Navigating crisis: exploring the links between threat perceptions, well-being, individual and workplace resilience among general hospital staff

BACKGROUND

Hospital staff frequently encounter high-stress situations, emergencies, and disasters, which profoundly impact their well-being and resilience. The aim of the study was to examine associations between perceived threats, well-being, individual resilience, and resilience at work among staff of a general hospital, following the unexpected Hamas assault on Israel on October 7, 2023, and during the Israel-Gaza conflict.

METHODS

This cross-sectional study was conducted at a central Israeli public hospital, a level-two trauma center, surveying 434 staff members. Validated questionnaires were used to assess perceived threats, well-being, individual and work resilience, alongside demographic and professional characteristics. Data was collected via Qualtrics and paper questionnaires. Descriptive statistics, Pearson's correlation, T-tests, ANOVA, Chi-square, and linear regression models were used to analyze relationships, differences, and key factors associated with well-being, personal resilience, and work resilience.

RESULTS

Key findings revealed that higher resilience at work and well-being are linked to greater individual resilience, while higher threat perception negatively affected well-being. Israeli-born individuals and those identifying as Jewish showed higher resilience. Men reported higher well-being than women, and physicians demonstrated higher well-being compared to nurses. Resilience at work was higher among administrative staff compared to nurses, with employment in the emergency department showing a significant negative relationship with resilience at work.

CONCLUSIONS

The study revealed significant predictors of well-being, individual resilience, and workplace resilience among hospital staff in conflict situations. The immediate threat of war was perceived as most significant, highlighting the dynamic nature of threat perceptions. Prolonged emergencies can severely impact well-being, necessitating timely support. The findings emphasize the importance of integrated programs that enhance individual well-being and foster resilience in both personal and professional domains. Significant gender differences and the positive role of religiosity in resilience underscore the need for targeted interventions and systemic organizational changes to better support healthcare workers during crises. These insights highlight the importance of a comprehensive approach for cultivating a robust and resilient medical staff capable of effectively managing future crises.

Anger and Aggression in Relation to Psychological Resilience and Alcohol Abuse among Health Professionals during the First Pandemic Wave

Mental health problems, behavior changes, and addictive issues have been consistently documented among healthcare workers during the pandemic. The objective of this study was to investigate the levels of anger and aggression in relation to psychological resilience and alcohol abuse among healthcare workers during the first wave of the COVID-19 pandemic. A total of 120 physicians and 123 nurses completed an online survey of the Dimensions of Anger Reactions-5 (DAR-5), the Brief Aggression Questionnaire (BAQ), the Brief Resilience Scale (BRS), and the Alcohol Screening questionnaire CAGE which is an acronym for the focus of the questions (Cutting down, Annoyance by criticism, Guilty feeling, and Eye-openers). Demographic and professional data were also recorded. A total of 53 men and 190 women participated in the study. Almost one-third of the participants had a positive score on the DAR-5 scale and one out of ten respondents presented with current problematic alcohol use. Male participants demonstrated lower scores on the DAR-5 scale compared to females. Individuals with current problematic alcohol use displayed higher scores on the BAQ compared to those without alcohol use disorders. Regression analysis revealed that 16.4% of the variance in the BAQ scores can be attributed to scores on the DAR-5, 5.9% to the BRS scores, 2.1% to the CAGE scores, 1.7% to gender, and 1.2% to years of work experience. Mediation analysis highlighted the role of psychological resilience as a negative mediator in the DAR-5 and BAQ relationship. Professional experience and alcohol abuse emerged as positive and negative risk factors contributing to aggression and psychological resilience. The findings hold practical implications for implementing interventions to strengthen resilience in order to compensate for aggressive tendencies and discourage addictive issues.

"Why Am I Even Here If I Can't Save the Patients?": The Frontline Healthcare Workers' Experience of Burnout during COVID-19 Pandemic in Mthatha, South Africa

INTRODUCTION

Globally, the high prevalence of burnout in healthcare workers (HCWs) is of the utmost concern. Burnout is a state of emotional exhaustion, depersonalization and a decreased sense of personal accomplishment. While the 2019 Coronavirus (COVID-19) exacerbated the burnout prevalence among HCWs, limited studies have explored this phenomenon using qualitative methodologies in the Eastern Cape Province and South Africa generally. This study explored how frontline healthcare workers experienced burnout during the COVID-19 pandemic in Mthatha Regional Hospital.

METHODS

Ten face-to-face in-depth interviews were conducted with non-specialized medical doctors and nurses who directly cared for COVID-19-infected patients during the pandemic in Mthatha Regional Hospital (MRH). In-depth interviews were digitally recorded and transcribed verbatim. Data were managed through NVIVO 12 software before being thematically analyzed using Colaizzi's analysis method.

RESULTS

Four main themes emerged from the analysis. These themes were burnout manifestation (emotional strain, detachment and irritability, uncertainty-induced fear, and anxiety, physical exhaustion, yet, low job accomplishment, dread and professional responsibility), precursors of burnout (occupational exposure to high mortality, staff shortages, elongated high patient volume and workload, disease uncertainties and consistent feeling of grief), alleviating factors of burnout (time off work, psychologist intervention, periods of low infection rate and additional staff), and the last theme was every cloud has a silver lining (improved infection prevention and control (IPC) measures, learning to be more empathetic, the passion remains and confidence grows).

CONCLUSION

The COVID-19 pandemic brought about a rapid change in the work environment of healthcare workers who are the backbone of efficient healthcare services, thereby rendering them vulnerable to increased burnout risks. This study provides strategic information for policymakers and managers on developing and strengthening welfare policies to promote and protect frontline health workers' well-being and work functioning.

When caring breeds contempt: The impact of moral emotions on healthcare professionals' commitment during a pandemic

The novel coronavirus (COVID-19) pandemic is a major heath crisis that continues to impact healthcare organizations worldwide. As infection rates surged, there was a global shortage of personal protective equipment, critical medications, ventilators, and hospital beds, meaning that healthcare professionals faced increasingly difficult workplace conditions. In this conceptual study, we argue these situations can lead to healthcare professionals experiencing moral emotions - defined as specific emotions which relate, or occur in response, to the interest or welfare of others - towards their organizations. This paper explores the three moral emotions of contempt, anger and disgust, and their potential influence on healthcare professionals' workplace commitment in the context of a pandemic. Drawing from the moral emotions and organizational commitment literature, we develop a process model to demonstrate how healthcare professionals' affective and continuous commitment are likely to decrease while, paradoxically, normative, and professional commitment may become amplified. The possible potential for positive outcomes from negative moral emotions is discussed, followed by theoretical and practical contributions of the model, and finally, directions for future research.

Perceived Covid-19-crisis intensity and family supportive organizational perceptions as antecedents of parental burnout: A study conducted in Italy in March/April 2021 and 2022

The purpose of this study is to investigate to what extent perceived Covid-19-crisis intensity (PCCI) leads to the experience of parental burnout (PB), a syndrome characterized by exhaustion, emotional detachment from one's own children and a sense of inefficacy in the role as parent. Furthermore, the mediating role of work-family conflict (WFC) is examined. The buffering effect of family supportive organizational perceptions during the pandemic (FSOP-p) on the relationship between work-family conflict and parental burnout is also explored. Data were collected in March-April 2021 and March/April 2022. In spring 2021, 222 Italian working parents with at least one minor child living at home filled out the questionnaire. Data from 2021 showed that PCCI was positively related to the experience of parental burnout. Moreover, WFC mediated this relationship. No significant interaction effect was found for FSOP-p; however it was found that FSOP-p is negatively related to PCCI and WFC, and indirectly to parental burnout. In spring 2022, we examined whether there were changes in PCCI, WFC, and FSOP-p in a sample of 83 Italian parents. Moreover, for the second data collection we examine the tensions experienced by parents in their families about vaccination and infection precaution measures (e.g., Covid-19 vaccination passport). The results are different in 2022; the effect of PCCI on parental burnout is now completely mediated by the amount of WFC. It seems that now we go 'back to normal' and homeworking has become more optional for many, there is still an effect of PCCI on WFC, but no longer directly on parental burnout. Furthermore, the prevalence of PCCI in 2022 is lower than in 2021, while WFC and FSOP-p are not significantly different between the two timepoints. As family supportive organizational perceptions reduce the level of perceived Covid-19 intensity, organizations are urged to develop practices of support and to create a supportive environment.

The Work Environment during Coronavirus Epidemics and Pandemics: A Systematic Review of Studies Using Quantitative, Qualitative, and Mixed-Methods Designs

We aimed to provide an overview of how work environment and occupational health are affected, and describe interventions designed to improve the work environment during epidemics and pandemics. The guidelines on Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) were followed. The databases Cinahl, Medline, PsycInfo, and Web of Science were searched for population: working population; exposure: coronavirus epidemic or pandemic; and outcome: work environment, in articles published until October 2020. Quality assessment was based on a modified version of the Mixed Methods Appraisal Tool (MMAT). After deduplication 3711 articles remained, of which 530 were selected for full-text screening and 119 for quality assessment. After the exclusion of studies that were low quality, 95 remained, of which 85 focused on healthcare personnel and 10 on employees in other industries; 73 used quantitative methods and 22 used qualitative or mixed methods; the majority were based on cross-sectional data. Healthcare staff experienced increased job demands, poor leadership, and lack of resources (personal protective equipment, personnel, and competence). High demands and work with infected patients were associated with negative mental health outcomes. There was a lack of studies assessing interventions, studies from industries other than healthcare, and studies of high quality.

The Role of Moral Distress on Physician Burnout during COVID-19

The purpose of this study was to explore the role of moral distress on physician burnout during COVID-19. Physicians in the US were interviewed between February and March 2021; 479 responded to our survey. The results indicated that moral distress was a key mediator in explaining the relationship between perceived organizational support, medical specialization, emotional labor, and coping with burnout. Results did not support increased burnout among female physicians, and contracting COVID-19 likewise did not play a role in burnout. Our findings suggest that physician burnout can be mitigated by increasing perceived organizational support; likewise, physicians who engaged in deep emotional labor and problem-focused coping tended to fare better when it came to feelings of moral distress and subsequent burnout.

Experience of Primary Care Physicians in the Aube Department, France, Regarding the COVID-19 Crisis

BACKGROUND

General practitioners (GPs) played a decisive role during the COVID-19 epidemic, particularly in the identification and care of patients at home. This study aimed to describe the primary care physicians' perceptions of the COVID-19 crisis and to guide future decisions regarding measures to prolong, abrogate, or improve upon methods for crisis management.

METHODS

This is a cross-sectional study based on a 30-item questionnaire aiming to investigate how primary care physicians (GPs) working in the rural Aube Department experienced the COVID-19 crisis.

RESULTS

Among the 152 respondents, 60.5% were not satisfied with the level of information from authorities during the crisis. By multivariate analysis, a feeling of having been adequately informed (OR 21.87, 95%CI 4.14-115.53) and a feeling that non-COVID-19-related diseases were adequately managed (OR 6.42, 95%CI 1.07-38.51) were both significantly associated with an overall satisfaction with the management of the crisis.

CONCLUSION

This study about rural primary care physicians in Eastern France highlights some of the weaknesses of the French healthcare system in terms of the provision of primary care during the epidemic. A leading cause of dissatisfaction was that the information relayed by the health authorities about the disease and its management largely overlooked the primary care providers, many of whom had to rely on traditional media to obtain information.

Job burnout among Israeli healthcare workers during the first months of COVID-19 pandemic: The role of emotion regulation strategies and psychological distress

The current worldwide COVID-19 pandemic has elicited widespread concerns and stress. Arguably, healthcare workers are especially vulnerable to experience burnout during these times due to the nature of their work. Indeed, high prevalence of burnout was found among healthcare workers during the outbreak. However, the individual differences predicting burnout among healthcare workers during the pandemic have been understudied. The aim of the current study was, therefore, to identify risk and protective factors contributing to the severity of burnout among healthcare workers, above and beyond levels of current psychological distress. The survey was distributed online during the period April 13–28, 2020, approximately two months after the first COVID-19 case was identified in Israel. Ninety-eight healthcare workers completed an online survey administered cross-sectionally via the Qualtrics platform that included questionnaires assessing habitual emotion regulation strategies (i.e., trait worry, reappraisal, and suppression), psychological distress, COVID-19 related concerns, and burnout. A hierarchical linear regression analysis revealed that only trait worry and psychological distress were significant predictors of job burnout among healthcare workers. These findings highlight the role of maladaptive emotion regulation tendencies, specifically trait worry, in job burnout among healthcare workers. These findings have implications for both the assessment and treatment of healthcare workers. We discuss potential mechanisms and implications for practice.

When fear about health hurts performance: COVID-19 and its impact on employee’s work

This study utilized terror management and conservation of resources theory to fulfill its aim of investigating the effects of fear of contamination of COVID-19 on performance of employees in the banking sector of Pakistan. A survey was conducted to collect data in two waves from 206 bank employees in Punjab region. SPSS was used for data analysis. The results demonstrated that such fear leads to emotional exhaustion which in turn negatively affects employee’s work performance. However, the perceptions of better precautionary measures taken by the organization against the spread of the disease moderated the said relationship and weakened the strength of fear on performance through emotional exhaustion. Amid the widespread fear, panic and detrimental effects of COVID-19 on organizations and economies of the worlds, this research has implications for policy makers by showing the importance of organizational measures taken and displayed to employees in decreasing the negative effects of extensive fear and uncertainty prevailing due to the pandemic.

Use of psychoactive substances by night-shift hospital healthcare workers during the first wave of the COVID-19 pandemic: a cross-sectional study based in Parisian public hospitals (ALADDIN)

OBJECTIVES

This study aimed to estimate the prevalence of psychoactive substance (PAS) use in night-shift healthcare workers (NSHW) during France's first COVID-19 wave (March-May 2020).

DESIGN

Observational cross-sectional online survey.

SETTING

39 public hospitals in the Assitance Publique des Hôpitaux de Paris (AP-HP) network in the Parisian area.

PARTICIPANTS

A total of 1238 nurses, assistant nurses, X-ray technicians, managers, lab technicians, midwives and childcare assistants working at night or alternating between days and nights answered the questionnaire.

INTERVENTION

Online survey.

OUTCOME MEASURES

PAS use prevalence after weighting data for sex, age and profession using calibration on margins, in order to be representative of all AP-HP NSHW. We used the Fagerström scale and the Alcohol Use Disorders Identification Test Concise to assess PAS use.

RESULTS

The weighted estimated prevalences of daily smoking, alcohol drinking and tranquilliser use in participating NSHW were 21.4, 1.3 and 2.4%, respectively. Twelve per cent (11.7%) of our study sample used opioids. During the first COVID-19 wave, PAS use remained stable except for tobacco use, with 8.6% of participants reporting an increase. Previous 3-month prevalences of tranquilliser and opioid use were significantly higher than in the general population.

CONCLUSION

Daily smoking (especially in younger men) and tranquilliser and opioid use were highly prevalent in NSHW in the AP-HP network during France's first COVID-19 wave. Specific interventions for quitting smoking and addressing determinants of tranquilliser and opioid use in NSHW need to be developed and evaluated to improve quality of life in these essential, underdiagnosed and undertreated health personnel.

The Impact of Job Stress and State Anger on Turnover Intention Among Nurses During COVID-19: The Mediating Role of Emotional Exhaustion

Based on the social exchange theory, the aim of this study is to identify the association between job stress state anger, emotional exhaustion and job turnover intention. This study postulates that job related stress and state anger among nurses during COVID-19 subsequently leads to their job turnover intentions. In addition, the study also aims to see the mediating role of emotional exhaustion between COVID-19-related job stress, state anger, and turnover intentions. The sample of this study is gathered from 335 registered nurses working in Pakistani hospitals dealing with COVID-19-related patients. The interrelationships between variables are checked by using structural equation modeling through AMOS. Key findings confirm that COVID-19-related job stress and state anger had a significant effect on nurses' turnover intentions. Furthermore, emotional exhaustion mediated the relationship between COVID-19-related job stress, state anger, and turnover intentions. There is a lack of research which has assessed the impact of Novel COVID-19-related job stress and state anger on nurses' turnover intentions in hospitals, providing empirical evidence from a developing country-Pakistan. This study offers managerial implications for hospital management and health policymakers. Moreover, nursing managers need to pay attention to nurses' turnover intentions who are facing the issue at the front line as patients receive their initial treatment from nurses in the COVID-19 outbreak.

Exploration of the occupational and personal dimensions impacted by the COVID-19 pandemic for nurses: A qualitative analysis of survey responses

Aim

To explore the occupational and personal life dimensions that have been impacted by the COVID‐19 pandemic for registered nurses (RN) and licensed practical nurses (LPN).

Design

Qualitative interpretive description approach.

Methods

Between July and September 2020, a web‐based cross‐sectional study was conducted among RNs and LPNs in Quebec, Canada. Included in this survey was an open‐ended question allowing nurses to describe the occupational and personal life dimensions that were impacted by the COVID‐19 pandemic. Thematic analysis was used to interpret the qualitative data from this open‐ended question. Reporting followed the Standards For Reporting Qualitative Research (SRQR).

Results

Of the 1860 survey respondents, 774 RNs and 43 LPNs responded to the open‐ended question (total n = 819). For the occupational dimension, six themes were identified: impacts of infection control on work, change in daily work tasks, offloading and reorganization of care, deterioration of working conditions, increased stress at work and issues related to the profession. For the personal dimension, four themes were found: impacts on the family, dealing with changes about leisure and personal life, impacts on physical and psychological health.

Conclusion

Knowing the dimensions affected by the COVID‐19 pandemic could help to identifying appropriate interventions to support RNs and LPNs.

Impact

The COVID‐19 pandemic has significantly impacted the occupational and personal lives RNs and LPNs working in the Quebec healthcare system. More specifically, Quebec's nurses experienced a major reorganization of care generated by important government decisions. Knowing how the pandemic affected different life dimensions will help in the development of support adapted to nurses' realities. Even in a pandemic context, improvements in the work environment or appropriate support could lead to an improved psychological health for nurses.

Healthcare Professionals, Post-traumatic Stress Disorder, and COVID-19: A Review of the Literature

The recent COVID-19 pandemic impacted healthcare professionals psychologically. They were unprepared to handle such a powerful and unknown virus. Consequently, they had to face situations of extreme distress, developing vicarious traumatization and post-traumatic stress disorder (PTSD). The first one is associated with the "cost of caring" for others and affected persons who constantly are exposed to other sufferings. PTSD is a psychiatric disorder that could affect people who have experienced or witnessed a traumatic event. Post-traumatic stress disorder (PTSD) and correlated symptoms might impact the lives of healthcare professionals at the personal, professional, and relational levels. Furthermore, the pandemic could decrease the empathy of healthcare professionals, influencing their relationship with patients. This review aimed to describe the incidence of PTSD among HPs during the COVID-19 pandemic. We focused on the following aspects: (a) PTSD symptoms and correlated psychological issues, (b) repercussions at working and personal levels, (c) change in empathetic involvement of healthcare professionals.

Stressors, self-reported overall health, potential protective factors and the workplace well-being of nurses during the COVID-19 pandemic in Switzerland: a longitudinal mixed-methods study protocol

INTRODUCTION

The COVID-19 pandemic was making a huge impact on Europe's healthcare systems in the spring of 2020, and most predictive models concurred that pandemic waves were in the offing. Most studies adopted a pathogenic approach to the subject; few used a salutogenic approach. These showed, however, that nurses can retain their health despite a pandemic by mobilising generalised resistance resources. Our study aims to understand how nurses working in Switzerland's hospitals protected their health and workplace well-being during the COVID-19 pandemic by investigating the moderating effects of the health resources they mobilised against the stressors inherent to the situation. The study aims to explore and describe the stressors and the resources nurses used to remain healthy during the COVID-19 pandemic.

METHOD AND ANALYSIS

We will use a concurrent mixed-methods panel design with qualitative analyses ancillary to quantitative analyses. Quantitative data will be collected using electronic questionnaires at four time points over 2 years. Qualitative data will be collected using focus groups. Nurses from Switzerland's two main linguistic regions who had direct, indirect or no contact with patients with COVID-19 will be invited to participate. The a priori sample size will be at least 3631 participants at T0 and 1852 at T4. Longitudinal structural equation modelling and knowledge mapping will be used to analyse quantitative and qualitative data, respectively. The results derived from the two data types will then be compared and discussed using a side-by-side approach to determine whether they agree or disagree and how they complement each other to achieve our aims.

ETHICS AND DISSEMINATION

Nurses will receive an electronic informed consent form. The data collected will be stored on a secure server at the authors' institution. This research project was approved by the Human Research Ethics Committee of the Canton of Vaud (2020-02845).

Does Sex in Managerial Positions Really Matter? Differences in Work-Related Feelings and Behaviors

PURPOSE

The aim of the current study was to test hypotheses regarding differences in work-related feelings (ie, dejection, anxiety, anger, and happiness) and behaviors (aggressive, avoidance-passive, and proactive) between males and females, managers and non-managers, and male and female managers.

METHODS

This survey-based study included a total of 3019 respondents, consisting of 502 managers and 2517 employees working in non-managerial positions. Data were collected using two questionnaires developed by the authors: the scale of work-related affective feelings (WORAF) and the scale of work-related behaviors (WORAB).

RESULTS

The results revealed significant differences between managers and non-managers, with managers being happier in their jobs and exhibiting more proactive behaviors. However, there were no differences in work-related feelings or work-related behaviors between males and females in the total sample of respondents or in the group of employees holding managerial positions.

CONCLUSION

In terms of work-related feelings and behaviors, there are no sex differences among working people. However, some differences between managers and non-managers were observed.

Mental Health Disorders in Nurses During the COVID-19 Pandemic: Implications and Coping Strategies

Nurses caring for patients who contract coronavirus disease 2019 (COVID-19) have experienced significant traumas in the form of increased workloads, negative patient outcomes, and less social support system access. Nurses should be provided with information regarding early detection, coping skills and treatment for anxiety, depression, post-traumatic stress syndrome (PTSS)/post-traumatic stress disorder (PTSD), and other mental health disorders. Early intervention is important as mental health disorders can cause dysfunction, internal suffering, and in the most extreme situations, lead to death if not properly cared for. Healthcare corporations should consider providing coverage for mental health treatment for employees who experience COVID-19 traumas. With the implementation of healthy coping skills and therapeutic intervention, nurses will be able to let go of the negative impacts that the COVID-19 pandemic has caused and reintegrate into their roles as caring and entrusted health care providers. The current paper evaluates the mental health disorders encountered by nurses in the COVID-19 era based on the current medical literature and aims to provide practical coping strategies.

The Psychological Experience of Frontline Perioperative Health Care Staff in Responding to COVID-19: Qualitative Study

BACKGROUND

The rapid spread of the novel coronavirus (COVID-19) has presented immeasurable challenges to health care workers who remain at the frontline of the pandemic. A rapidly evolving body of literature has quantitatively demonstrated significant psychological impacts of the pandemic on health care workers. However, little is known about the lived experience of the pandemic for frontline medical staff.

OBJECTIVE

This study aimed to explore the qualitative experience of perioperative staff from a large trauma hospital in Melbourne, Australia.

METHODS

Inductive thematic analysis using a critical realist approach was used to analyze data from 9 semistructured interviews.

RESULTS

Four key themes were identified. Hospital preparedness related to the perceived readiness of the hospital to respond to the pandemic and encompassed key subthemes around communication of policy changes, team leadership, and resource availability. Perceptions of readiness contributed to the perceived psychological impacts of the pandemic, which were highly varied and ranged from anger to anxiety. A number of coping strategies were identified in response to psychological impacts which incorporated both internal and external coping mechanisms. Finally, adaptation with time reflected change and growth over time, and encompassed all other themes.

CONCLUSIONS

While frontline staff and hospitals have rapidly marshalled a response to managing the virus, relatively less consideration was seen regarding staff mental health in our study. Findings highlight the vulnerability of health care workers in response to the pandemic and reinforce the need for a coordinated approach to managing mental health.

Telepsychiatry to Provide Mental Health Support to Healthcare Professionals during the COVID-19 Crisis: A Cross-Sectional Survey among 321 Healthcare Professionals in France

Pandemics are difficult times for the mental health of healthcare professionals, who are more likely to present with PTSD-like symptoms. In the context of a highly contagious communicable disease, telemedicine is a useful alternative to usual care, and should be considered as a means to support healthcare professionals’ mental health. This is a multicenter (n = 19), cross-sectional study, based on a 27-item questionnaire, aiming to investigate the acceptability to healthcare workers of a telepsychiatry service as a means of providing mental health support during the COVID-19 pandemic. Between October and December 2020, 321 responses were received, showing that women, caregiving staff, and those directly involved in the care of COVID-19 patients are less favorable to the idea of receiving remote support. In our population, barriers were related to the clinical setting or ethics, and most of the respondents would not accept a drug prescription by telepsychiatry. Although telepsychiatry should be a part of the armamentarium of mental health management, it is not suitable as a stand-alone approach, and should be combined with conventional face-to-face consultations.

Understanding stressor–strain relationships during the COVID-19 pandemic: the role of social support, adjustment to remote work, and work–life conflict

This study investigates how the transition to remote work during the coronavirus disease 2019 pandemic is experienced by employees. We investigate to what extent perceived work stressors relate to psychological strain through perceptions of social support, work–life conflict, and adjustment to remote work. The findings expound the mechanisms underlying psychological strain in the context of sudden organizational change. Specifically, this study shows that both challenge stressors and hindrance stressors have negative impact on adjustment to remote work, whereas hindrance stressors are more strongly negatively related to social support. The study further demonstrates that there is hardly any buffering impact of job control, work structuring, and communication technology use on the implications of these work stressors. These findings contribute to our theoretical understanding and provide actionable implications for organizational policies in facilitating employees' adaptation to remote work.

Psychological distress and trauma in doctors providing frontline care during the COVID-19 pandemic in the United Kingdom and Ireland: a prospective longitudinal survey cohort study

OBJECTIVES

The psychological impact of the COVID-19 pandemic on doctors is a significant concern. Due to the emergence of multiple pandemic waves, longitudinal data on the impact of COVID-19 are vital to ensure an adequate psychological care response. The primary aim was to assess the prevalence and degree of psychological distress and trauma in frontline doctors during the acceleration, peak and deceleration of the COVID-19 first wave. Personal and professional factors associated with psychological distress are also reported.

DESIGN

A prospective online three-part longitudinal survey.

SETTING

Acute hospitals in the UK and Ireland.

PARTICIPANTS

Frontline doctors working in emergency medicine, anaesthetics and intensive care medicine during the first wave of the COVID-19 pandemic in March 2020.

PRIMARY OUTCOME MEASURES

Psychological distress and trauma measured using the General Health Questionnaire-12 and the Impact of Events-Revised.

RESULTS

The initial acceleration survey distributed across networks generated a sample of 5440 doctors. Peak and deceleration response rates from the original sample were 71.6% (n=3896) and 56.6% (n=3079), respectively. Prevalence of psychological distress was 44.7% (n=1334) during the acceleration, 36.9% (n=1098) at peak and 31.5% (n=918) at the deceleration phase. The prevalence of trauma was 23.7% (n=647) at peak and 17.7% (n=484) at deceleration. The prevalence of probable post-traumatic stress disorder was 12.6% (n=343) at peak and 10.1% (n=276) at deceleration. Worry of family infection due to clinical work was the factor most strongly associated with both distress (R2=0.06) and trauma (R2=0.10).

CONCLUSION

Findings reflect a pattern of elevated distress at acceleration and peak, with some natural recovery. It is essential that policymakers seek to prevent future adverse effects through (a) provision of vital equipment to mitigate physical and psychological harm, (b) increased awareness and recognition of signs of psychological distress and (c) the development of clear pathways to effective psychological care.

TRIAL REGISTRATION NUMBER

ISRCTN10666798.

The Impact of Epidemics and Pandemics on the Mental Health of Healthcare Workers: A Systematic Review

BACKGROUND

There is increasing evidence that healthcare workers (HCWs) experience significant psychological distress during an epidemic or pandemic. Considering the increase in emerging infectious diseases and the ongoing COVID-19 pandemic, it is timely to review and synthesize the available evidence on the psychological impact of disease outbreaks on HCWs. Thus, we conducted a systematic review to examine the impact of epidemics and pandemics on the mental health of HCWs.

METHOD

PubMed, PsycInfo, and PsycArticles databases were systematically searched from inception to June-end 2020 for studies reporting the impact of a pandemic/epidemic on the mental health of HCWs.

RESULTS

Seventy-six studies were included in this review. Of these, 34 (45%) focused on SARS, 28 (37%) on COVID-19, seven (9%) on MERS, four (5%) on Ebola, two (3%) on H1N1, and one (1%) on H7N9. Most studies were cross-sectional (93%) and were conducted in a hospital setting (95%). Common mental health symptoms identified by this review were acute stress disorder, depression, anxiety, insomnia, burnout, and post-traumatic stress disorder. The associated risk factors were working in high-risk environments (frontline), being female, being a nurse, lack of adequate personal protective equipment, longer shifts, lack of knowledge of the virus, inadequate training, less years of experience in healthcare, lack of social support, and a history of quarantine.

CONCLUSION

HCWs working in the frontline during epidemics and pandemics experience a wide range of mental health symptoms. It is imperative that adequate psychological support be provided to HCWs during and after these extraordinary distressful events.

Rapid Evidence Assessment of Mental Health Outcomes of Pandemics for Health Care Workers: Implications for the Covid-19 Pandemic

Background: Little is known about the long-term mental health (MH) impact of the Covid-19 pandemic on health care workers (HCWs). However, synthesizing knowledge from past pandemics can help to anticipate this, along with identifying interventions required, when, and target populations most in need. This paper provides a balanced evaluation of what is currently known about short- and long-term MH impacts of pandemics on HCWs and effect of methodological limitations on knowledge claims. Method: A rapid evidence assessment (REA) was conducted on 41 studies published in the past two decades that examined MH outcomes for HCWs in relation to pandemics. Results: Findings of literary synthesis highlight common MH outcomes across pandemics, including increased stress, distress, burnout, and anxiety in the short-term, and post-traumatic stress and depression in the long-term. Findings also show the key role that organizations and public health bodies play in promoting adaptive coping and reducing health worries and the emotional and psychological distress caused by this. Evidence highlights particular groups at risk of developing MH issues (contact with patients that are infected, having children), and time points where risk may increase (initial response phase, when quarantined). However, inconsistencies in measures, analysis, and reporting all create limitations for pooling data. Conclusions: Findings can be used by researchers to provide a knowledge framework to inform future research that will assist HCWs in responding to pandemics, and by policy makers and service planners to provide an evidence-led brief about direction and evidence base for related policy initiatives, interventions or service programmes.

Factors mediating the psychological well-being of healthcare workers responding to global pandemics: A systematic review

This paper reviewed mediators of psychological well-being among healthcare workers responding to pandemics. After registration on PROSPERO, a systematic review was performed in four databases and 39 studies were included. Worse mental health outcomes, such as stress, depressive symptoms, anxiety and burnout were related to demographic characteristics, contact with infected patients and poor perceived support. Self-efficacy, coping ability, altruism and organisational support were protective factors. Despite limitations in the quality of available evidence, this review highlights the prevalence of poor mental health in healthcare workers and proposes target mediators for future interventions.

Evaluations of Healthcare Providers' Perceived Support From Personal, Hospital, and System Resources: Implications for Well-Being and Management in Healthcare in Montreal, Quebec, During COVID-19

Increased stressful experiences are pervasive among healthcare providers (HCPs) during the COVID-19 pandemic. Identifying resources that help mitigate stress is critical to maintaining HCPs' well-being. However, to our knowledge, no instrument has systematically examined how different levels of resources help HCPs cope with stress during COVID-19. This cross-sectional study involved 119 HCPs (64 nurses and 55 physicians) and evaluated the perceived availability, utilization, and helpfulness of a list of personal, hospital, and healthcare system resources. Participants also reported on their level of burnout, psychological distress, and intentions to quit. Results revealed that HCPs perceived the most useful personal resource to be family support; the most useful hospital resources were a safe environment, personal protective equipment, and support from colleagues; the most useful system resources were job protection, and clear communication and information about COVID. Moreover, HCPs who perceived having more available hospital resources also reported lower levels of psychological distress symptoms, burnout, and intentions to quit. Finally, although training and counseling services were perceived as useful to reduce stress, training was not perceived as widely available, and counseling services, though reported as being available, were underutilized. This instrument helps identify resources that support HCPs, providing implications for healthcare management.

Burnout among healthcare professionals during COVID-19 pandemic: a cross-sectional study

Purpose

To describe the prevalence of burnout among healthcare professionals dealing with COVID-19 patients and the associated factors.

Methods

In this cross-sectional survey, healthcare workers at six university-affiliated hospitals, who had been taking care of COVID-19 patients were studied. Age, gender, marital status, having children, hospital, job category, experience, and work load, as well as the level of burnout in each subscale were measured.

Results

326 persons (53.0%) experienced high levels of burnout. The average score in emotional exhaustion, depersonalization and lack of personal accomplishment was 26.6, 10.2, and 27.3, respectively. The level of burnout in the three subscales varied based on the personal as well as work-related factors and gender was the only variable that was associated with high levels of all three domains.

Conclusions

Burnout is prevalent among healthcare workers caring for COVID-19 patients. Age, gender, job category, and site of practice contribute to the level of burnout that the staff experience.

History for some or lesson for all? A systematic review and meta-analysis on the immediate and long-term mental health impact of the 2002-2003 Severe Acute Respiratory Syndrome (SARS) outbreak

BACKGROUND

The aims of this systematic review and meta-analysis are to examine the prevalence of adverse mental health outcomes, both short-term and long-term, among SARS patients, healthcare workers and the general public of SARS-affected regions, and to examine the protective and risk factors associated with these mental health outcomes.

METHODS

We conducted a systematic search of the literature using databases such as Medline, Pubmed, Embase, PsycInfo, Web of Science Core Collection, CNKI, the National Central Library Online Catalog and dissertation databases to identify studies in the English or Chinese language published between January 2003 to May 2020 which reported psychological distress and mental health morbidities among SARS patients, healthcare workers, and the general public in regions with major SARS outbreaks.

RESULTS

The literature search yielded 6984 titles. Screening resulted in 80 papers for the review, 35 of which were included in the meta-analysis. The prevalence of post-recovery probable or clinician-diagnosed anxiety disorder, depressive disorder, and post-traumatic stress disorder (PTSD) among SARS survivors were 19, 20 and 28%, respectively. The prevalence of these outcomes among studies conducted within and beyond 6 months post-discharge was not significantly different. Certain aspects of mental health-related quality of life measures among SARS survivors remained impaired beyond 6 months post-discharge. The prevalence of probable depressive disorder and PTSD among healthcare workers post-SARS were 12 and 11%, respectively. The general public had increased anxiety levels during SARS, but whether there was a clinically significant population-wide mental health impact remained inconclusive. Narrative synthesis revealed occupational exposure to SARS patients and perceived stigmatisation to be risk factors for adverse mental health outcomes among healthcare workers, although causality could not be determined due to the limitations of the studies.

CONCLUSIONS

The chronicity of psychiatric morbidities among SARS survivors should alert us to the potential long-term mental health complications of covid-19 patients. Healthcare workers working in high-risk venues should be given adequate mental health support. Stigmatisation against patients and healthcare workers should be explored and addressed. The significant risk of bias and high degree of heterogeneity among included studies limited the certainty of the body of evidence of the review.

Do mindfulness and perceived organizational support work? Fear of COVID-19 on restaurant frontline employees' job insecurity and emotional exhaustion

The coronavirus disease (COVID-19) outbreak has impacted the restaurant industry tremendously. Building on the Conservation of Resources Theory, the current study investigates the relationships among U.S. restaurant frontline employees' fear of COVID-19, job insecurity, and emotional exhaustion. The study also examines the moderating role of employee mindfulness and perceived organizational support. SPSS PROCESS macro was used for hypotheses testing. Results suggested that restaurant frontline employees' fear of COVID-19 was positively associated with both job insecurity and emotional exhaustion. Fear of COVID-19 had an indirect effect on restaurant frontline employees' emotional exhaustion via job insecurity. Employee mindfulness buffered the positive relationship between fear of COVID-19 and job insecurity. Perceived organizational support was found to intensify the positive relationship between job insecurity and frontline employees' emotional exhaustion. The research provided useful human resource management practices for U.S. restaurant businesses amid crises such as COVID-19.

Factors Associated With Psychological Distress in Health-Care Workers During an Infectious Disease Outbreak: A Rapid Systematic Review of the Evidence

Objective: Health-care workers (HCW) are at risk for psychological distress during an infectious disease outbreak, such as the coronavirus pandemic, due to the demands of dealing with a public health emergency. This rapid systematic review examined the factors associated with psychological distress among HCW during an outbreak. Method: We systematically reviewed literature on the factors associated with psychological distress (demographic characteristics, occupational, social, psychological, and infection-related factors) in HCW during an outbreak (COVID-19, SARS, MERS, H1N1, H7N9, and Ebola). Four electronic databases were searched (2000 to 15 November 2020) for relevant peer-reviewed research according to a pre-registered protocol. A narrative synthesis was conducted to identify fixed, modifiable, and infection-related factors linked to distress and psychiatric morbidity. Results: From the 4,621 records identified, 138 with data from 143,246 HCW in 139 studies were included. All but two studies were cross-sectional. The majority of the studies were conducted during COVID-19 (k = 107, N = 34,334) and SARS (k = 21, N = 18,096). Consistent evidence indicated that being female, a nurse, experiencing stigma, maladaptive coping, having contact or risk of contact with infected patients, and experiencing quarantine, were risk factors for psychological distress among HCW. Personal and organizational social support, perceiving control, positive work attitudes, sufficient information about the outbreak and proper protection, training, and resources, were associated with less psychological distress. Conclusions: This review highlights the key factors to the identify HCW who are most at risk for psychological distress during an outbreak and modifying factors to reduce distress and improve resilience. Recommendations are that HCW at risk for increased distress receive early interventions and ongoing monitoring because there is evidence that HCW distress can persist for up to 3 years after an outbreak. Further research needs to track the associations of risk and resilience factors with distress over time and the extent to which certain factors are inter-related and contribute to sustained or transient distress.

Psychiatric symptoms, risk, and protective factors among university students in quarantine during the COVID-19 pandemic in China

BACKGROUND

The COVID-19 pandemic has made unprecedented impact on the psychological health of university students, a population vulnerable to distress and mental health disorders. This study investigated psychiatric symptoms (anxiety, depression, and traumatic stress) during state-enforced quarantine among university students in China (N = 1912) through a cross-sectional survey during March and April 2020.

RESULTS

Psychiatric symptoms were alarmingly prevalent: 67.05% reported traumatic stress, 46.55% had depressive symptoms, and 34.73% reported anxiety symptoms. Further, 19.56% endorsed suicidal ideation. We explored risk and protective factors of psychological health, including demographic variables, two known protective factors for mental health (mindfulness, perceived social support), four COVID-specific factors (COVID-19 related efficacy, perceived COVID-19 threat, perceived COVID-19 societal stigma, COVID-19 prosocial behavior) and screen media usage. Across symptom domains, mindfulness was associated with lower symptom severity, while COVID-19 related financial stress, perceived COVID-19 societal stigma, and perceived COVID-19 threat were associated with higher symptom severity. COVID-19 threat and COVID-19 stigma showed main and interactive effects in predicting all mental health outcomes, with their combination associated with highest symptom severity. Screen media device usage was positively associated with depression. Female gender and COVID-19 prosocial behavior were associated with higher anxiety, while COVID-19 self-efficacy associated with lower anxiety symptoms.

CONCLUSIONS

Findings suggest high need for psychological health promotion among university students during the COVID-19 pandemic and inform an ecological perspective on the detrimental role of stigma during an emerging infectious disease outbreak. Interventions targeting multi-level factors, such as promoting mindfulness and social support at individual and interpersonal levels while reducing public stigma about COVID-19, may be particularly promising. Attending to the needs of disadvantaged groups including those financially impacted by COVID-19 is needed.

How can we build and maintain the resilience of our health care professionals during COVID-19? Recommendations based on a scoping review

OBJECTIVE

To explore how to build and maintain the resilience of frontline healthcare professionals exposed to COVID-19 outbreak working conditions.

DESIGN

Scoping review supplemented with expert interviews to validate the findings.

SETTING

Hospitals.

METHODS

We searched PubMed, Embase, PsycINFO, CINAHL, bioRxiv and medRxiv systematically and grey literature for articles focusing on the impact of COVID-19-like working conditions on the physical and/or mental health of healthcare professionals in a hospital setting. Articles using an empirical design about determinants or causes of physical and/or mental health and about interventions, measures and policies to preserve physical and/or mental health were included. Four experts were interviewed to reflect on the results from the scoping review.

RESULTS

In total, 4471 records were screened leading to an inclusion of 73 articles. Recommendations prior to the outbreak fostering resilience included optimal provision of education and training, resilience training and interventions to create a feeling of being prepared. Recommendations during the outbreak consisted of (1) enhancing resilience by proper provision of information, psychosocial support and treatment (eg, create enabling conditions such as forming a psychosocial support team), monitoring the health status of professionals and using various forms and content of psychosocial support (eg, encouraging peer support, sharing and celebrating successes), (2) tasks and responsibilities, in which attention should be paid to kind of tasks, task mix and responsibilities as well as the intensity and weight of these tasks and (3) work patterns and working conditions. Findings of the review were validated by experts.

CONCLUSIONS

Recommendations were developed on how to build and maintain resilience of frontline healthcare professionals exposed to COVID-19 outbreak working conditions. These practical and easy to implement recommendations can be used by hospitals and other healthcare organisations to foster and preserve short-term and long-term physical and mental health and employability of their professionals.

Mental health of clinical staff working in high-risk epidemic and pandemic health emergencies a rapid review of the evidence and living meta-analysis

PURPOSE

The SARS-CoV-2 / COVID-19 pandemic has raised concerns about the potential mental health impact on frontline clinical staff. However, given that poor mental health is common in acute medical staff, we aimed to estimate the additional burden of work involving high exposure to infected patients.

METHODS

We report a rapid review, meta-analysis, and living meta-analysis of studies using validated measures from outbreaks of COVID-19, Ebola, H1N1 influenza, Middle East respiratory syndrome (MERS), and severe acute respiratory syndrome (SARS).

RESULTS

A random effects meta-analysis found that high-exposure work is not associated with an increased prevalence of above cut-off scoring (anxiety: RR = 1.30, 95% CI 0.87-1.93, Total N = 12,473; PTSD symptoms: RR = 1.16, 95% CI 0.75-1.78, Total N = 6604; depression: RR = 1.50, 95% CI 0.57-3.95, Total N = 12,224). For continuous scoring, high-exposure work was associated with only a small additional burden of acute mental health problems compared to low-exposure work (anxiety: SMD = 0.16, 95% CI 0.02-0.31, Total N = 6493; PTSD symptoms: SMD = 0.20, 95% CI 0.01-0.40, Total N = 5122; depression: SMD = 0.13, 95% CI -0.04-0.31, Total N = 4022). There was no evidence of publication bias.

CONCLUSION

Although epidemic and pandemic response work may add only a small additional burden, improving mental health through service management and provision of mental health services should be a priority given that baseline rates of poor mental health are already very high. As new studies emerge, they are being added to a living meta-analysis where all analysis code and data have been made freely available: https://osf.io/zs7ne/ .

Hearing the Voices of Wingless Angels: A Critical Content Analysis of Nurses' COVID-19 Experiences

The world has been affected by an outbreak of the novel coronavirus (COVID-19). Health care workers are among those most at risk of contracting the virus. In the fight against the coronavirus, nurses play a critical role. Still, most social media platforms demonstrate that nurses fear that their health is not being prioritized. The purpose of this study is to investigate nurses' experiences through analyzing the main themes shared on Instagram by nurses during the COVID-19 pandemic. In contrast with highly structured research, the current paper highlights nurses' natural language use in describing their experiences during the first months of the outbreak in their workplace. Instagram captions were utilized as a data source. Leximancer was utilized for the content analysis of nurses' narratives towards their coronavirus experience. We sought to accomplish three research objectives: the first was to identify the main themes in the descriptions of nurses' experiences shared via their social media, specifically Instagram; then, to determine the relationships among concepts, and finally, to give useful implications based on the findings. The current study uses a qualitative (i.e., narratives) approach to analyze the main components of the nurses' experiences during the pandemic. The Leximancer software analysis revealed nine major textual themes and the relationships among these themes. In order of the relative importance, the themes were "patients", "coronavirus", "exhaustion", "family", "hospital", "personal protective equipment" (PPE), "shift", "fear", and "uncertainty". The results offer practical implications based on the social media information regarding nurses' overall experiences.

Psychological impact of an epidemic/pandemic on the mental health of healthcare professionals: a rapid review

BACKGROUND

Epidemics or pandemics, such as the current Coronavirus Disease 2019 (COVID-19) crisis, pose unique challenges to healthcare professionals (HCPs). Caring for patients during an epidemic/pandemic may impact negatively on the mental health of HCPs. There is a lack of evidence-based advice on what would be effective in mitigating this impact.

OBJECTIVES

This rapid review synthesizes the evidence on the psychological impact of pandemics/epidemics on the mental health of HCPs, what factors predict this impact, and the evidence of prevention/intervention strategies to reduce this impact.

METHOD

According to rapid review guidelines, systematic searches were carried out in Embase.com , PubMed, APA PsycINFO-Ovid SP, and Web of Science (core collection). Searches were restricted to the years 2003 or later to ensure inclusion of the most recent epidemic/pandemics, such as Severe Acute Respiratory Syndrome (SARS). Papers written in French or English, published in peer-reviewed journals, and of quantitative design using validated measures of mental health outcomes were included. Of 1308 papers found, 50 were included. The full protocol for this rapid review was registered with Prospero (reg.no. CRD42020175985).

RESULTS

Results show that exposed HCPs working with patients during an epidemic/pandemic are at heightened risk of mental health problems in the short and longer term, particularly: psychological distress, insomnia, alcohol/drug misuse, and symptoms of posttraumatic stress disorder (PTSD), depression, anxiety, burnout, anger, and higher perceived stress. These mental health problems are predicted by organizational, social, personal, and psychological factors and may interfere with the quality of patient care. Few evidence-based early interventions exist so far.

DISCUSSION

HCPs need to be provided with psychosocial support to protect their mental wellbeing if they are to continue to provide high quality patient care. Several recommendations relevant during and after an epidemic/pandemic, such as COVID-19, and in preparation for a future outbreak, are proposed.

COVID-19 emergency response assessment study: a prospective longitudinal survey of frontline doctors in the UK and Ireland: study protocol

INTRODUCTION

The COVID-19 pandemic is putting an unprecedented strain on healthcare systems globally. The psychological impact on frontline doctors of dealing with the COVID-19 pandemic is currently unknown. This longitudinal professional survey aims to understand the evolving and cumulative effects of working during the COVID-19 outbreak on the psychological well-being of doctors working in emergency departments (ED), intensive care units (ICU) and anaesthetics during the pandemic.

METHODS AND ANALYSIS

This study is a longitudinal questionnaire-based study with three predefined time points spanning the acceleration, peak and deceleration phases of the COVID-19 pandemic.The primary outcomes are psychological distress and post-trauma stress as measured by the General Health Questionnaire-12 (GHQ-12) and Impact of Events Scale-Revised (IES-R). Data related to personal and professional characteristics will also be collected. Questionnaires will be administered prospectively to all doctors working in ED, ICU and anaesthetics in the UK and Ireland via existing research networks during the sampling period. Data from the questionnaires will be analysed to assess the prevalence and degree of psychological distress and trauma, and the nature of the relationship between personal and professional characteristics and the primary outcomes. Data will be described, analysed and disseminated at each time point; however, the primary endpoint will be psychological distress and trauma at the final time point.

ETHICS AND DISSEMINATION

Ethical approval was obtained from the University of Bath, UK (ref: 4421), and Children's Health Ireland at Crumlin, Ethics Committee. Regulatory approval from the Health Regulation Authority (UK), Health and Care Research Wales (IRAS: 281944).This study is limited by the fact that it focuses on doctors only and is survey based without further qualitative interviews of participants. It is expected this study will provide clear evidence of the psychological impact of COVID-19 on doctors and will allow present and future planning to mitigate against any psychological impact.

TRIAL REGISTRATION NUMBER

ISRCTN10666798.

Perceived Threat of COVID-19 Contagion and Frontline Paramedics' Agonistic Behaviour: Employing a Stressor-Strain-Outcome Perspective

Historically, infectious diseases have been the leading cause of human psychosomatic strain and death tolls. This research investigated the recent threat of COVID-19 contagion, especially its impact among frontline paramedics treating patients with COVID-19, and their perception of self-infection, which ultimately increases their agonistic behaviour. Based on the stressor-strain-outcome paradigm, a research model was proposed and investigated using survey-based data through a structured questionnaire. The results found that the perceived threat of COVID-19 contagion (emotional and cognitive threat) was positively correlated with physiological anxiety, depression, and emotional exhaustion, which led toward agonistic behaviour. Further, perceived social support was a key moderator that negatively affected the relationships between agonistic behaviour and physiological anxiety, depression, and emotional exhaustion. These findings significantly contributed to the current literature concerning COVID-19 and pandemic-related effects on human behaviour. This study also theorized the concept of human agonistic behaviour, which has key implications for future researchers.

Occurrence, prevention, and management of the psychological effects of emerging virus outbreaks on healthcare workers: rapid review and meta-analysis

OBJECTIVE

To examine the psychological effects on clinicians of working to manage novel viral outbreaks, and successful measures to manage stress and psychological distress.

DESIGN

Rapid review and meta-analysis.

DATA SOURCES

Cochrane Central Register of Controlled Trials, PubMed/Medline, PsycInfo, Scopus, Web of Science, Embase, and Google Scholar, searched up to late March 2020.

ELIGIBILITY CRITERIA FOR STUDY SELECTION

Any study that described the psychological reactions of healthcare staff working with patients in an outbreak of any emerging virus in any clinical setting, irrespective of any comparison with other clinicians or the general population.

RESULTS

59 papers met the inclusion criteria: 37 were of severe acute respiratory syndrome (SARS), eight of coronavirus disease 2019 (covid-19), seven of Middle East respiratory syndrome (MERS), three each of Ebola virus disease and influenza A virus subtype H1N1, and one of influenza A virus subtype H7N9. Of the 38 studies that compared psychological outcomes of healthcare workers in direct contact with affected patients, 25 contained data that could be combined in a pairwise meta-analysis comparing healthcare workers at high and low risk of exposure. Compared with lower risk controls, staff in contact with affected patients had greater levels of both acute or post-traumatic stress (odds ratio 1.71, 95% confidence interval 1.28 to 2.29) and psychological distress (1.74, 1.50 to 2.03), with similar results for continuous outcomes. These findings were the same as in the other studies not included in the meta-analysis. Risk factors for psychological distress included being younger, being more junior, being the parents of dependent children, or having an infected family member. Longer quarantine, lack of practical support, and stigma also contributed. Clear communication, access to adequate personal protection, adequate rest, and both practical and psychological support were associated with reduced morbidity.

CONCLUSIONS

Effective interventions are available to help mitigate the psychological distress experienced by staff caring for patients in an emerging disease outbreak. These interventions were similar despite the wide range of settings and types of outbreaks covered in this review, and thus could be applicable to the current covid-19 outbreak.

The scale of Work-Related Affective Feelings (WORAF)

Interest in the field of emotions in the workplace continues to grow. However, a narrow range of measurements exists for the examination of affective states in organizational settings, all of which were developed based on the discrete-emotions approach. The main objective of the current study was to develop and validate a new instrument to assess four work-related (WR) affective feelings (WORAF): WR feelings of happiness, WR feelings of anxiety, WR feelings of anger, and WR feelings of dejection. Three independent samples of Polish employees in different occupations were included in the study (n = 297, n = 3019, n = 284). The results provide significant evidence for the validity of the proposed WORAF scale, although further investigations are needed.

The Psychological Impact of Epidemic and Pandemic Outbreaks on Healthcare Workers: Rapid Review of the Evidence

PURPOSE OF REVIEW

We aim to provide quantitative evidence on the psychological impact of epidemic/pandemic outbreaks (i.e., SARS, MERS, COVID-19, ebola, and influenza A) on healthcare workers (HCWs).

RECENT FINDINGS

Forty-four studies are included in this review. Between 11 and 73.4% of HCWs, mainly including physicians, nurses, and auxiliary staff, reported post-traumatic stress symptoms during outbreaks, with symptoms lasting after 1-3 years in 10-40%. Depressive symptoms are reported in 27.5-50.7%, insomnia symptoms in 34-36.1%, and severe anxiety symptoms in 45%. General psychiatric symptoms during outbreaks have a range comprised between 17.3 and 75.3%; high levels of stress related to working are reported in 18.1 to 80.1%. Several individual and work-related features can be considered risk or protective factors, such as personality characteristics, the level of exposure to affected patients, and organizational support. Empirical evidence underlines the need to address the detrimental effects of epidemic/pandemic outbreaks on HCWs' mental health. Recommendations should include the assessment and promotion of coping strategies and resilience, special attention to frontline HCWs, provision of adequate protective supplies, and organization of online support services.

A Systematic Review of the Impact of Viral Respiratory Epidemics on Mental Health: An Implication on the Coronavirus Disease 2019 Pandemic

Background: The twenty-first century viral respiratory epidemics have taught us valuable lessons. Our systematic review examined the impact of these epidemics, including coronavirus disease 2019 (COVID-19), on mental health among different population groups, drawing on their insights for recommendations for the current COVID-19 pandemic. Methods: Searches were performed on PubMed, Embase, PsycINFO, Web of Science, Scopus, CINAHL, and Cochrane on April 4, 2020. Studies that had undefined mental health outcomes or did not use a validated scale for measure were excluded. Quality assessment was carried out via the Newcastle-Ottawa Scale. Results: We included 95 studies, most of which were conducted in Hong Kong (31.6%) and China (21.4%). A total of 30 (30.9%) studies are on the general public, 41 (42.2%) on healthcare workers, and 26 (26.6%) on patients and quarantined individuals. Furthermore, 36 (37.1%) of the studies are of high quality, 48 (49.5%) are of moderate quality, and 13 (13.4%) are of low quality. The most significant mental health outcomes reported include anxiety, depression, and post-traumatic stress disorder symptoms. The subgroups identified to have a higher risk of psychiatric symptoms among the general public include females, the elderly, individuals with chronic illness, migrant workers, and students. Long-term mental health impact was reported in some healthcare workers and epidemic patients, even up to 3 years in the former. Interestingly, when compared to non-quarantined groups, quarantine was not significantly associated with worse mental health outcomes. Conclusion: Important implications for the COVID-19 pandemic were highlighted. Respiratory epidemics pose a significant psychological morbidity onto many population groups. Psychological support for vulnerable groups, including healthcare workers and patients, should be implemented to prevent them from spiraling into clinical psychiatric conditions.

The need for a systematic approach to disaster psychosocial response: a suggested competency framework

Competency models attempt to define what makes expert performers "experts." Successful disaster psychosocial planning and the institutionalizing of psychosocial response within emergency management require clearly-defined skill sets. This necessitates anticipating both the short- and long-term psychosocial implications of a disaster or health emergency (ie, pandemic) by developing effective and sustained working relationships among psychosocial providers, programs, and other planning partners. The following article outlines recommended competencies for psychosocial responders to enable communities and organizations to prepare for and effectively manage a disaster response. Competency-based models are founded on observable performance or behavioral indicators, attitudes, traits, or personalities related to effective performance in a specific role or job. After analyzing the literature regarding competency-based frameworks, a proposed competency framework that details 13 competency domains is suggested. Each domain describes a series of competencies and suggests behavioral indicators for each competency and, where relevant, associated training expectations. These domains have been organized under three distinct categories or types of competencies: general competency domains; disaster psychosocial intervention competency domains; and disaster psychosocial program leadership and coordination competency domains. Competencies do not replace job descriptions nor should they be confused with performance assessments. What they can do is update and revise job descriptions; orient existing and new employees to their disaster/emergency roles and responsibilities; target training needs; provide the basis for ongoing self-assessment by agencies and individuals as they evaluate their readiness to respond; and provide a job- or role-relevant basis for performance appraisal dimensions or standards and review discussions. Using a modular approach to psychosocial planning, service providers can improve their response capacity by utilizing differences in levels of expertise and training. The competencies outlined in this paper can thus be used to standardize expectations about levels of psychosocial support interventions. In addition this approach provides an adaptable framework that can be adjusted for various contexts.