mental health services, and treatment options for insomnia, as well as re-structure current work schedules and ensure that rest breaks are taken.

Post-COVID-19 condition in pregnant and postpartum women: a long-term follow-up, observational prospective study

Background

Post-COVID-19 condition has recently been defined as new or persistent common COVID-19 symptoms occurring three months after disease onset. The pathology of the disease is unclear, but immune and vascular factors seem to play a significant role. The incidence, severity, and implications of the disease after COVID-19 infection in pregnancy have not been established. We aimed to study the incidence and main risk factors for post-COVID-19 condition in an obstetric population and their implications for maternal and perinatal morbimortality.

Methods

This is a prospective observational cohort study undertaken including women during pregnancy or at admission for labour with acute COVID-19 infection from March 9th, 2020 to June 11th, 2022. The inclusion criteria were confirmed acute COVID-19 infection during the recruitment period, a lack of significant language barrier and consent for follow-up. Patients were clinically followed-up by telephone via semi structured questionnaires. The exclusion criteria were loss to follow-up, spontaneous miscarriage, and legal termination of pregnancy. Patients were classified into groups according to the severity of symptoms at onset. We included patients from the first six first waves of the pandemic according to national epidemiological data in Spain. We studied the incidence of post-COVID-19 condition and their main demographic, clinical and obstetric risk factors.

Findings

A total of 409 pregnant women were recruited at acute diagnosis, and 286 were followed-up. The mean time to follow-up was 92 weeks (standard deviation ± 28 weeks; median 100 weeks (Interquartile range: 76; 112)). A total of 140 patients had at least one post-COVID-19 symptom at least three months after acute infection. Neurological (60%) and cutaneous (55%) manifestations were the most frequent findings. The following profiles were identified as presenting a higher risk of post-COVID-19 condition: migrant women born in countries with lower Human Development Index; multiparous women; women with COVID-19 during pregnancy, mainly during the first and third trimesters, and in the first and second waves of the pandemic; women who had a higher number of symptoms; women who had a higher incidence of moderate and severe symptoms; women who required hospitalisation due to COVID-19 complications; and women who were not vaccinated before disease onset. We did not find any significant difference in perinatal results, such as gestational week at delivery, birthweight, the need for neonatal care or 5-min Apgar score, and newborns benefited from a high rate of breastfeeding at discharge. Women who were infected during successive waves of the pandemic had a significant and constant decrease in the risk of post-COVID-19 condition comparing to estimated risk in the first wave (OR: 0.70; 95% CI: 0.62, 0.92). Symptoms tended to resolve over time heterogeneously. Symptoms of myalgia and arthralgia took longer to resolve (mean of 60 weeks and 54 weeks, respectively). In a small but significant proportion of patients, neurological and psycho-emotional symptoms tended to become chronic after 90 weeks.

Interpretation

At least 34.2% of obstetric patients from our cohort with acute COVID-19 infection presented post-COVID-19 condition symptoms. Demographic and acute disease characteristics as well as specific pregnancy-related risk factors were identified. This is the first study to assess post-COVID-19 condition in pregnant women. Further analysis on the biological pathophysiology of post-COVID-19 is needed to explain the characteristics of the disease.

Funding

This study has been funded by Instituto de Salud Carlos III (ISCIII) through the project "PI21/01244" and co-funded by the European Union, as well as P2022/BMD-7321 (Comunidad de Madrid) and ProACapital, Halekulani S.L. and MJR.

Post-Traumatic Stress Disorder among Polish Healthcare Staff in the Era of the COVID-19 Pandemic

INTRODUCTION

The COVID-19 pandemic has brought many adverse phenomena, particularly in the area of health for both individuals and society as a whole. Healthcare staff also suffered dire consequences.

AIM

The aim of this study was to assess whether the COVID-19 pandemic increased the risk of post-traumatic stress disorder among healthcare professionals in Poland.

MATERIAL AND METHOD

The survey was conducted between 4 April 2022 and 4 May 2022. The study applied the Computer Assisted Web Interview (CAWI) technique using the standardised Peritraumatic Distress Inventory (PDI) questionnaire.

RESULTS

The average score obtained by the respondents on the PDI was 21.24 ± 8.97. There was a statistically significant difference between the average PDI score obtained based on the gender of the subject (Z = 3.873, p = 0.0001.) The score obtained amongst nurses was statistically significantly higher compared to the paramedic group (H = 6.998, p = 0.030). There was no statistically significant difference between the average PDI score obtained based on the age of the participants (F = 1.282, p = 0.281), nor with their length of service (F = 0.934, p = 0.424). A total of 82.44% of the respondents received 14 PDI points, the cut-off point indicating the risk of PTSD that was adopted in the study. It was concluded that 6.12% of respondents did not require intervention (<7 PDI score); 74.28% of respondents needed further follow-up for PTSD and a reassessment of the PDI approximately 6 weeks after the initial testing; and 19.59% required coverage for PTSD prevention and mitigation (>28 PDI score).

CONCLUSIONS

The study has shown a high risk of post-traumatic stress disorder among healthcare professionals in Poland. This risk is related to the gender of the respondents, with an indication of a higher risk of PTSD among women. The results have also shown a correlation between increased risk of post-traumatic stress disorder and occupation, with nurses being the most affected group. In contrast, no association has been found in terms of age and length of service for an increase in the risk of PTSD, following exposure to trauma in relation to healthcare services during the COVID-19 pandemic.

The prevalence of probable mental health disorders among hospital healthcare workers during COVID-19: A systematic review and meta-analysis

OBJECTIVES

The mental health impacts of the COVID-19 pandemic continue to be documented worldwide with systematic reviews playing a pivotal role. Here we present updated findings from our systematic review and meta-analysis on the mental health impacts among hospital healthcare workers during COVID-19.

METHODS

We searched MEDLINE, CINAHL, PsycINFO, Embase and Web Of Science Core Collection between 1st January 2000 to 17th February 2022 for studies using validated methods and reporting on the prevalence of diagnosed or probable mental health disorders in hospital healthcare workers during the COVID-19 pandemic. A meta-analysis of proportions and odds ratio was performed using a random effects model. Heterogeneity was investigated using test of subgroup differences and 95 % prediction intervals.

RESULTS

The meta-analysis included 401 studies, representing 458,754 participants across 58 countries. Pooled prevalence of depression was 28.5 % (95 % CI: 26.3-30.7), anxiety was 28.7 % (95 % CI: 26.5-31.0), PTSD was 25.5 % (95 % CI: 22.5-28.5), alcohol and substance use disorder was 25.3 % (95 % CI: 13.3-39.6) and insomnia was 24.4 % (95 % CI: 19.4-29.9). Prevalence rates were stratified by physicians, nurses, allied health, support staff and healthcare students, which varied considerably. There were significantly higher odds of probable mental health disorders in women, those working in high-risk units and those providing direct care.

LIMITATIONS

Majority of studies used self-report measures which reflected probable mental health disorders rather than actual diagnosis.

CONCLUSIONS

These updated findings have enhanced our understanding of at-risk groups working in hospitals. Targeted support and research towards these differences in mental health risks are recommended to mitigate any long-term consequences.

Personality traits and risk of posttraumatic stress disorder among dental residents during COVID-19 crisis

PURPOSE/OBJECTIVES

The coronavirus disease 2019 (COVID-19) pandemic has presented mental health challenges among healthcare professionals, including posttraumatic stress disorder (PTSD). Few studies have examined PTSD predictors in dental settings. This cross-sectional study aimed to describe the relationship between personality traits and PTSD symptoms among US dental residents engaged in patient care during the pandemic.

METHODS

An online survey was administered to residents in advanced education in general dentistry, dental anesthesia, general practice residency, oral and maxillofacial surgery, and pediatric dentistry programs between September 2020 and April 2021. The survey included a sociodemographic questionnaire, the Big Five Inventory, and the PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Logistic regression models, analysis of variance, and Tukey tests were used to examine the association between variables and PTSD scores and assess differences in personality traits and PTSD by specialty.

RESULTS

Among 149 respondents (mean age = 29.9 ± 4.9 years; 57.0% female), 53.7% reported experiencing stress during the pandemic. Many residents (38.9%) were not aware of available mental health resources. A total of 17.4% of residents met the diagnostic criteria for PTSD, but only 1.3% reported a previous PTSD diagnosis. The most significant predictors of PTSD were neuroticism (odds ratio = 2.90, p = 0.046) and stress unrelated to the resident's program role during the pandemic (odds ratio = 5.88, p = 0.02).

CONCLUSIONS

PTSD symptoms were highly prevalent among dental residents, with stress and neuroticism being the most significant predictors.

COVID-19 Pandemic Psychological Impact and Volunteering Experience Perceptions of Medical Students after 2 Years

Undergraduate healthcare students were mobilized to support healthcare systems during the COVID-19 pandemic, but we have scarce information regarding their experience and its impact on their wellbeing. An anonymous online survey was conducted among undergraduate students and recently graduated physicians of a medical university in Spain, regarding their symptoms and volunteering experience during the initial months of the Spanish COVID-19 pandemic. Respondents showed a high prevalence of perceived stress, anxiety, and depressive symptoms, measured by the PHQ-9 and GAD-7. 14.5% reported healthcare-related volunteering tasks. Volunteering was a satisfactory experience for most of the respondents and the majority felt ready to do volunteering tasks (66.6%). Yet, 16.6% acknowledged not getting appropriate specific-task education before starting, 20.8% reported not having appropriate supervision, and 33.3% feel they did not have proper protective equipment. More than half of volunteers feared getting infected, more than 70% feared infecting their relatives or friends, and 54.2% reported stigmatization. Volunteers showed significantly higher stress, anxiety, and depression scores than the rest of the respondents, and 32% reported a highly traumatic event during volunteering, with high scores on the IES-R in the 16% of volunteers. Our results should help guide future potential volunteering processes in emergencies, enhance academic programs at medical schools and provide valuable data for psychological support services.

"Room to Reflect": A Pilot Workplace Resiliency Intervention for Nurses

Rising workload demands for nurses necessitate the implementation of easily accessible and innovative clinician well-being resources on health care units. This pre/post pilot study sought to measure the impact of a mobile workplace intervention, “Room to Reflect” on staff nurse and nurse manager resilience. A mobile toolbox with a sound machine, Virtual Reality headset, and associated Quick Response code audio/video offerings, and a paper Pocket Guide of mindful restoration practices were provided to 7 health care units for a 3 month period. Pre/post questionnaires assessed perceived resilience using the Connor-Davidson Resilience scale, and intervention feasibility (ease of use), accessibility (spaces used), and effectiveness (restoration). Data analysis consisted of descriptive statistics, paired and independent samples t-tests, and Wilcoxon Signed Rank tests. From the pre (n = 97) to post (n = 57) intervention period, there was a significant difference in resilience for Clinician 3 staff nurses. A mean increase in resilience was noted among nurse managers following participation in the intervention, z = −2.03, p < 0.05. The Pocket Guide was the easiest offering to use, while VR offerings were accessed the most through Quick Response code. Space and time were the most common barriers to Room to Reflect use. Staff nurses felt supported by managers to use the program, and managers perceived that the program improved nurse job satisfaction.