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Kogan CS, Garcia-Pacheco JA, Rebello TJ, Montoya MI, Robles R, Khoury B, Kulygina M, Matsumoto C, Huang J, Medina-Mora ME, Gureje O, Stein DJ, Sharan P, Gaebel W, Kanba S, Andrews HF, Roberts MC, Pike KM, Zhao M, Ayuso-Mateos JL, Sadowska K, Maré K, Denny K, Reed GM. Longitudinal Impact of the COVID-19 Pandemic on Stress and Occupational Well-Being of Mental Health Professionals: An International Study. Int J Neuropsychopharmacol 2023; 26:747-760. [PMID: 37531283 PMCID: PMC10586039 DOI: 10.1093/ijnp/pyad046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 07/31/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND Increased levels of occupational stress among health professionals during the COVID-19 pandemic have been documented. Few studies have examined the effects of the pandemic on mental health professionals despite the heightened demand for their services. METHOD A multilingual, longitudinal, global survey was conducted at 3 time points during the pandemic among members of the World Health Organization's Global Clinical Practice Network. A total of 786 Global Clinical Practice Network members from 86 countries responded to surveys assessing occupational distress, well-being, and posttraumatic stress symptoms. RESULTS On average, respondents' well-being deteriorated across time while their posttraumatic stress symptoms showed a modest improvement. Linear growth models indicated that being female, being younger, providing face-to-face health services to patients with COVID-19, having been a target of COVID-related violence, and living in a low- or middle-income country or a country with a higher COVID-19 death rate conveyed greater risk for poor well-being and higher level of stress symptoms over time. Growth mixed modeling identified trajectories of occupational well-being and stress symptoms. Most mental health professions demonstrated no impact to well-being; maintained moderate, nonclinical levels of stress symptoms; or showed improvements after an initial period of difficulty. However, some participant groups exhibited deteriorating well-being approaching the clinical threshold (25.8%) and persistently high and clinically significant levels of posttraumatic stress symptoms (19.6%) over time. CONCLUSIONS This study indicates that although most mental health professionals exhibited stable, positive well-being and low stress symptoms during the pandemic, a substantial minority of an already burdened global mental health workforce experienced persistently poor or deteriorating psychological status over the course of the pandemic.
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Affiliation(s)
- Cary S Kogan
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Tahilia J Rebello
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | | | - Rebeca Robles
- Center for Global Mental Health Research, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
| | - Brigitte Khoury
- Department of Psychiatry, American University of Beirut Medical Center, Beirut, Lebanon
| | - Maya Kulygina
- Training and Research Centre, Mental-health clinic No.1 named after N.A. Alekseev, Moscow, Russian Federation
| | | | - Jingjing Huang
- Shanghai Mental Health Center and Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - María Elena Medina-Mora
- Faculty of Psychology, National Autonomous University of Mexico and Center for Global Mental Health Research, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
| | - Oye Gureje
- WHO Collaborating Centre for Research and Training in Mental Health, Neuroscience, Drug and Alcohol Abuse, Department of Psychiatry, University of Ibadan, Ibadan, Nigeria
| | - Dan J Stein
- Department of Psychiatry, Neuroscience Institute, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital, Observatory, South Africa
- SAMRC Unit on Risk and Resilience on Mental Disorders, Department of Psychiatry, University of Cape Town and Groote Schuur Hospital, Observatory, South Africa
| | - Pratap Sharan
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Wolfgang Gaebel
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Shigenobu Kanba
- Kyushu University, Fukuoka and Japan Depression Center, Tokyo, Japan
| | - Howard F Andrews
- Departments of Biostatistics and Psychiatry, Columbia University and New York State Psychiatric Institute, Columbia University Medical Center, New York, New York, USA
| | - Michael C Roberts
- Clinical Child Psychology Program, University of Kansas, Lawrence, Kansas, USA
| | - Kathleen M Pike
- Departments of Psychiatry and Epidemiology, Columbia University Irving Medical Center, New York, New York, USA
| | - Min Zhao
- Shanghai Mental Health Center and Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - José Luis Ayuso-Mateos
- Department of Psychiatry, Universidad Autónoma de Madrid, Instituto de Salud Carlos III, Centro de Investigacíon Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Investigacíon Sanitaria La Princesa, Madrid, Spain
| | - Karolina Sadowska
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Karen Maré
- Department of Psychiatry, Neuroscience Institute, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital, Observatory, South Africa
| | - Keith Denny
- Department of Sociology and Anthropology, Carleton University, Ottawa, Ontario, Canada
| | - Geoffrey M Reed
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
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Kogan CS, Maj M, Rebello TJ, Keeley JW, Kulygina M, Matsumoto C, Robles R, Huang J, Zhong N, Chakrabarti S, Figueira ML, Stein DJ, Strakowski SM, Garcia-Pacheco JA, Burns S, Montoya M, Andrade L, Ayuso-Mateos JL, Arango I, Balhara YPS, Bryant R, Cournos F, Porto JAD, Meyer TD, Medina-Mora ME, Gureje O, First MB, Gaebel W, Khoury B, Krasnov VN, de Jesus Mari J, Maruta T, Pike KM, Roberts MC, Sharan P, Zhao M, Reed GM. A global field study of the international classification of diseases (ICD-11) mood disorders clinical descriptions and diagnostic guidelines. J Affect Disord 2021; 295:1138-1150. [PMID: 34706426 DOI: 10.1016/j.jad.2021.08.050] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 07/18/2021] [Accepted: 08/21/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND We report results of an internet-based field study evaluating the diagnostic guidelines for ICD-11 mood disorders. Accuracy of clinicians' diagnostic judgments applying draft ICD-11 as compared to the ICD-10 guidelines to standardized case vignettes was assessed as well as perceived clinical utility. METHODS 1357 clinician members of the World Health Organization's Global Clinical Practice Network completed the study in English, Spanish, Japanese or Russian. Participants were randomly assigned to apply ICD-11 or ICD-10 guidelines to one of eleven pairs of case vignettes. RESULTS Clinicians using the ICD-11 and ICD-10 guidelines achieved similar levels of accuracy in diagnosing mood disorders depicted in vignettes. Those using the ICD-11 were more accurate in identifying depressive episode in recurrent depressive disorder. There were no statistically significant differences detected across classifications in the accuracy of identifying dysthymic or cyclothymic disorder. Circumscribed problems with the proposed ICD-11 guidelines were identified including difficulties differentiating bipolar type I from bipolar type II disorder and applying revised severity ratings to depressive episodes. Clinical utility of ICD-11 bipolar disorders was found to be significantly lower than for ICD-10 equivalent categories. LIMITATIONS Standardized case vignettes were manipulated to evaluate specific changes. The degree of accuracy of clinicians' diagnostic judgments may not reflect clinical decision-making with patients. CONCLUSIONS Alignment of the ICD-11 with current research appears to have been achieved without sacrificing diagnostic accuracy or clinical utility though specific training may be necessary as ICD-11 is implemented worldwide. Areas in which the ICD-11 guidelines did not perform as intended resulted in further revisions.
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Affiliation(s)
- Cary S Kogan
- School of Psychology, University of Ottawa, 136 Jean-Jacques Lussier Pvt., Vanier Building, Ottawa, Ontario K1N 6N5, Canada.
| | - Mario Maj
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | - Tahilia J Rebello
- Global Mental Health Program, Columbia University and New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032, USA
| | - Jared W Keeley
- Department of Psychology, Virginia Commonwealth University, 800 W. Franklin Street, P.O. Box 842018, Richmond, VA, 23284-2018, USA
| | - Maya Kulygina
- Moscow Research Institute of Psychiatry, Poteshnaya 3, 107076, Moscow, Russian Federation
| | - Chihiro Matsumoto
- National Study Coordinator for ICD-11 Field Studies, ICD-11 Committee, Japanese Society of Psychiatry and Neurology, Hongo-Yumicho Building, 2-38-4, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Rebeca Robles
- Instituto Nacional de Psiquiatría 'Ramón de la Fuente', WHO Collaborating Centre on Addictions and Mental Health, Calzada Mexico-Xochimilco 101, Tlalpan, ZC 14370, Ciudad de México, Mexico
| | - Jingjing Huang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, WHO Collaborating Centre for Research and Training in Mental Health, 600 Wan Ping Nan Rd., Shanghai, 200030, People's Republic of China
| | - Na Zhong
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, WHO Collaborating Centre for Research and Training in Mental Health, 600 Wan Ping Nan Rd., Shanghai, 200030, People's Republic of China
| | - Subho Chakrabarti
- Dept. Of Psychiatry, Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, - 160012, India
| | - Maria Luisa Figueira
- Department of Psychiatry, Faculty of Medicine, University of Lisbon, 1699, Lisboa Codex, Portugal
| | - Dan J Stein
- Department of Psychiatry, University of Cape Town and Groote Schuur Hospital, J-Block, Anzio Road, Observatory 7925, South Africa
| | - Stephen M Strakowski
- Dell Medical School, University of Texas at Austin, Health Learning Building, 1501 Red River St., Austin, Texas, 78712, USA
| | - José A Garcia-Pacheco
- Centro de Investigación y Docencia Económica, Carr. México-Toluca 3655, Santa Fe, Altavista, Álvaro Obregón, 01210, Ciudad de México, México
| | - Samantha Burns
- School of Psychology, University of Ottawa, 136 Jean-Jacques Lussier Pvt., Vanier Building, Ottawa, Ontario K1N 6N5, Canada
| | - Madeline Montoya
- School of Psychology, University of Ottawa, 136 Jean-Jacques Lussier Pvt., Vanier Building, Ottawa, Ontario K1N 6N5, Canada
| | - Laura Andrade
- Institute of Psychiatry, School of Medicine, University of São Paulo, Av. Dr. Arnaldo, 455 - Cerqueira César, São Paulo, 01246903, Brazil
| | - José L Ayuso-Mateos
- Department of Psychiatry, Universidad Autonoma de Madrid; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM); Instituto de Investigación Sanitaria La Princesa, Madrid, Spain
| | - Ivan Arango
- Instituto Nacional de Psiquiatría 'Ramón de la Fuente', WHO Collaborating Centre on Addictions and Mental Health, Calzada Mexico-Xochimilco 101, Tlalpan, ZC 14370, Ciudad de México, Mexico
| | - Yatan Pal Singh Balhara
- National Drug Dependence Treatment Center and Department of Psychiatry, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | | | - Francine Cournos
- Departments of Epidemiology and Psychiatry, Columbia University Medical Center, 722 West 168th St, 10032, New York, NY
| | - José Alberto Del Porto
- Department of Psychiatry, Universidade Federal de São Paulo, Rua Borges Lagoa 570 - 1° andar, Vila Clementino- São Paulo-SP, 04038-000, Brazil
| | - Thomas D Meyer
- Faillace Department of Psychiatry & Behavioral Sciences, McGovern Medical School, University of Texas HSC at Houston, 1941 East Road, Houston, Texas, 77054, USA
| | - Maria-Elena Medina-Mora
- The Health Management Center, Seitoku University, 550 Iwase, Matsudo City, Chiba Prefecture, 271-8555, Japan
| | - Oye Gureje
- Department of Psychiatry, University of Ibadan, WHO Collaborating Centre for Research and Training in Mental Health, Neurosciences and Drug and Alcohol Abuse, University College Hospital, PMB, 5116 Ibadan, Nigeria
| | - Michael B First
- Department of Psychiatry, Columbia University Medical Center and New York State Psychiatric Institute, 722 West 168th St, 10032, New York, NY
| | - Wolfgang Gaebel
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, WHO Collaborating Centre for Quality Assurance and Empowerment in Mental Health, Bergische Landstr. 2, 40629, Düsseldorf, Germany
| | - Brigitte Khoury
- Department of Psychiatry, American University of Beirut Medical Center, P.O. Box 11-0236 - Riad El Solh 1107 2020 Beirut, Lebanon
| | - Valery N Krasnov
- Moscow Research Institute of Psychiatry, Poteshnaya 3, 107076, Moscow, Russian Federation
| | - Jair de Jesus Mari
- Department of Psychiatry, Universidade Federal de São Paulo, Rua Borges Lagoa 570 - 1° andar, Vila Clementino- São Paulo-SP, 04038-000, Brazil
| | - Toshimasa Maruta
- The Health Management Center, Seitoku University, 550 Iwase, Matsudo City, Chiba Prefecture, 271-8555, Japan
| | - Kathleen M Pike
- Global Mental Health Program, Columbia University and New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032, USA
| | - Michael C Roberts
- University of Kansas, Clinical Child Psychology Program, Dole Human Development Center, Lawrence, KS, 66045, USA
| | - Pratap Sharan
- Department of Psychiatry, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Min Zhao
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, WHO Collaborating Centre for Research and Training in Mental Health, 600 Wan Ping Nan Rd., Shanghai, 200030, People's Republic of China
| | - Geoffrey M Reed
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA, and Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
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